.jpg "Joshua McBride, PharmD, BCCCP photo")
Jennifer Hanify, PharmD, BCCCP
Clinical Pharmacist
Duke University Hospital, United States
Disclosure information not submitted.
James Breslin, PharmD, BCPS
Clinical Pharmacy Specialist
Health First Holmes Regional Medical Center, United States
Disclosure information not submitted.
Kristina Larizadeh, PharmD, BCPS, BCCCP
Clinical Pharmacy Specialist
Health First Holmes Regional Medical Center, Florida, United States
Disclosure information not submitted.
Stephen Gilbert, PharmD, BCCCP
Clinical Pharmacy Specialist
Health First Inc., United States
Disclosure information not submitted.
Michael Sanchez, PharmD, BCCCP
Pharmacy Residency Coordinator
Health First Holmes Regional Medical Center, Florida, United States
Disclosure information not submitted.
Title: Comparison of dual antiplatelet therapy regimens following placement of a carotid artery stent.
Introduction: Carotid stenting reduces the risk of cerebrovascular events in carotid artery stenosis, however there is a risk of ischemic complications after placement. Dual antiplatelet therapy with aspirin and clopidogrel is recommended post-procedure. P2Y12 antagonists, such as ticagrelor, have demonstrated effective platelet inhibition in cardiac settings, however evidence in carotid artery stenting is limited. Furthermore, platelet function testing post-carotid stenting has had minimal investigation.
Methods: This retrospective cohort study included patients on dual antiplatelet therapy after carotid stenting from July 2016 through June 2020. Cohorts included patients who received either clopidogrel or ticagrelor, each in combination with aspirin. The primary outcome was rate of ischemic events after 90 days. Secondary outcomes included major bleeding and clinically relevant non-major bleeding at 90 days, hospital and intensive care unit (ICU) length of stay, and percentage of patients with a therapeutic level on platelet function testing.
Results: Sixty eight patients met criteria for inclusion. No significant difference was found between ticagrelor and clopidogrel cohorts for ischemic events (15.4% vs. 4.8%; p = 0.133) or major bleeding (11.5% vs. 11.9%; p = 0.964). There was no significant difference in length of ICU (4.1 days vs. 3.5 days; p = 0.074) or hospital stay (8.1 days vs. 7.2 days; p = 0.072). There was a significant increase in percentage of patients who achieved a therapeutic P2Y12 level with ticagrelor compared to clopidogrel (80.8% vs. 47.2%; p = 0.006), however the subgroup analysis did not show a significant difference in ischemic (19% vs. 10%; p = 0.413) or major bleeding (9.5% vs. 10%; p = 0.959) events in these patients.
Conclusions: Ticagrelor may be as safe and efficacious as clopidogrel for carotid stents, however larger prospective studies are warranted. P2Y12 level monitoring led to more therapeutic levels achieved with ticagrelor as compared to clopidogrel.