Abstract
As a part of dual antiplatelet therapy (DAPT), prasugrel or ticagrelor is prescribed along with aspirin to patients of acute coronary syndrome (ACS) undergoing percutaneous coronary intervention (PCI). We aimed to assess if the PRECISE-DAPT score, which provides prediction of bleeding during DAPT, could be used to choose between prasugrel and ticagrelor for DAPT initiation. 181 patients out of which 71 received prasugrel and 110 received ticagrelor were enrolled in this prospective cohort study. PRECISE-DAPT score was calculated for everyone and was used to dichotomize patients into two subgroups (score <25 and ≥25). After balancing potential confounders in baseline characteristics of the subgroups using propensity scores, comparison of a composite outcome of 4-point major adverse cardiovascular events (4P-MACE) (i.e., cardiovascular death, non-fatal myocardial infarction, non-fatal stroke, or coronary revascularization due to stent thrombosis) and bleeding (any type as defined by the Bleeding Academic Research Consortium) within 1-year post-PCI was performed among the subgroups using Cox proportional hazards regression. Prasugrel was associated with lower and comparatively higher 4P-MACE events in subgroups with score ≥25 (HR: 0.17; 95% CI, 0.04-0.77) and score <25 (HR: 3.58; 95% CI, 0.62-20.70) respectively. For bleeding outcome, prasugrel trended towards more clinical benefit for scores ≥25 (HR: 0.44; 95% CI, 0.10-1.93) than <25 (HR: 0.93; 95% CI, 0.13-6.58). Therefore, prasugrel was associated with better clinical effectiveness and trended towards a lower bleeding risk compared to ticagrelor within 1-year post-PCI for those with a high PRECISE-DAPT score (≥25). This finding requires validation through larger studies.
References
Ndrepepa G, Lahu S, Aytekin A et al (2022) One-year ischemic and bleeding events according to renal function in patients with Non-ST-Segment elevation Acute coronary syndromes treated with percutaneous coronary intervention and third-generation antiplatelet drugs. Am J Cardiol 176(10):15–23. https://doi.org/10.1016/j.amjcard.2022.04.040
Lahu S, Scalamogna M, Ndrepepa G et al (2022) Prior myocardial infarction and treatment effect of Ticagrelor Versus Prasugrel in patients with Acute Coronary Syndromes - a post-hoc analysis of the ISAR-REACT 5 Trial. J Am Heart Assoc 11(24):e027257. https://doi.org/10.1161/JAHA.122.027257
Lahu S, Presch A, Ndrepepa G et al (2022) Ticagrelor or Prasugrel in patients with Acute Coronary Syndrome and high bleeding risk. Circ Cardiovasc Interv 15(10):e012204. https://doi.org/10.1161/CIRCINTERVENTIONS.122.012204
Godtfredsen SJ, Kragholm KH, Leutscher P et al (2022) Effectiveness and safety of P2Y12 inhibitors in patients with ST-segment elevation myocardial infarction undergoing percutaneous coronary intervention: a nationwide registry-based study. Eur Heart J Acute Cardiovasc Care 11(9):697–705. https://doi.org/10.1093/ehjacc/zuac095
Costa F, van Klaveren D, James S et al (2017) Derivation and validation of the predicting bleeding complications in patients undergoing stent implantation and subsequent dual antiplatelet therapy (PRECISE-DAPT) score: a pooled analysis of individual-patient datasets from clinical trials. Lancet 389(10073):1025–1034. https://doi.org/10.1016/S0140-6736(17)30397-5
Mehran R, Rao SV, Bhatt DL, Gibson CM, Caixeta A, Eikelboom J et al (2011) Standardized bleeding definitions for cardiovascular clinical trials: a consensus report from the Bleeding Academic Research Consortium. Circulation 123(23):2736–2747
Acknowledgements
None.
Author information
Authors and Affiliations
Corresponding author
Ethics declarations
Conflict of interest
None.
Financial disclosures
None.
Additional information
Publisher’s Note
Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.
Rights and permissions
About this article
Cite this article
Ray, A., Najmi, A., Khandelwal, G. et al. Usefulness of the PRECISE-DAPT score at differentiating between ticagrelor and prasugrel for dual antiplatelet therapy initiation. J Thromb Thrombolysis 56, 411–413 (2023). https://doi.org/10.1007/s11239-023-02857-z
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s11239-023-02857-z