• Gianluca Caiazzo, Salvatore De Rosa, Daniele Torella, Carmen Spaccarotella, Annalisa Mongiardo, Salvatore Giampà, Mariella Micieli, Eleonora Palella, Elio Gulletta, and Ciro Indolfi.
• From the Division of Cardiology, Department of Medical and Surgical Sciences (G.C., S.D.R., D.T., C.S., A.M., S.G., M.M., C.I.) and Clinical Pathology Unit, Department of Health Sciences (E.P., E.G.), Magna Graecia University of Catanzaro, Catanzaro, Italy; and URT-CNR, Department of Medicine, Consiglio Nazionale delle Ricerche, Catanzaro, Italy (C.I.).
• Circ Cardiovasc Interv. 2014 Feb 1; 7 (1): 104-12.

BackgroundTicagrelor outperforms clopidogrel in preventing cardiovascular events in acute coronary syndrome. Despite the inclusion of a loading dose in the Platelet Inhibition and Patient Outcomes (PLATO) trial for all patients randomized to ticagrelor, it may not be necessary in patients receiving ongoing clopidogrel therapy. The aim of the present study was to assess whether a ticagrelor loading dose is associated with a further platelet inhibition during the switch from clopidogrel to ticagrelor in patients with acute coronary syndrome receiving ongoing antiplatelet treatment.Methods And ResultsFifty patients with acute coronary syndrome receiving aspirin and clopidogrel treatment were randomly assigned to a starting dose of ticagrelor (group 1, 90 mg; group 2, 180 mg). Platelet aggregation was measured using multiple electrode aggregometry and standard light transmission aggregometry just before the switch and at 2, 6, 24, and 72 hours. No relevant difference in platelet aggregation was observed between the 2 study arms at baseline (P=0.256). Residual platelet aggregation was significantly reduced in both arms 2 hours after the first administration of ticagrelor (P<0.001 for both), with no difference in aggregation between groups (multiple electrode aggregometry, 17.6±7.2 versus 18.1±6 U; P=0.281). Similar results were observed with LTA.ConclusionsSwitching from clopidogrel to ticagrelor without a reloading dose is feasible, and it does not hinder platelet aggregation inhibition in patients with acute coronary syndrome. Further prospective studies are needed to assess the clinical relevance of our findings.Clinical Trial Registration Urlhttp://www.clinicaltrials.gov. Unique identifier: NCT01795820.

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