P2Y<sub>12</sub> Inhibition in Patients Requiring Oral Anticoagulation after Percutaneous Coronary Intervention: The SWAP-AC–2 Study (JACC Cardiovascular Interventions June 2024)-Article: P2Y<sub>12</sub> Inhibition in Patients Requiring Oral Anticoagulation after Percutaneous Coronary Intervention: The SWAP-AC

Article: P2Y₁₂ Inhibition in Patients Requiring Oral Anticoagulation after Percutaneous Coronary Intervention: The SWAP-AC–2 Study

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The SWAP-AC-2 study compared the effects of ticagrelor vs. clopidogrel in patients with impaired clopidogrel response undergoing PCI and needing oral anticoagulation. Ticagrelor, at a 60mg dose twice daily, resulted in decreased platelet reactivity compared to clopidogrel after 30 days, showing superior P2Y12 inhibitory effects in these patients. Ticagrelor reduced high platelet reactivity, indicating lower thrombotic risk, but showed no significant difference in non-P2Y12 thrombotic pathways compared to clopidogrel. The study suggests that ticagrelor-based dual antithrombotic therapy may provide better platelet inhibition, particularly in patients with impaired clopidogrel response post-PCI requiring oral anticoagulation. The document discusses the importance of tailored antiplatelet therapy using the ABCD-GENE score for such high-risk patients, highlighting the potential of ticagrelor-based therapy in reducing platelet reactivity without affecting other thrombosis markers. While the study's results are promising, further research in larger trials is needed for validation. The study contributes valuable insights for personalized medicine in cardiology by optimizing antiplatelet therapy selection based on individual patient characteristics and responses.

Keywords

SWAP-AC-2 study

ticagrelor

clopidogrel

platelet reactivity

P2Y12 inhibitory effects

dual antithrombotic therapy

ABC-GENE score

personalized medicine

antiplatelet therapy

cardiology