{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,10,12]],"date-time":"2025-10-12T02:02:40Z","timestamp":1760234560540,"version":"build-2065373602"},"reference-count":18,"publisher":"MDPI AG","issue":"11","license":[{"start":{"date-parts":[[2021,6,2]],"date-time":"2021-06-02T00:00:00Z","timestamp":1622592000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JCM"],"abstract":"<jats:p>Ticagrelor is believed to be a more potent and faster antiplatelet agent compared with clopidogrel and may result in lower ischemic outcomes in patients with acute coronary syndrome. However, the best strategy of switching from ticagrelor to clopidogrel is unclear. Current guidelines advocate clopidogrel bridging with a 600 mg loading dose (LD). This study aimed to compare the safety and feasibility of switching protocols from ticagrelor to clopidogrel 600 mg or 300 mg LD in patients with unstable angina pectoris (USAP). One hundred and eighty patients with USAP undergoing adhoc percutaneous coronary intervention (PCI) received preprocedural ticagrelor 180 mg\/daily. The decision to switch antiplatelet therapy to clopidogrel with either 300 mg LD or 600 mg LD at 12 h was left to the discretion of the treating physician. The primary outcome was a composite of an efficacy endpoint major adverse cardiac and cerebrovascular events (MACCEs) and a safety endpoint Bleeding Academic Research Consortium scale (BARC) (\u22651). There were no differences in our composite clinical endpoint of MACCE between the two strategies, with one event occurring in each group. One patient in each group had myocardial infarction due to stent thrombosis, and the patient in the 300 mg switching group died due to stent thrombosis. No difference between the two arms was observed in terms of BARC bleeding criteria. This study showed that among USAP patients undergoing PCI, switching to clopidogrel with 300 mg LD showed no significant difference compared to 600 mg clopidogrel LD. Ticagrelor LD in ad hoc PCI and de-escalation to clopidogrel with 300 mg LD could translate to lower costs for patients with USAP without compromising safety and efficacy.<\/jats:p>","DOI":"10.3390\/jcm10112463","type":"journal-article","created":{"date-parts":[[2021,6,2]],"date-time":"2021-06-02T10:38:39Z","timestamp":1622630319000},"page":"2463","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":3,"title":["Switching Ticagrelor to 600 mg or 300 mg Clopidogrel Loading Bridge in Patients with Unstable Angina"],"prefix":"10.3390","volume":"10","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-2714-4584","authenticated-orcid":false,"given":"Sinem","family":"Cakal","sequence":"first","affiliation":[{"name":"Cardiology Department, Haseki Training and Research Hospital, University of Health Sciences, 34668 Istanbul, Turkey"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Beytullah","family":"Cakal","sequence":"additional","affiliation":[{"name":"Cardiology Department, Istanbul Medipol University, 34513 Istanbul, Turkey"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Zafer","family":"G\u00fcven","sequence":"additional","affiliation":[{"name":"Cardiology Department, Istanbul Medipol University, 34513 Istanbul, Turkey"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ayd\u0131n Rodi","family":"Tosu","sequence":"additional","affiliation":[{"name":"Cardiology Department, Haseki Training and Research Hospital, University of Health Sciences, 34668 Istanbul, Turkey"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6552-0942","authenticated-orcid":false,"given":"Muhsin","family":"Kalyoncuoglu","sequence":"additional","affiliation":[{"name":"Cardiology Department, Haseki Training and Research Hospital, University of Health Sciences, 34668 Istanbul, Turkey"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Halil Ibrahim","family":"Biter","sequence":"additional","affiliation":[{"name":"Cardiology Department, Haseki Training and Research Hospital, University of Health Sciences, 34668 Istanbul, Turkey"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3508-8658","authenticated-orcid":false,"given":"Ziya","family":"Apayd\u0131n","sequence":"additional","affiliation":[{"name":"Cardiology Department, Haseki Training and Research Hospital, University of Health Sciences, 34668 Istanbul, Turkey"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ibrahim Oguz","family":"Karaca","sequence":"additional","affiliation":[{"name":"Cardiology Department, Istanbul Medipol University, 34513 Istanbul, Turkey"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Erdal","family":"Belen","sequence":"additional","affiliation":[{"name":"Cardiology Department, Haseki Training and Research Hospital, University of Health Sciences, 34668 Istanbul, Turkey"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Mehmet Mustafa","family":"Can","sequence":"additional","affiliation":[{"name":"Cardiology Department, Haseki Training and Research Hospital, University of Health Sciences, 34668 Istanbul, Turkey"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1968","published-online":{"date-parts":[[2021,6,2]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"215","DOI":"10.1097\/FJC.0000000000000459","article-title":"Efficacy and Safety of Novel Oral P2Y12 Receptor Inhibitors in Patients with ST-Segment Elevation Myocardial Infarction Undergoing PCI: A Systematic Review and Meta-Analysis","volume":"69","author":"Sun","year":"2017","journal-title":"J. Cardiovasc. Pharmacol."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"849","DOI":"10.1001\/jama.2009.1232","article-title":"Association of cytochrome P450 2C19 genotype with the antiplatelet effect and clinical efficacy of clopidogrel therapy","volume":"302","author":"Shuldiner","year":"2009","journal-title":"JAMA"},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"1045","DOI":"10.1056\/NEJMoa0904327","article-title":"Ticagrelor versus clopidogrel in patients with acute coronary syndromes","volume":"361","author":"Wallentin","year":"2009","journal-title":"N. Engl. J. Med."},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"283","DOI":"10.1016\/S0140-6736(09)62191-7","article-title":"Comparison of ticagrelor with clopidogrel in patients with a planned invasive strategy for acute coronary syndromes (PLATO): A randomised double-blind study","volume":"375","author":"Cannon","year":"2010","journal-title":"Lancet"},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"213","DOI":"10.1093\/eurheartj\/ehx419","article-title":"2017 ESC focused update on dual antiplatelet therapy in coronary artery disease developed in collaboration with EACTS: The Task Force for dual antiplatelet therapy in coronary artery disease of the European Society of Cardiology (ESC) and of the European Association for Cardio-Thoracic Surgery (EACTS)","volume":"39","author":"Valgimigli","year":"2018","journal-title":"Eur. Heart J."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"2945","DOI":"10.1093\/eurheartj\/ehr231","article-title":"Characterization of dyspnoea in PLATO study patients treated with ticagrelor or clopidogrel and its association with clinical outcomes","volume":"32","author":"Storey","year":"2011","journal-title":"Eur. Heart J."},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1007\/s11239-019-01860-7","article-title":"De-escalation from ticagrelor to clopidogrel in acute coronary syndrome patients: A systematic review and meta-analysis","volume":"48","author":"Angiolillo","year":"2019","journal-title":"J. Thromb. Thrombolysis"},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"1289","DOI":"10.1093\/eurheartj\/ehaa575","article-title":"2020 ESC Guidelines for the management of acute coronary syndromes in patients presenting without persistent ST-segment elevation","volume":"42","author":"Collet","year":"2021","journal-title":"Eur. Heart J."},{"key":"ref_9","first-page":"S1","article-title":"2018 ESC\/EACTS Guidelines on myocardial revascularization. The Task Force on myocardial revascularization of the European Society of Cardiology (ESC) and European Association for Cardio-Thoracic Surgery (EACTS)","volume":"20","author":"Neumann","year":"2019","journal-title":"Giornale Italiano di Cardiologia"},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"2736","DOI":"10.1161\/CIRCULATIONAHA.110.009449","article-title":"Standardized bleeding definitions for cardiovascular clinical trials: A consensus report from the Bleeding Academic Research Consortium","volume":"123","author":"Mehran","year":"2011","journal-title":"Circulation"},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"11","DOI":"10.1038\/nrcardio.2015.113","article-title":"Switching P2Y12-receptor inhibitors in patients with coronary artery disease","volume":"13","author":"Rollini","year":"2016","journal-title":"Nat. Rev. Cardiol."},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"1747","DOI":"10.1016\/S0140-6736(17)32155-4","article-title":"Guided de-escalation of antiplatelet treatment in patients with acute coronary syndrome undergoing percutaneous coronary intervention (TROPICAL-ACS): A randomised, open-label, multicentre trial","volume":"390","author":"Sibbing","year":"2017","journal-title":"Lancet"},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"1955","DOI":"10.1161\/CIRCULATIONAHA.117.031164","article-title":"International Expert Consensus on Switching Platelet P2Y12 Receptor-Inhibiting Therapies","volume":"136","author":"Angiolillo","year":"2017","journal-title":"Circulation"},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"459","DOI":"10.4244\/EIJ-D-17-00092","article-title":"Incidence and outcome of switching of oral platelet P2Y12 receptor inhibitors in patients with acute coronary syndromes undergoing percutaneous coronary intervention: The SCOPE registry","volume":"13","author":"Musumeci","year":"2017","journal-title":"EuroIntervention"},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"303","DOI":"10.1160\/TH16-04-0340","article-title":"A randomised study for optimising crossover from ticagrelor to clopidogrel in patients with acute coronary syndrome: The Capital OPTI-CROSS Study","volume":"117","author":"Pourdjabbar","year":"2017","journal-title":"Thromb. Haemost."},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"681","DOI":"10.1016\/j.amjcard.2006.03.054","article-title":"Onset and offset of platelet inhibition after high-dose clopidogrel loading and standard daily therapy measured by a point-of-care assay in healthy volunteers","volume":"98","author":"Price","year":"2006","journal-title":"Am. J. Cardiol."},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"2450","DOI":"10.1161\/CIRCULATIONAHA.118.033983","article-title":"Pharmacodynamic Effects of Switching from Ticagrelor to Clopidogrel in Patients with Coronary Artery Disease: Results of the SWAP-4 Study","volume":"137","author":"Franchi","year":"2018","journal-title":"Circulation"},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"1089","DOI":"10.1016\/j.jcin.2016.02.039","article-title":"Pharmacodynamic Effects of Switching from Prasugrel to Ticagrelor: Results of the Prospective, Randomized SWAP-3 Study","volume":"9","author":"Franchi","year":"2016","journal-title":"JACC Cardiovasc. 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