Effects of Low-dose Ticagrelor vs. Clopidogrel in Stable Patients Undergoing Elective Percutaneous Coronary Intervention

Prior treatment

• On treatment with prasugrel or ticagrelor;
• Use of an intravenous antiplatelet therapy (i.e., cangrelor or GPI) in the prior 24 hours;
• Concomitant therapy with strong CYP3A4 inhibitors or CYP3A4 substrates;
• Use of oral anticoagulant therapy;
• History of previous intracerebral bleed at any time;
• Increased risk of bradycardic events (e.g., known sick sinus syndrome, second or third degree AV block or previous documented syncope suspected to be due to bradycardia) unless treated with a pacemaker;

Other illness

• Myocardial infarction at the time of index PCI;
• Documented hypersensitivity to clopidogrel;
• Active pathological bleeding;
• Documented hypersensitivity to ticagrelor;
• Known severe liver disease;

Lab values

• Known platelet count \<80x106/mL;
• Known hemoglobin \<9 g/dL;

Other

• Women of child-bearing potential (i.e., those who are not chemically or surgically sterilized or who are not post-menopause) who are not willing to use a medically accepted method of contraception that is considered reliable in the judgment of the investigator OR who have a positive pregnancy test at enrollment or randomization OR women who are breast-feeding.
• Inability to provide written informed consent.

• Stable CAD undergoing elective PCI;
• Male or females, Age ≥ 18 years old;
• Troponin negative before coronary angiography;
• On treatment with low-dose aspirin (81mg od) and clopidogrel for at least 24 hours after index PCI;
• ABCD-GENE score greater or equal than 10.
  • Troponin negative is defined as hs-cTn below the URL for the laboratory (Male \< 22 ng/L; Female \< 14 ng/L) or modestly positive hs-cTn (Male: 22-99 ng/L; Female: 14-99 ng/L) flat or decreasing from hour 0 to 3.