PB0056 - Platelet aggregation test in different dual anti-platelet therapies in patients with acute coronary syndrome with percutaneous coronary intervention

Background: Acute coronary syndrome (ACS) is caused by atherosclerosis, which causes atheromatous plaque. In atherosclerosis, there is an increase in platelet aggregation. One of the treatments for ACS is percutaneous coronary intervention (PCI). Patients undergoing PCI treatment are recommended to receive dual anti-platelet therapy (DAPT) to minimize the risk of thrombus during the PCI procedure, and also the effects of stents.

Aims: This study aims to compare the effectiveness of aspirin-clopidogrel, aspirin-ticagrelor, and aspirin-prasugrel for reducing platelet aggregation in ACS patients with PCI treatment.

Methods: Prospective cohort design, carried out at Dr. Soetomo General Academic Hospital, Indonesia, in the period December 2022 to 2023. Ethical clearance was approved by the Ethical Committee of this hospital. Patients were recruited based on consecutive sampling based on the Declaration of Helsinki and divided into three groups of DAPT based on high and low bleeding risk according to the ARC-HBR score. Platelet aggregation test was performed on day 1st before PCI as the initial dose and on day 7th of treatment as a maintenance dose, using the light transmission aggregometry method, with adenosine diphosphate (ADP) agonist. Statistical analysis using paired t-test for difference intragroup, and one-way ANOVA test for the differences between groups.

Results: A total of 68 subjects, consisting of 15 on aspirin-clopidogrel, 30 on aspirin-ticagrelor and 23 on aspirin-prasugrel therapies. A significant difference in % maximum aggregation in the initial dose and maintenance dose in the aspirin-ticagrelor group (p=0.012), as well as the aspirin-prasugrel group (p < 0.000). The delta of % maximum aggregation was analyzed between the groups, and the result significant difference (p=0.004), in which the group of aspirin-prasugrel therapy have the highest delta of % maximum aggregation.

Conclusion(s): Aspirin-prasugrel gives the best inhibition of platelet aggregation both in the initial dose and maintenance dose in ACS patients with PCI treatment.