2023-08-17 03:19:49
A study has found that aspirin, which is administered to prevent blood clots following coronary angioplasty (PCI), can be replaced with the anti-inflammatory drug colchicine.
Aspirin increases the risk of bleeding, but colchicine has a relatively low risk, so colchicine can be a useful option for those at high risk of bleeding.
The results of a study on the effect of a combination therapy of colchicine and a P2Y12 inhibitor to prevent thrombotic events in acute coronary syndrome (ACS) patients conducted by Lee Seung-yul and other researchers at the Cardiovascular Center of Korea University Guro Hospital were published in the Journal of the American College of Cardiology (JACC) on the 16th. doi.org/10.1016/j.jcin.2023.05.035).
A study has found that colchicine can be administered instead of aspirin to patients at high risk of post-PCI bleeding.
Dual antiplatelet therapy (DAPT) consisting of aspirin and a P2Y12 inhibitor has become the standard of care for preventing thrombotic events in patients with ACS undergoing PCI.
The problem is that because the risk of bleeding increases in proportion to the dose and administration time of aspirin, other options were needed for those at high risk of bleeding.
Focusing on the fact that P2Y12 inhibitor monotherapy, excluding aspirin following a short period of DAPT therapy, effectively reduces the risk of bleeding, the research team recently received the first approval from the US FDA as an anti-inflammatory agent that lowers the risk of myocardial infarction, stroke, and coronary artery revascularization. A study was undertaken to confirm the possibility of the received colchicine.
200 patients with non-ST-segment elevation ACS and ST-segment elevation myocardial infarction (STEMI) undergoing PCI were given aspirin in combination with a P2Y12 inhibitor (ticagrel or prasugrel).
The day following PCI, aspirin was discontinued and the P2Y12 inhibitor was changed to low-dose colchicine (0.6 mg once a day), and stent-related thrombosis was determined within 3 months.
Then, a high-sensitivity C-reactive protein (hs-CRP) test, which is used to check platelet reactivity and inflammation levels before discharge, was also performed.
A total of 190 patients completed a 3-month follow-up, and stent-related thrombosis occurred in 2 patients (1.0%), but only one patient reported definitive thrombosis because one did not take antiplatelet drugs.
The overall level of platelet reactivity was 27 ± 42 PRU, and most patients (91%) met the criteria for low platelet reactivity, while only one patient had a high platelet reactivity of 208 or higher.
The hs-CRP level decreased from 6.1 mg/L at 24 hours to 0.6 mg/L at 1 month following PCI, and the prevalence of hyperinflammation greater than 2 mg/L decreased from 81.8% to 11.00%.
“This study confirms that in patients with ACS undergoing PCI, low-dose colchicine administered the day following PCI instead of ticagrel or prasugrel P2Y12 inhibitor combined with aspirin is feasible,” said the researchers. “This approach can improve platelet function and inflammation. It has to do with the profile.”
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