Dual Antiplatelet Therapy in ACS Patients

The study cohort has been described previously [21 (link)]. In total, 206 ACS patients on daily aspirin (100 mg/day), and either prasugrel (10 mg/d, n = 116) or ticagrelor (180 mg/d, n = 90), were included. Pre- and periprocedurally, all patients received weight-adjusted unfractionated heparin (UFH) (70–100 IU/kg, aiming for an activated clotting time > 250 s) [22 (link)]. None of the patients received a GPIIb/IIIa inhibitor. After successful PCI, blood was drawn after an overnight fast. Exclusion criteria included oral anticoagulation with either vitamin K antagonists (warfarin, phenprocoumon and acenocoumarol) or direct oral anticoagulants (edoxaban, dabigatran, apixaban and rivaroxaban), a known aspirin, prasugrel or ticagrelor intolerance (allergic reaction and gastrointestinal bleeding complication), a history of bleeding complications or a positive family history of bleeding complications, treatment with ticlopidine, dipyridamole or nonsteroidal antirheumatic drugs, malignant myeloproliferative disorders or heparin-induced thrombocytopenia, major surgery within one week before enrollment, severe hepatic failure with impaired hepatic synthesis (spontaneous international normalized ratio [INR] ≥1.5 and albumin levels <35 mg/dl) [23 (link)], known qualitative defects in platelet function, a platelet count < 100.000 or > 450.000/µL and a hematocrit < 30%.
The study protocol was in accordance with the criteria of the Declaration of Helsinki and has been approved by the Ethics Committee of the Medical University of Vienna (EC-No. 1940/2013). All study participants gave written informed consent.