Benefit of switching dual antiplatelet therapy after acute coronary syndrome: the TOPIC (timing of platelet inhibition after acute coronary syndrome) randomized study

RCT (n=645) reports switching dual antiplatelet therapy (DAPT) from aspirin + newer P2Y12 blocker to clopidogrel after 1 month results in occurrence of primary endpoint (composite CV death, urgent revascularisation, stroke and bleeding) of 26.3% vs 13.4% respectively (P < 0.01).

This is the first randomised clinical trial investigating a switch from prasugrel or ticagrelor to clopidogrel vs. continuing either drug after a percutaneous coronary intervention for ACS.

 

In a related editorial, the authors note the limitations of this study, stating “The open-label nature of the trial, the telephone-based follow-up, the internal event adjudication, as well as an envelope system of randomisation warrant a judicious interpretation. Importantly, the number of patients lost to follow-up plus the patients crossing over to the other treatment strategy arm exceeds the total number of many of the individual endpoints which also prohibits making definite conclusions”.