Ticagrelor vs clopidogrel followed by ticagrelor re-loading in patients with ST-segment elevation myocardial infarction undergoing primary percutaneous coronary intervention: A randomized, pharmacodynamic comparison.
Τίτλος | Ticagrelor vs clopidogrel followed by ticagrelor re-loading in patients with ST-segment elevation myocardial infarction undergoing primary percutaneous coronary intervention: A randomized, pharmacodynamic comparison. |
Publication Type | Journal Article |
Year of Publication | 2016 |
Authors | Alexopoulos, D., Kontoprias K., Gkizas V., Karanikas S., Ziakas A., Barampoutis N., Tsigkas G., Koutsogiannis N., Davlouros P., Patsilinakos S., Karvounis H., Hahalis G., & Xanthopoulou I. |
Journal | Platelets |
Volume | 27 |
Issue | 5 |
Pagination | 420-6 |
Date Published | 2016 Jul |
ISSN | 1369-1635 |
Λέξεις κλειδιά | Adenosine, Biomarkers, Blood Platelets, Electrocardiography, Myocardial Infarction, Percutaneous Coronary Intervention, Platelet Activation, Platelet Aggregation Inhibitors, Platelet Function Tests, Risk Factors, Ticlopidine |
Abstract | Among patients allocated to ticagrelor in the primary percutaneous coronary intervention (PCI) cohort of Platelet Inhibition and Patient Outcomes (PLATO) trial, 40.7% had received pre-randomization 600 mg of clopidogrel. This scenario is frequently employed in real-world practice. In a prospective, three-center, single-blind, parallel design study, 74 P2Y12 inhibitor-naive patients undergoing primary PCI were randomized (Hour 0) to ticagrelor 180 mg loading dose (LD) vs clopidogrel 600 mg LD followed after 2 h by ticagrelor 180 mg re-LD. Platelet reactivity (VerifyNow, in PRU) was assessed at Hour 0, 2, 4, 6, and 24. The primary comparison was non-inferiority of ticagrelor to clopidogrel followed by ticagrelor re-LD regarding platelet reactivity at 24 h using a prespecified margin of <35 PRU for the upper bound of the one-sided 97.5% confidence interval (CI). Ticagrelor was proven non-inferior to clopidogrel followed by ticagrelor re-LD with a difference between arms of 13.5 PRU (28.8 upper 97.5% CI), p = 0.001. At Hour 2, platelet reactivity was lower in ticagrelor only vs clopidogrel followed by ticagrelor re-LD groups with least square estimate mean difference (95% CI) -105.7 (-140.6 to -70.8), p < 0.001, without significant difference thereafter. In conclusion, in patients undergoing primary PCI, a strategy of ticagrelor LD only was proven non-inferior to clopidogrel LD followed by ticagrelor re-LD, in terms of antiplatelet efficacy at 24 h post-randomization and provided an earlier onset of platelet inhibition. |
DOI | 10.3109/09537104.2015.1125874 |
Alternate Journal | Platelets |
PubMed ID | 26763727 |