High and low on-treatment platelet reactivity to P2Y12 inhibitors in a contemporary cohort of acute coronary syndrome patients undergoing percutaneous coronary intervention.
Thromb Res
; 175: 95-101, 2019 Mar.
Article
em En
| MEDLINE
| ID: mdl-30738371
ABSTRACT
INTRODUCTION:
There is compelling evidence supporting the association between high on-treatment platelet reactivity (HPR) and low on-treatment platelet reactivity (LPR) to clopidogrel with atherothrombotic and bleeding events, respectively. However, it is uncertain if current cutoff values should be used in prasugrel- or ticagrelor-treated subjects. The objective of this analysis was to evaluate the pharmacodynamic (PD) efficacy of P2Y12 antagonists in a contemporary real-world population. MATERIALS ANDMETHODS:
This PD study included 988 patients with acute coronary syndromes (ACS) undergoing percutaneous coronary intervention (PCI) and receiving dual therapy with aspirin and a P2Y12 inhibitor (clopidogrel, prasugrel or ticagrelor). Platelet function was assessed at day 1 and day 30 post-PCI by VerifyNow P2Y12 assay, multiple electrode aggregometry and vasodilator-stimulated phosphoprotein (VASP) assay.RESULTS:
Clopidogrel-treated patients (nâ¯=â¯324) had greater platelet reactivity than those receiving ticagrelor (nâ¯=â¯469) or prasugrel (nâ¯=â¯195) at both time points (pâ¯<â¯0.001 for all comparisons). No difference between ticagrelor and prasugrel was observed at day 1 with the VerifyNow P2Y12 assay (51.5⯱â¯2.8 vs. 42.7⯱â¯3.5 PRUs; pâ¯=â¯0.298), whereas ticagrelor achieved greater platelet inhibition at day 30 (48.1⯱â¯2.5 vs. 89.2⯱â¯4.2 PRUs; pâ¯<â¯0.001). Similar results were obtained with the VASP assay. Both prasugrel and ticagrelor had markedly lower HPR rates than clopidogrel and very high rates of LPR at both time points.CONCLUSIONS:
Prasugrel and ticagrelor displayed more potent and consistent PD effects than clopidogrel in ACS patients undergoing PCI, with a trend towards greater platelet inhibition with ticagrelor during the maintenance phase of therapy compared to prasugrel.Palavras-chave
Texto completo:
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Base de dados:
MEDLINE
Assunto principal:
Testes de Função Plaquetária
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Síndrome Coronariana Aguda
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Antagonistas do Receptor Purinérgico P2Y
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Intervenção Coronária Percutânea
Tipo de estudo:
Clinical_trials
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Observational_studies
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Risk_factors_studies
Limite:
Aged
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Female
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Humans
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Male
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Middle aged
Idioma:
En
Ano de publicação:
2019
Tipo de documento:
Article