Evolving pattern of on-prasugrel and on-ticagrelor platelet reactivity over time in ST elevation myocardial infarction patients

Alexopoulos, Dimitrios; Xanthopoulou, Ioanna; Siapika, Argyro; Tsoni, Evropi; Stavrou, Katerina; Θεοδωρόπουλος, Κωνσταντίνος; Davlouros, Periklis

doi:10.1016/j.ijcard.2013.01.191

Cited by 9 publications

(3 citation statements)

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“…Although not randomised, our study represents the largest so far comparison between ticagrelor and prasugrel in an unselected population, which confirms and extends previous observations from small sized studies in specific patients groups or early post loading dose of the two agents (5)(6)(7)(8)(9)17). In an observational study assessing PR at one month after the onset of ACS using light transmittance aggregometry, a hypothesis-generating significantly lower response with ticagrelor than prasugrel has been found (18).…”

Section: Discussionsupporting

confidence: 86%

Ticagrelor vs prasugrel one-month maintenance therapy: Impact on platelet reactivity and bleeding events

Alexopoulos¹,

Stavrou²,

Koniari³

et al. 2014

Thromb Haemost

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Platelet reactivity (PR) and bleeding events following therapy with ticagrelor vs prasugrel have not been adequately studied. We aimed to compare PR and bleeding events in patients with acute coronary syndrome (ACS) undergoing percutaneous coronary intervention (PCI) while on ticagrelor vs prasugrel for one month. Consecutive patients who were discharged either on ticagrelor 90 mg bid maintenance dose (MD) or prasugrel 10 mg MD were invited for PR assessment (VerifyNow, in PRU) at one month. High PR (HPR) was defined as >208 PRU. Bleeding events [Bleeding Academic Research Consortium (BARC) classification] were monitored. Out of 937 screened patients, 512 were analysed, 278 under ticagrelor MD and 234 under prasugrel MD. PR at 30 days (C-statistic of the propensity score model 0.63, 0.58-0.67 95% CI, p<0.001) was lower when on ticagrelor compared with prasugrel (33.3, 95% CI 29.3-37.3 vs 84.6, 95% CI 73.6-95.6, p<0.001). In the analysed population more BARC type 1 bleeding events were observed with ticagrelor compared to prasugrel (36.7% vs 28.2%, p=0.047). In 221 propensity score matched pairs, BARC type 1 bleeding rate was marginally higher in ticagrelor vs prasugrel treated patients (35.7% vs 27.1%, p=0.05). BARC type ≥2 events did not differ between groups 5 (2.3%) vs 5 (2.3%). HPR rate was higher for prasugrel-treated patients (5.4% vs 0%, p<0.001). In conclusion, in patients with ACS undergoing PCI, ticagrelor MD produces a significantly higher platelet inhibition compared to prasugrel MD. This pharmacodynamic difference might be associated with more nuisance bleeding events with ticagrelor use.

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Section: Discussionsupporting

confidence: 86%

Ticagrelor vs prasugrel one-month maintenance therapy: Impact on platelet reactivity and bleeding events

Alexopoulos¹,

Stavrou²,

Koniari³

et al. 2014

Thromb Haemost

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“…The observation of a link between non-CABG-related major bleeding and LPR during prasugrel therapy further supports the potential role of PFT, particularly as these findings do not appear to be specific for any P2Y 12 inhibitor. The consistent potent platelet inhibition achieved in ticagrelor-treated patients with PR values presenting within a small range have limited the ability to determine a bleeding threshold in such patients, at least by using the VerifyNow assay (64,65).…”

Section: Relation Of Platelet Function To Bleeding In Pci-treated Pat...mentioning

confidence: 99%

Consensus and Update on the Definition of On-Treatment Platelet Reactivity to Adenosine Diphosphate Associated With Ischemia and Bleeding

Tantry

Bonello

Aradi

et al. 2013

Journal of the American College of Cardiology

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Dual antiplatelet therapy with aspirin and a P2Y12 receptor blocker is a key strategy to reduce platelet reactivity and to prevent thrombotic events in patients treated with percutaneous coronary intervention. In an earlier consensus document, we proposed cutoff values for high on-treatment platelet reactivity to adenosine diphosphate (ADP) associated with post-percutaneous coronary intervention ischemic events for various platelet function tests (PFTs). Updated American and European practice guidelines have issued a Class IIb recommendation for PFT to facilitate the choice of P2Y12 receptor inhibitor in selected high-risk patients treated with percutaneous coronary intervention, although routine testing is not recommended (Class III). Accumulated data from large studies underscore the importance of high on-treatment platelet reactivity to ADP as a prognostic risk factor. Recent prospective randomized trials of PFT did not demonstrate clinical benefit, thus questioning whether treatment modification based on the results of current PFT platforms can actually influence outcomes. However, there are major limitations associated with these randomized trials. In addition, recent data suggest that low on-treatment platelet reactivity to ADP is associated with a higher risk of bleeding. Therefore, a therapeutic window concept has been proposed for P2Y12 inhibitor therapy. In this updated consensus document, we review the available evidence addressing the relation of platelet reactivity to thrombotic and bleeding events. In addition, we propose cutoff values for high and low on-treatment platelet reactivity to ADP that might be used in future investigations of personalized antiplatelet therapy.

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“…Furthermore, few studies have evaluated the longitudinal changes in PR from the initial to the mid-term periods. Moreover, the optimal timing for platelet function measurement, with respect to fluctuations as seen in the early period of ACS, is still debated (8,9).…”

Section: A C C E P T E Dmentioning

confidence: 99%

Clinical significance of high on-treatment platelet reactivity in patients with prolonged clopidogrel therapy

Kim¹,

Han

Choi

et al. 2021

Korean J Intern Med

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Background/Aims: Prolonged dual antiplatelet therapy (DAPT) with aspirin and clopidogrel beyond 1 year has been shown to reduce ischemic events at the expense of increased bleeding. However, limited data are available on the clinical significance of platelet reactivity (PR) at 1 year. Methods: We retrospectively identified 331 patients who underwent percutaneous coronary intervention and assessed the on-clopidogrel PR using VerifyNow P2Y12 Assay at 1 year in a single center. 211 patients were on DAPT for >1 year. The relationship between high on-treatment platelet reactivity (HPR) at 1 year and clinical outcomes beyond 1 year, as well as the longitudinal change in PR was analyzed. Results: At 1 year, 135 (64%) patients showed HPR and 76 (36%) did not. There was a significant increase in ischemic endpoint events, including cardiovascular death, nonfatal myocardial infarction, and stroke/transient ischemic attack in patients with compared to without HPR at 1 year (hazard ratio [HR], 2.68; 95% confidence interval [CI], 1.06-6.77, p=0.036). However, the incidence of any Bleeding Academic Research Consortium (BARC) bleeding was significantly lower in the HPR group (HR, 0.11; 95% CI, 0.02-0.65, p=0.015). In the longitudinal analysis, PR significantly decreased from post-load to 1 year after index PCI in the non-HPR group. Conversely, the HPR group showed high PR from baseline through 1 year. Conclusions: HPR at 1 year may be a useful surrogate for predicting ischemic and bleeding events in patients on prolonged DAPT. Patients with and without HPR at 1 year showed different patterns of longitudinal change in PR.

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Evolving pattern of on-prasugrel and on-ticagrelor platelet reactivity over time in ST elevation myocardial infarction patients

Cited by 9 publications

References 10 publications

Ticagrelor vs prasugrel one-month maintenance therapy: Impact on platelet reactivity and bleeding events

Ticagrelor vs prasugrel one-month maintenance therapy: Impact on platelet reactivity and bleeding events

Consensus and Update on the Definition of On-Treatment Platelet Reactivity to Adenosine Diphosphate Associated With Ischemia and Bleeding

Clinical significance of high on-treatment platelet reactivity in patients with prolonged clopidogrel therapy

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