Rationale and Role of High Loading Dose Clopidogrel in Patients with Acute Coronary Syndrome Undergoing Percutaneous Coronary Intervention

Mathew, Sam T.; S, Gayathri Devi; Prasanth, V V; B, Vinod

doi:10.4236/pp.2012.34066

Cited by 2 publications

(4 citation statements)

References 27 publications

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“…In contrast to normal volunteers and stable coronary disease patients, the IPA by P2Y12 receptor inhibitors is delayed for several hours especially in STEMI patients, but also in NSTEMI patients (10)(11)(12)(13)(14)(15)(22)(23)(24). Therefore, some patients continue to demonstrate inadequate IPA in the early hours after LD administration, particularly at 1 and 2 h following the LD, a state associated with a higher risk of thrombotic events (16,25).…”

Section: Discussionmentioning

confidence: 99%

“…Similarly, in patients with stable coronary artery disease ticagrelor achieves more rapid and greater IPA than a high loading dose of clopidogrel (10). In more recent studies it has been shown that, contrary to normal volunteers and patients with stable coronary artery disease, when administrating a P2Y12 inhibitor, the time to peak IPA may take up to 4 h in patients with ACS and even longer in patients with ST-elevation myocardial infarction (STEMI) (11)(12)(13)(14)(15). This delay in platelet inhibition in response to a ticagrelor loading dose (LD) has been related primarily to a drugdrug interaction, impaired intestinal absorption and increased platelet turn-over, associated with ACS as well as to the type of myocardial infarction, advanced age and diabetes mellitus (11)(12)(13)(14)(15)(16).…”

Section: Introductionmentioning

confidence: 99%

“…In more recent studies it has been shown that, contrary to normal volunteers and patients with stable coronary artery disease, when administrating a P2Y12 inhibitor, the time to peak IPA may take up to 4 h in patients with ACS and even longer in patients with ST-elevation myocardial infarction (STEMI) (11)(12)(13)(14)(15). This delay in platelet inhibition in response to a ticagrelor loading dose (LD) has been related primarily to a drugdrug interaction, impaired intestinal absorption and increased platelet turn-over, associated with ACS as well as to the type of myocardial infarction, advanced age and diabetes mellitus (11)(12)(13)(14)(15)(16). Since it was suggested that delay in intestinal absorption plays a pivotal role in delaying platelet response to anti-platelet agents in ACS, a recent trial examined whether swallowing crushed pills of a 180 mg LD of ticagrelor versus integral tablets of an equal dose, could accelerate early platelet inhibition in STEMI patients.…”

Section: Introductionmentioning

confidence: 99%

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Chewing versus Swallowing Ticagrelor to Accelerate Platelet Inhibition in Acute Coronary Syndrome - the CHEERS study

Asher

Frydman²,

Katz³

et al. 2017

Thromb Haemost

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It was the study objective to evaluate whether chewing a 180 mg loading dose of ticagrelor versus an equal dose of traditional oral administration, enhances inhibition of platelet aggregation 1 hour (h) after administering a ticagrelor loading dose in non-ST elevation myocardial infarction (NSTEMI) patients. Dual anti-platelet therapy represents standard care for treating NSTEMI patients. Ticagrelor is a direct acting P2Y12 inhibitor and, unlike clopidogrel and prasugrel, does not require metabolic activation. Fifty NSTEMI patients were randomised to receive either a chewing loading dose of 180 mg ticagrelor or an equal standard oral dose of ticagrelor. Platelet reactivity was evaluated by VerifyNow at baseline, 1 and 4 h post-loading dose. Results are reported in P2Y12 reaction units. Patients then continued to receive standard 90 mg oral ticagrelor twice daily. Baseline characteristics did not differ between the two groups. P2Y12 reaction units in the chewing group compared with the standard group at 0, 1 and 4 h after ticagrelor loading dose were: 245 vs 239 (p=0.59), 45 vs 130 (p=0.001) and 39 vs 60 (p=0.12), respectively, corresponding to a relative inhibition of platelet aggregation of 83 % vs only 47 % at 1 h (p< 0.001), and 84 % vs 77 % (p=0.59) at 4 h. Major adverse cardiac and cardiovascular events at 30 days were low (2 %), occurring in only one patient in the standard group. In conclusion, chewing a 180 mg ticagrelor loading dose is feasible and facilitates both faster and improved early inhibition of platelet aggregation in NSTEMI patients, compared with a standard oral-loading dose.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Chewing versus Swallowing Ticagrelor to Accelerate Platelet Inhibition in Acute Coronary Syndrome - the CHEERS study

Asher

Frydman²,

Katz³

et al. 2017

Thromb Haemost

View full text Add to dashboard Cite

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“…STEMI is a type of ACS (acute coronary syndrome) 1 . Thin fibrous cap with large lipid core and inflammation of atherosclerotic plaque may result in plaque fissuring.…”

Section: Introductionmentioning

confidence: 99%

Frequency of LV Thrombus Formation after Anterior Wall St-Segment Acute Myocardial Infarction

Rashid¹,

Afridi²,

Butt³

et al. 2023

PJMHS

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Objective: To assess the frequency of thrombus formation in LV post Anterior wall ST Segment elevation acute MI. Methodology: In this descriptive case series during the year 2018 we included 100 cases of age 40-70years of either gender presenting with STEMI planned to undergo Transthoracic echocardiography. Demographic information including name, age, gender, BMI, smoking and diabetes (BSR>186mg/dl) was also noted. Then patients were admitted in cardiology wards and were followed-up there. Then patients were discharged after 3days and were followed-up in OPD for one week. After one week, patients were evaluated on 2-D Transthoracic echocardiography and LV thrombus was labeled. The patients who had LV thrombus, were managed as per hospital protocol. Results: The mean age of patients was 56.68±8.59years. There were 90 (90%) males and 10 (10%) females. The mean BMI of patients was 24.54±3.49kg/m2. There were 43 (43%) smokers and 57 (57%) were non-smokers. There were 36 (36%) diabetics and 64 (64%) were non-diabetics. In this study, 63 (63%) underwent thrombolysis and 87 (87%) underwent primary PCI after STEMI. There were 7 (7%) cases who developed LV thrombus while 93 (93%) were remained free of LV thrombus. Concussion: Frequency of Left ventricular thrombus formation is low in our local population. Keywords: Left ventricular thrombus, anterior wall myocardial infarction, ST-segment elevation myocardial infarction, Transthoracic echocardiography

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Rationale and Role of High Loading Dose Clopidogrel in Patients with Acute Coronary Syndrome Undergoing Percutaneous Coronary Intervention

Cited by 2 publications

References 27 publications

Chewing versus Swallowing Ticagrelor to Accelerate Platelet Inhibition in Acute Coronary Syndrome - the CHEERS study

Chewing versus Swallowing Ticagrelor to Accelerate Platelet Inhibition in Acute Coronary Syndrome - the CHEERS study

Frequency of LV Thrombus Formation after Anterior Wall St-Segment Acute Myocardial Infarction

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