Ticagrelor Improves Peripheral Arterial Function in Patients with a Previous Acute Coronary Syndrome

Abstract

Objective: The novel P2Y₁₂ antagonist ticagrelor inhibits adenosine diphosphate (ADP)-induced platelet aggregation more potently than clopidogrel and reduces the incidence of myocardial infarction and total death in patients with an acute coronary syndrome (ACS). Furthermore, ticagrelor inhibits adenosine reuptake and increases coronary flow reserve during adenosine infusion in man. We wanted to determine whether ticagrelor improves peripheral arterial function in patients with a previous ACS compared to patients treated with aspirin, clopidogrel, or prasugrel. Methods: 127 patients with a previous ACS (>3 months to <3 years ago) on maintenance dose of (1) no ADP blocker (n = 35); (2) clopidogrel 75 mg (n = 35); (3) prasugrel 10 mg (n = 32), or (4) ticagrelor 90 mg twice daily (n = 25) were evaluated with peripheral arterial tonometry after forearm ischemia. Results: Ticagrelor improves peripheral arterial function compared to the other groups [(1) controls 1.78 ± 0.53; (2) clopidogrel 1.78 ± 0.45; (3) prasugrel 1.64 ± 0.33, and (4) ticagrelor 2.25 ± 0.54 (means ± SD)] with a significance of p < 0.01 for ticagrelor versus no ADP blocker, p < 0.01 for ticagrelor versus clopidogrel, and p < 0.001 for ticagrelor versus prasugrel. There were fewer patients with endothelial dysfunction (<1.67 reactive hyperemia index) in the ticagrelor group (12%) compared to aspirin (51%), clopidogrel (46%), and prasugrel (53%) (p < 0.01). Conclusion: Treatment with ticagrelor improves peripheral endothelial function compared to no ADP blocker, clopidogrel, or prasugrel treatment.

Ticagrelor mitigates ischaemia–reperfusion induced vascular endothelial dysfunction in healthy young males – a randomized, single‐blinded study

“…Further, the effect of prasugrel was not assessed in this study and it remains unclear whether this P2Y 12 receptor antagonist affects the endothelium-dependent FBF response. However, available data suggests that prasugrel does not improve vascular function substantially [32,33].…”

Potential Benefits of Ticagrelor beyond Platelet Inhibition

“…Assuming that peripheral endothelial dysfunction is improved by ticagrelor, this would imply a beneficial effect of this agent on coronary microcirculation, with a potential to reduce risk of secondary events following ACS. However, the results presented by Torngren et al [6] are at present hypothesis-generating and need to be verified in future randomized studies.…”

“…In the latest issue of Cardiology , Kristina Torngren and coworkers have evaluated the effect of ticagrelor as compared to clopidogrel, prasugrel and placebo, respectively, on the reactive hyperemia index in stable patients on maintenance therapy following an ACS [6]. This method has been shown to correlate with coronary endothelial dysfunction [7].…”

“…Torngren et al [6] suggest that the combined effects of ticagrelor on both ATP release and adenosine reuptake may result in circulating plasma levels of adenosine high enough to improve microcirculation. A contributing factor could be that vascular smooth muscle cells express P2Y12 receptors and contract in response to ADP [17].…”

Endothelial dysfunction and increased platelet reactivity in patients with acute coronary syndrome and undiagnosed COPD: insights into the SCAP trial

“…We found that both COPD and UCOPD patients benefit from ticagrelor. A previous study on ACS patients showed that treatment with ticagrelor was able to improve endothelial function (tested with peripheral arterial tonometry) [10]. This was confirmed in a randomised clinical trial of COPD patients with stable coronary artery disease [6].…”