Ticagrelor: The first approved reversible oral antiplatelet agent

Goel, Divya

doi:10.4103/2229-516x.112234

Cited by 23 publications

(18 citation statements)

References 7 publications

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“…Schindler et al have reported that, using the AT1-receptor antagonist candesartan in patients with severe atherosclerosis after superficial femoral artery stenting produces a significantly better effect against restenosis than the treatment with the ACE inhibitor quinapril [44] . Goel et al have found that Ticagrelor, a P2Y12 antagonist, prevents restenosis by inhibiting the inflammation induced by the P2Y12 receptor [45] . Wong et al have shown that PAR4 inhibition has the potential therapeutic advantage of antithrombotic activity with a low bleeding risk [46] .…”

Section: Discussionmentioning

confidence: 99%

“…As a result, to confirm that the methodology is a good approach for a particular group of patients would require extensive studies involving a large number of patient populations; we are addressing this goal in ongoing efforts. Regardless of these limitations, our studies compared cilostazol with aspirin, in contrast to previous studies, which have focused on the additional inhibition of platelet aggregation by cilostazol when co-administered with aspirin and clopidogrel [44][45][46][47] . Therefore, these data warrant a larger scale prospective randomized controlled trial for patients with aspirin intolerance.…”

Section: Discussionmentioning

confidence: 99%

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The efficacy and safety of cilostazol as an alternative to aspirin in Chinese patients with aspirin intolerance after coronary stent implantation: a combined clinical study and computational system pharmacology analysis

Xue

Feng

et al. 2017

Acta Pharmacol Sin

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Dual antiplatelet therapy (DAT) with aspirin and clopidogrel is the standard regimen to achieve rapid platelet inhibition and prevent thrombotic events. Currently, little information is available regarding alternative antiplatelet therapy in patients with an allergy or intolerance to aspirin. Although cilostazol is already a common alternative to aspirin in clinical practice in China, its efficacy and safety remain to be determined. We retrospectively analyzed 613 Chinese patients who had undergone primary percutaneous coronary intervention (PCI). Among them, 405 patients received standard DAT (aspirin plus clopidogrel) and 205 patients were identified with intolerance to aspirin and received alternative DAT (cilostazol plus clopidogrel). There were no significant differences between the two groups in their baseline clinical characteristics. The main outcomes of the study included major adverse cardiac events (MACEs) and bleeding events during 12 months of follow-up. The MACEs endpoint was reached in 10 of 205 patients treated with cilostazol (4.9%) and in 34 of 408 patients treated with aspirin (8.3%). No statistically significant difference was observed in MACEs between the two groups. However, patients in the cilostazol group had less restenosis than did patients in the aspirin group (1.5% vs 4.9%, P=0.035). The occurrence of bleeding events tended to be lower in the cilostazol group (0.49% vs 2.7%, P=0.063). These clinical observations were further analyzed using network system pharmacology analysis, and the outcomes were consistent with clinical observations and preclinical data reports. We conclude that in Chinese patients with aspirin intolerance undergoing coronary stent implantation, the combination of clopidogrel with cilostazol may be an efficacious and safe alternative to the standard DAT regimen.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

The efficacy and safety of cilostazol as an alternative to aspirin in Chinese patients with aspirin intolerance after coronary stent implantation: a combined clinical study and computational system pharmacology analysis

Xue

Feng

et al. 2017

Acta Pharmacol Sin

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“…Some clinical drugs take advantage of pathway specificity for platelet activation. For example, ticagrelor inhibits platelet activation by inhibiting ADP signaling through the P2Y12 receptor but not through other receptors (Goel, 2013;Patel et al, 2013;von Kugelgen, 2017).…”

Section: Discussionmentioning

confidence: 99%

Acetylcholine Inhibits Platelet Activation

Bennett

Ture

Schmidt

et al. 2019

J Pharmacol Exp Ther

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Platelets are key mediators of thrombosis. Many agonists of platelet activation are known, but fewer endogenous inhibitors of platelets, such as prostacyclin and nitric oxide (NO), have been identified. Acetylcholinesterase inhibitors, such as donepezil, can cause bleeding in patients, but the underlying mechanisms are not well understood. We hypothesized that acetylcholine is an endogenous inhibitor of platelets. We measured the effect of acetylcholine or analogs of acetylcholine on human platelet activation ex vivo. Acetylcholine and analogs of acetylcholine inhibited platelet activation, as measured by P-selectin translocation and glycoprotein IIb IIIa conformational changes. Conversely, we found that antagonists of the acetylcholine receptor, such as pancuronium, enhance platelet activation. Furthermore, drugs inhibiting acetylcholinesterase, such as donepezil, also inhibit platelet activation, suggesting that platelets release acetylcholine. We found that NO mediates acetylcholine inhibition of platelets. Our data suggest that acetylcholine is an endogenous inhibitor of platelet activation. The cholinergic system may be a novel target for antithrombotic therapies.

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“…There are clinical drugs which take advantage of pathway specificity for platelet activation. For example, ticagrelor inhibits platelet activation by thromboxane-A2, but does not inhibit their activation with ADP or collagen (45–47).…”

Section: Discussionmentioning

confidence: 99%

Acetylcholine inhibits platelet activation and regulates hemostasis

Bennett

et al. 2018

Preprint

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22Word Count: 5145 23 Figure Count: 5 figures 24 25 26 42 platelets express members of the acetylcholine signaling pathway including CHRNA2, CHRNA7,43 CHRNB1, and ACHE. Platelets from mice lacking Chrna7 are hyperactive when stimulated by 44 thrombin and resistant to inhibition by acetylcholine. Furthermore, acetylcholinesterase 45 inhibitors prolonged bleeding in wild-type mice. Knockout mice lacking Chrna7 subunits of the 46 acetylcholine receptor display prolonged bleeding as well. 47 52 Abbreviations 53 NO nitric oxide 54 CHRNA7 cholinergic receptor neuronal nicotinic alpha polypeptide 7 55 GPIIbIIIA glycoprotein IIb IIIa 56 AChR acetylcholine receptors 57 AChE acetylcholinesterase 58 TRAP thrombin receptor activating peptide 6 59 PAR1 protease activated receptor 1 60 P2Y12 purinergic receptor P2Y 61 GPVI glycoprotein VI 62 NOS3 nitric oxide synthase isoform 3 63 L-NAME L-nitroarginine methyl ester

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Ticagrelor: The first approved reversible oral antiplatelet agent

Cited by 23 publications

References 7 publications

The efficacy and safety of cilostazol as an alternative to aspirin in Chinese patients with aspirin intolerance after coronary stent implantation: a combined clinical study and computational system pharmacology analysis

The efficacy and safety of cilostazol as an alternative to aspirin in Chinese patients with aspirin intolerance after coronary stent implantation: a combined clinical study and computational system pharmacology analysis

Acetylcholine Inhibits Platelet Activation

Acetylcholine inhibits platelet activation and regulates hemostasis

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