TRimetazidine as an Agent to affeCt clopidogrEl Response: The TRACER Study

Seecheran, Naveen; Seebalack, Victoria; Seecheran, Rajeev; Maharaj, Aarti; Boodhai, Brent; Seecheran, Valmiki; Persad, Sangeeta; Motilal, Shastri; Tello‐Montoliu, Antonio; Schneider, David J.

doi:10.1007/s40119-019-0139-0

Cited by 4 publications

(4 citation statements)

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“…Platelet function assays included the VerifyNow TM P2Y 12 (VN-P2Y 12 ) assay (Instrumentation Laboratory, Massachusetts, USA). The assays were performed according to standard protocols, as previously described [7][8][9]. The VN-P2Y 12 assay reports the results as P2Y 12 reaction units (PRU).…”

Section: Blood Sampling and Verifynow Tm P2y 12 Testingmentioning

confidence: 99%

The Effect of Empagliflozin on Platelet Function Profiles in Patients with Stable Coronary Artery Disease in Trinidad: The EFFECT Pilot Study

Seecheran

Ramdeen²,

Debideen³

et al. 2020

Cardiol Ther

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Introduction This prospective pharmacodynamic (PD) study aimed to assess the effect of the sodium–glucose cotransporter 2 inhibitor (SGLT2i) empagliflozin on platelet reactivity. Methods Patients with stable coronary artery disease (CAD) and type 2 diabetes mellitus (T2DM) ( n = 20) who were actively treated with dual antiplatelet therapy (DAPT) of aspirin 81 mg daily and clopidogrel 75 mg daily were recruited. Platelet function was measured with the VerifyNow™ P2Y 12 assay (Instrumentation Laboratory, Massachusetts, USA) and assessed before the initiation of and after 10 days of treatment with empagliflozin 25 mg once daily maintenance dose regimen. Results were compared with a paired t test. Results The mean P2Y 12 reaction units (PRU) on empagliflozin was significantly less than without empagliflozin at baseline (187.35, 95% confidence interval (CI) 155.38–219.32 vs. 217.25, CI 180.60–253.90; p < 0.030). The mean difference in PRU was 29.90 (95% CI 3.17–56.63). No patients experienced any serious adverse events (SAEs). Conclusions Significantly attenuated platelet reactivity was observed on empagliflozin as compared to without empagliflozin. This dedicated pharmacodynamic study could be clinically pertinent for Trinidadian patients with stable CAD and T2DM on DAPT. Further studies are required to confirm these exploratory findings. (Funded by the University of the West Indies, St. Augustine; EFFECT). Clinical Trial Registration ClinicalTrials.gov number NCT04342819.

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Section: Blood Sampling and Verifynow Tm P2y 12 Testingmentioning

confidence: 99%

The Effect of Empagliflozin on Platelet Function Profiles in Patients with Stable Coronary Artery Disease in Trinidad: The EFFECT Pilot Study

Seecheran

Ramdeen²,

Debideen³

et al. 2020

Cardiol Ther

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“…Diabetes is implicated in accentuating platelet reactivity via a complex thrombotic milieu [ 5 ]. The study also had a relatively higher proportion of women (56%) as compared to prior studies performed by this group in a similar setting [ 6 , 10 ]. Thus, any emerging recommendations cannot be extrapolated to other populations, such as patients with ACS.…”

Section: Discussionmentioning

confidence: 90%

“…A recent East Asian systematic review suggested that low-dose ticagrelor revealed an antiplatelet efficacy similar to that of standard-dose ticagrelor, which was faster and more potent than clopidogrel, however, required further evaluation in a large-scale randomized clinical trial [ 9 ]. These findings raised the question as to whether the current recommended dose of ticagrelor is suitable for the Trinidadian population, a population often described as multiethnic and cosmopolitan, comprising an admixture of South Asian, Caribbean Black, East Asian, Arabic, and Caucasian ancestries [ 6 , 10 ]. Therefore, we conducted this exploratory pilot study to assess the antiplatelet PD effect of low-dose ticagrelor in a Trinidadian subpopulation with stable coronary artery disease (CAD).…”

Section: Introductionmentioning

confidence: 99%

The Effect of Low-Dose Ticagrelor on Platelet Function Profiles in Patients With Stable Coronary Artery Disease in Trinidad: The TWIST Pilot Study

et al. 2020

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Introduction This prospective, pharmacodynamic study aimed to explore the potential applicability of a low-dose ticagrelor regimen in a heterogeneous Trinidadian subpopulation. Methods Patients with stable coronary artery disease ( n = 25) who were actively treated with dual antiplatelet therapy of aspirin 81 mg daily and clopidogrel 75 mg daily were recruited. Platelet function was measured with the VerifyNow P2Y 12 assay (Accriva Diagnostics, San Diego, CA, USA) and assessed before initiation of and after 14 days of treatment with a low-dose ticagrelor 45 mg twice daily maintenance dose regimen. Results were compared with a paired t test. Results The mean P2Y 12 reaction units (PRU) score on ticagrelor was significantly less compared to that of clopidogrel (50.4, 95% confidence interval (CI) 29–73.9; vs. 149.6, 95% CI 129.4–169.9; p value < 0.001). Of the patients, 4% experienced Medical Research Council class 1 dyspnea, and Bleeding Academic Research Consortium class 1 bleeding on the ticagrelor regimen (one patient each). Conclusions Significantly attenuated platelet reactivity was seen on the low ticagrelor maintenance dose as compared to clopidogrel. This dedicated pharmacodynamic study could be applicable and informative for Trinidadian stable coronary artery disease patients. Further studies are required to confirm these exploratory findings.(Funded by the University of the West Indies, St. Augustine). Trial Registration ClinicalTrials.gov number NCT04206176.

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“…Десять років тому був описаний негативний вплив блокатора протонної помпи омепразолу на зменшення антитромбоцитарної активності клопідогрелю in vitro [27]. Результати нещодавно опублікованого дослідження TRACER (2019) показали істотне погіршення антитромбоцитарного потенціалу клопідогрелю в разі додавання триметазидину [28]. Останній вважається препаратом метаболічної дії, який в умовах ішемії пригнічує активність 3-кетоацил-коензим-А-тіолази в клітинах міокарда [29].…”

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Capabilities of Cardioprotective Therapy in the Treatment and Prevention of Heart Failure in the Postinfarction Period

Batushkin¹

2020

Kardiol. nauk prakt.

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Recently, numerous and quite convincing data has been accumulated on the effectiveness and safety of lipid-lowering drugs, beta-blockers, antiplatelet and antihypertensive drugs in patients with chronic heart failure (CHF), depending on the origin of the latter. The practitioner is suggested to use several drugs of different classes at the same time in order to reduce cardiovascular mortality, as well as the risk of recurrent myocardial infarction and ischemic stroke. In CHF, metabolism in cardiomyocytes varies depending on the stage of the disease. The changes that occur in the postinfarction period are compensatory in nature, which contributes to the partial improvement of impaired metabolism, while others, on the contrary, further inhibit the processes of energy production in the myocardium. In our research paper we will discuss some capabilities of metabolic therapy of CHF and prospects in the treatment and prevention using hawthorn extract; analyze the features of interaction of some well-known cardioprotective drugs with long-term antiplatelet therapy in the postinfarction period. Initiation of therapy with a new drug in addition to clopidogrel, such as trimetazidine, may adversely affect antiplatelet activity of clopidogrel (TRACER study, 2019). As a compromise, some herbal cardioprotective drugs may be used. Hawthorn preparations containing vaso- and cardioactive substances have significant potential in the treatment of cardiovascular diseases. Diversified mechanism of action of hawthorn has a significant impact on various parts of the cardiovascular system. Clinical trials of more than 4,000 patients confirm that standardized hawthorn extracts are effective as adjunctive therapy in the treatment of NYHA stage I–III CHF. The main two-year results of the WISO cohort study showed that the three pivotal symptoms of heart failure — fatigue (p = 0.036), stress dyspnea (p = 0.020) and palpitations (p = 0.048) — were significantly less marked after treatment in the hawthorn group versus comparative group. Cochrane analysis (2009) of studies investigating hawthorn extract included 14 studies where hawthorn was used primarily as an adjunct to conventional treatment. Exercise tolerance increased significantly during the treatment with hawthorn extract. Thus, the weighted difference between the average double multiplication rates during cardiac stress test (CST) was 122.76 W/min, whereas end-diastolic pressure in the right ventricle and myocardial oxygen consumption decreased with hawthorn treatment (a weighted mean difference was 19.22 mmHg per 1 min). The reported side effects were infrequent, mild and transient. A special hawthorn extract is indicated for the treatment of patients with NYHA stage II heart failure as an alternative and supplement to the standard evidence-based drug therapy. The beneficial effect on clinical symptoms allowed patients in the Crataegus group to reduce the use of angiotensin-converting enzyme (ACE) inhibitors from 54 to 36% (p = 0.004), cardiac glycosides from 37 to 18% (p = 0.001), diuretics from 61 to 49% (p = 0.061), beta-blockers from 33 to 22% (p = 0.052). At the same time, SPICE and HERB CHF studies show greater efficacy of Crataegus preparations in the treatment of mild to moderate heart failure (NYHA stage I–II). Higher doses (1800 mg) may be required for critically ill patients in order to achieve sustained improvement. Analysis of the data available to date is promising but suggests the need for a more focused approach to dosing based on the disease severity.

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TRimetazidine as an Agent to affeCt clopidogrEl Response: The TRACER Study

Cited by 4 publications

References 50 publications

The Effect of Empagliflozin on Platelet Function Profiles in Patients with Stable Coronary Artery Disease in Trinidad: The EFFECT Pilot Study

The Effect of Empagliflozin on Platelet Function Profiles in Patients with Stable Coronary Artery Disease in Trinidad: The EFFECT Pilot Study

The Effect of Low-Dose Ticagrelor on Platelet Function Profiles in Patients With Stable Coronary Artery Disease in Trinidad: The TWIST Pilot Study

Capabilities of Cardioprotective Therapy in the Treatment and Prevention of Heart Failure in the Postinfarction Period

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