Randomized Assessment of Ticagrelor Versus Prasugrel Antiplatelet Effects in Patients with ST-Segment–Elevation Myocardial Infarction

• DOI: 10.1161/circinterventions.112.972323
• Publication Date: 2012-11-21T07:02:13Z
• Authors: Dimitrios Alexopo...; Ioanna Xanthopoulou; Vassilios Gkizas; George Kassimis; Konstantinos C. T...; George Makris; Nikolaos Koutsogi...; Anastasia Damelou; Grigorios Tsigkas; Periklis Davlouros; George Hahalis
• Keywords: Blood Platelets; Male; Adenosine; Greece; Platelet Aggregation; Platelet Function Tests; Myocardial Infarction; Middle Aged; Drug Administration Schedule; Piperazines; 3. Good health; 03 medical and health sciences; Percutaneous Coronary Intervention; 0302 clinical medicine; Linear Models; Purinergic P2Y Receptor Antagonists; Humans; Female; Prospective Studies; Least-Squares Analysis; Prasugrel Hydrochloride; Platelet Aggregation Inhibitors; Aged

Background— Ticagrelor and prasugrel provide stronger platelet inhibition compared with clopidogrel. Direct pharmacodynamic comparison between them has not yet been reported in ST-segment–elevation myocardial infarction patients. Methods Results— In a prospective, single-center, single-blind study, 55 out of 117 (47%) screened consecutive patients undergoing primary percutaneous coronary intervention were randomized to either ticagrelor 180 mg loading followed by 90 bid, or 60 10 od for 5 days. Platelet reactivity (PR) was assessed the VerifyNow P2Y12 function assay Multiplate Analyzer at 0, 1, 2, 6, 24 hours, days postrandomization. The end point, PR hour did differ significantly versus (257.3 reaction unit [PRU], 95% CI 230.8–283.8 231.3 PRU, 205.3–257.4; P =0.2). although day it lower than (25.6 12.3–38.9 50.3 36.4–64.1; =0.01). At high on-treatment rates (cutoff 208 PRU) 46.2% 34.6% prasugrel, respectively, decreased thereafter, whereas 2 agents all time points study. Conclusions— intervention, both exhibit an initial delay onset their antiplatelet action. appear superior reducing during first hours infarction. Clinical Trial Registration— URL: http://www.clinicaltrials.gov . Unique identifier: NCT01463163.