Chewed ticagrelor tablets provide faster platelet inhibition compared to integral tablets: The inhibition of platelet aggregation after administration of three different ticagrelor formulations (IPAAD-Tica) study, a randomised controlled trial. Issue 149 (January 2017)

• Record Type: Journal Article
• Authors: Venetsanos, Dimitrios; Sederholm Lawesson, Sofia; Swahn, Eva; Alfredsson, Joakim
• Is Part Of: Thrombosis research. Issue 149(2017)
• Page Start: 88
• Page End: 94
• Publication Date: 2017-01
• Subjects: Pharmacodynamic -- Chewed -- Crushed -- VerifyNow -- Platelet -- Aggregation; Thrombosis -- Periodicals; 616.135
• DOI: 10.1016/j.thromres.2016.10.013
• Languages: English
• ISSNs: 0049-3848

Abstract

Abstract: Aims: To provide pharmacodynamic data of crushed and chewed ticagrelor tablets, in comparison with standard integral tablets. Methods: Ninety nine patients with stable angina were randomly assigned, in a 3:1:1 fashion, to one of the following 180 mg ticagrelor loading dose (LD) formulations: A) Integral B) Crushed or C) Chewed tablets. Platelet reactivity (PR) was assessed with VerifyNow before, 20 and 60 min after LD. High residual platelet reactivity (HRPR) was defined as > 208 P2Y12 reaction units (PRU). Results: There was no significant difference in PRU values at baseline. PRU 20 min after LD were 237 (182–295), 112 (53–238) and 84 (29–129) and 60 min after LD, 56 (15–150), 51 (18–85) and 9 (7–34) in integral, crushed and chewed ticagrelor LD, respectively (p < 0.01 for both). Chewed ticagrelor tablets resulted in significantly lower PRU values compared to crushed or integral tablets at 20 and 60 min. Crushed ticagrelor LD resulted in significantly lower PRU values compared to integral tablets at 20 min whereas no difference was observed at 60 min. At 20 min, no patients had HRPR with chewed ticagrelor compared to 68% with integral and 30% with crushed ticagrelor LD (p < 0.01). Conclusion: With crushed or chewed ticagrelor tablets a more rapid platelet inhibition may be achieved, compared to standard integral tablets. We also show that administration of chewed tablets is feasible and provides faster inhibition than either crushed or integral tablets. CLINICAL TRIAL REGISTRATION: European Clinical Trial Database (EudraCT number 2014-002227-96). Highlights: Insufficient platelet inhibition during PCI increases the risk of periprocudural and early ischemic complications. Chewed or crushed ticagrelor administration improves the pharmacodynamic properties of orally administrated ticagrelor. Chewed ticagrelor as a loading dose is feasible and may provide a faster platelet inhibition compared to crushed ticagrelor tablets. The clinical efficacy and safety of chewed ticagrelor loading dose should be tested in large-scale clinical trials.