High and low on-treatment platelet reactivity to P2Y12 inhibitors in a contemporary cohort of acute coronary syndrome patients undergoing percutaneous coronary intervention. Issue 175 (March 2019)

• Record Type: Journal Article
• Authors: Ferreiro, José Luis; Vivas, David; De La Hera, Jesús María; Marcano, Ana Lucrecia; Lugo, Leslie Marisol; Gómez-Polo, Juan Carlos; Silva, Iria; Tello-Montoliu, Antonio; Marín, Francisco; Roldán, Inmaculada
• Is Part Of: Thrombosis research. Issue 175(2019)
• Page Start: 95
• Page End: 101
• Publication Date: 2019-03
• Subjects: Antiplatelet therapy -- Acute coronary syndrome -- P2Y12 inhibitors -- Platelet function testing; Thrombosis -- Periodicals; 616.135
• DOI: 10.1016/j.thromres.2019.01.021
• Languages: English
• ISSNs: 0049-3848

Abstract

Abstract: Introduction: There is compelling evidence supporting the association between high on-treatment platelet reactivity (HPR) and low on-treatment platelet reactivity (LPR) to clopidogrel with atherothrombotic and bleeding events, respectively. However, it is uncertain if current cutoff values should be used in prasugrel- or ticagrelor-treated subjects. The objective of this analysis was to evaluate the pharmacodynamic (PD) efficacy of P2Y12 antagonists in a contemporary real-world population. Materials and methods: This PD study included 988 patients with acute coronary syndromes (ACS) undergoing percutaneous coronary intervention (PCI) and receiving dual therapy with aspirin and a P2Y12 inhibitor (clopidogrel, prasugrel or ticagrelor). Platelet function was assessed at day 1 and day 30 post-PCI by VerifyNow P2Y12 assay, multiple electrode aggregometry and vasodilator-stimulated phosphoprotein (VASP) assay. Results: Clopidogrel-treated patients ( n = 324) had greater platelet reactivity than those receiving ticagrelor ( n = 469) or prasugrel ( n = 195) at both time points ( p < 0.001 for all comparisons). No difference between ticagrelor and prasugrel was observed at day 1 with the VerifyNow P2Y12 assay (51.5 ± 2.8 vs. 42.7 ± 3.5 PRUs; p = 0.298), whereas ticagrelor achieved greater platelet inhibition at day 30 (48.1 ± 2.5 vs. 89.2 ± 4.2 PRUs; p < 0.001). Similar results were obtained with the VASP assay. Both prasugrel and ticagrelor had markedly lower HPR rates than clopidogrel and very high rates of LPR at both time points. Conclusions: Prasugrel and ticagrelor displayed more potent and consistent PD effects than clopidogrel in ACS patients undergoing PCI, with a trend towards greater platelet inhibition with ticagrelor during the maintenance phase of therapy compared to prasugrel. Highlights: Prasugrel and ticagrelor have more potent and consistent effects than clopidogrel. Greater platelet inhibition with ticagrelor compared to prasugrel at long term Platelet function assays: current thresholds in doubt for prasugrel or ticagrelor