title: Ticagrelor versus prasugrel in diabetic patients with an acute coronary syndrome. A pharmacodynamic randomised study.
abstract: Optimal P2Y12 receptor blockade is critical to prevent ischaemic recurrence in patients undergoing percutaneous coronary intervention (PCI). We aimed to compare the level of platelet reactivity (PR) inhibition achieved by prasugrel and ticagrelor loading dose (LD) in diabetic acute coronary syndrome (ACS) patients undergoing PCI. We performed a single-center prospective open-label randomised trial. Patients with diabetes mellitus undergoing PCI for an ACS were randomised to receive prasugrel 60 mg or ticagrelor 180 mg. The primary endpoint of the study was the level of platelet reactivity (PR) assessed between 6 and 18 hours post-LD using the VASP index. We randomised 100 diabetic patients undergoing PCI for an ACS. No difference was observed in baseline characteristics between the two groups. In particular, the rate of patient receiving insulin therapy was identical (25 vs 28.6%; p =0.7). Ticagrelor achieved a significantly lower PR compared to prasugrel loading dose (17.3 ± 14.2 vs 27.7 ± 23.3%; p=0.009). In addition the rate of high on-treatment platelet reactivity, defined by a VASP ≥50%, tend to be lower in the ticagrelor group although the difference did not reach statistical significance (6 vs 16%; p=0.2). The rate of low on treatment PR was identical (60 vs 54%; p=0.8). The present study demonstrates that ticagrelor LD is superior to prasugrel LD to reduce PR in ACS patients with diabetes mellitus. Whether the higher potency of ticagrelor could translate into a clinical benefit should be investigated.
authors.forename: Marc
authors.initials: M
authors.lastname: Laine
authors.forename: Corinne
authors.initials: C
authors.lastname: Frère
authors.forename: Richard
authors.initials: R
authors.lastname: Toesca
authors.forename: Julie
authors.initials: J
authors.lastname: Berbis
authors.forename: Pierre
authors.initials: P
authors.lastname: Barnay
authors.forename: Michel
authors.initials: M
authors.lastname: Pansieri
authors.forename: Pierre
authors.initials: P
authors.lastname: Michelet
authors.forename: Jacques
authors.initials: J
authors.lastname: Bessereau
authors.forename: Elise
authors.initials: E
authors.lastname: Camilleri
authors.forename: Olivia
authors.initials: O
authors.lastname: Ronsin
authors.forename: Olfa
authors.initials: O
authors.lastname: Helal
authors.forename: Franck
authors.initials: F
authors.lastname: Paganelli
authors.forename: Françoise
authors.initials: F
authors.lastname: Dignat-George
authors.affiliation: Laurent Bonello, MD, PhD, Department of cardiology, Hôpital universitaire nord, Chemin des bourrely, 13015 Marseille, France, Tel.: +33 491 968 858, Fax: +33 491 968 979, E-mail: laurentbonello@yahoo.fr.
authors.forename: Laurent
authors.initials: L
authors.lastname: Bonello
mesh_terms: D054058:Acute Coronary Syndrome / Q000097:blood / Q000175:diagnosis / Q000628:therapy*; D000241:Adenosine / Q000031:analogs & derivatives* / Q000627:therapeutic use; D000368:Aged; D015415:Biomarkers / Q000097:blood; D001792:Blood Platelets / Q000187:drug effects* / Q000378:metabolism; D015815:Cell Adhesion Molecules / Q000097:blood; D003920:Diabetes Mellitus / Q000097:blood* / Q000188:drug therapy; D005260:Female; D005602:France; D006801:Humans; D007004:Hypoglycemic Agents / Q000627:therapeutic use; D007328:Insulin / Q000627:therapeutic use; D008297:Male; D008840:Microfilament Proteins / Q000097:blood; D008875:Middle Aged; D062645:Percutaneous Coronary Intervention / Q000009:adverse effects; D010750:Phosphoproteins / Q000097:blood; D010865:Pilot Projects; D010879:Piperazines / Q000627:therapeutic use*; D010979:Platelet Function Tests; D000068799:Prasugrel Hydrochloride; D011446:Prospective Studies; D058925:Receptors, Purinergic P2Y12 / Q000097:blood / Q000187:drug effects; D013876:Thiophenes / Q000627:therapeutic use*; D000077486:Ticagrelor; D013997:Time Factors; D016896:Treatment Outcome; D000098662:Vasodilator-Stimulated Phosphoprotein
chemical_list: D015415:Biomarkers; D015815:Cell Adhesion Molecules; D007004:Hypoglycemic Agents; D007328:Insulin; D008840:Microfilament Proteins; C548576:P2RY12 protein, human; D010750:Phosphoproteins; D010879:Piperazines; D058925:Receptors, Purinergic P2Y12; D013876:Thiophenes; D000098662:Vasodilator-Stimulated Phosphoprotein; D000068799:Prasugrel Hydrochloride; D000077486:Ticagrelor; D000241:Adenosine
keywords: P2Y12 receptor blockade; VASP index; acute coronary syndrome; diabetes mellitus; percutaneous coronary intervention