title: Ticagrelor vs prasugrel one-month maintenance therapy: impact on platelet reactivity and bleeding events.
abstract: Platelet reactivity (PR) and bleeding events following therapy with ticagrelor vs prasugrel have not been adequately studied. We aimed to compare PR and bleeding events in patients with acute coronary syndrome (ACS) undergoing percutaneous coronary intervention (PCI) while on ticagrelor vs prasugrel for one month. Consecutive patients who were discharged either on ticagrelor 90 mg bid maintenance dose (MD) or prasugrel 10 mg MD were invited for PR assessment (VerifyNow, in PRU) at one month. High PR (HPR) was defined as >208 PRU. Bleeding events [Bleeding Academic Research Consortium (BARC) classification] were monitored. Out of 937 screened patients, 512 were analysed, 278 under ticagrelor MD and 234 under prasugrel MD. PR at 30 days (C-statistic of the propensity score model 0.63, 0.58-0.67 95% CI, p<0.001) was lower when on ticagrelor compared with prasugrel (33.3, 95% CI 29.3-37.3 vs 84.6, 95% CI 73.6-95.6, p<0.001). In the analysed population more BARC type 1 bleeding events were observed with ticagrelor compared to prasugrel (36.7% vs 28.2%, p=0.047). In 221 propensity score matched pairs, BARC type 1 bleeding rate was marginally higher in ticagrelor vs prasugrel treated patients (35.7% vs 27.1%, p=0.05). BARC type ≥2 events did not differ between groups 5 (2.3%) vs 5 (2.3%). HPR rate was higher for prasugrel-treated patients (5.4% vs 0%, p<0.001). In conclusion, in patients with ACS undergoing PCI, ticagrelor MD produces a significantly higher platelet inhibition compared to prasugrel MD. This pharmacodynamic difference might be associated with more nuisance bleeding events with ticagrelor use.
authors.affiliation: Dimitrios Alexopoulos, MD, FACC, FESC, Cardiology Department, Patras University Hospital, Rion 26500, Patras, Greece, Tel/Fax: +30 2610992941, E-mail: dalex@med.upatras.gr.
authors.forename: D
authors.initials: D
authors.lastname: Alexopoulos
authors.forename: K
authors.initials: K
authors.lastname: Stavrou
authors.forename: I
authors.initials: I
authors.lastname: Koniari
authors.forename: V
authors.initials: V
authors.lastname: Gkizas
authors.forename: A
authors.initials: A
authors.lastname: Perperis
authors.forename: K
authors.initials: K
authors.lastname: Kontoprias
authors.forename: C
authors.initials: C
authors.lastname: Vogiatzi
authors.forename: T
authors.initials: T
authors.lastname: Bampouri
authors.forename: I
authors.initials: I
authors.lastname: Xanthopoulou
mesh_terms: D054058:Acute Coronary Syndrome / Q000601:surgery*; D000241:Adenosine / Q000008:administration & dosage / Q000009:adverse effects / Q000031:analogs & derivatives*; D000368:Aged; D005260:Female; D006470:Hemorrhage / Q000139:chemically induced* / Q000188:drug therapy / Q000517:prevention & control; D006801:Humans; D060046:Maintenance Chemotherapy; D008297:Male; D008875:Middle Aged; D062645:Percutaneous Coronary Intervention / Q000009:adverse effects; D010879:Piperazines / Q000008:administration & dosage / Q000009:adverse effects*; D015539:Platelet Activation / Q000187:drug effects; D010975:Platelet Aggregation Inhibitors / Q000008:administration & dosage / Q000009:adverse effects*; D010979:Platelet Function Tests; D000068799:Prasugrel Hydrochloride; D013876:Thiophenes / Q000008:administration & dosage / Q000009:adverse effects*; D000077486:Ticagrelor; D016896:Treatment Outcome
chemical_list: D010879:Piperazines; D010975:Platelet Aggregation Inhibitors; D013876:Thiophenes; D000068799:Prasugrel Hydrochloride; D000077486:Ticagrelor; D000241:Adenosine
keywords: Ticagrelor; percutaneous coronary intervention; platelet aggregation; prasugrel