title: Comparison of platelet inhibition by prasugrel versus ticagrelor over time in patients with acute myocardial infarction.
abstract: High on-treatment platelet reactivity (HTPR) despite use of P2Y12 antagonists is associated with adverse cardiac events. The long-term variability in response to prasugrel and ticagrelor is unclear. Our aim was to assess residual platelet reactivity (PR) and rates of HTPR during treatment with prasugrel versus ticagrelor in patients with myocardial infarction (MI). 114 patients with MI treated with percutaneous coronary intervention (PCI) were included. Sixty-two patients were treated with prasugrel (mean age 58 ± 8 years, 21 % women, 29 % diabetes), and 52 patients with ticagrelor (mean age 63 ± 9, 19 % women, 37 % diabetes). Patients were tested for PR at 2-4 days and 30 days post-PCI, using the VerifyNow P2Y12 assay and the multiple-electrode aggregometry. Our results show a higher residual PR in patients treated with prasugrel than those treated with ticagrelor (VerifyNow: 65.4 ± 60.6 vs. 26.0 ± 24.2 P2Y12 reaction units, p < 0.001 at 2-4 days, and 67.3 ± 62.5 vs. 21.1 ± 26.1, p < 0.001 at follow-up). HTPR rates were higher in the prasugrel group (8.1-11.3 % vs. none with ticagrelor in the early test, and 8.7-10.9 % vs. none with ticagrelor at follow-up). In conclusion, in patients with MI undergoing PCI, treatment with ticagrelor resulted in greater platelet inhibition and lower HTPR rates compared with prasugrel, up to 30 days after the event.
authors.affiliation: Department of Cardiology, Rabin Medical Center, Jabotinski st. 39, 49100, Petah Tiqwa, Israel.
authors.forename: Leor
authors.initials: L
authors.lastname: Perl
authors.forename: Noa
authors.initials: N
authors.lastname: Zemer-Wassercug
authors.forename: Eldad
authors.initials: E
authors.lastname: Rechavia
authors.forename: Muthiah
authors.initials: M
authors.lastname: Vaduganathan
authors.forename: Katia
authors.initials: K
authors.lastname: Orvin
authors.forename: Adaya
authors.initials: A
authors.lastname: Weissler-Snir
authors.forename: Hila
authors.initials: H
authors.lastname: Lerman-Shivek
authors.forename: Ran
authors.initials: R
authors.lastname: Kornowski
authors.forename: Eli I
authors.initials: EI
authors.lastname: Lev
mesh_terms: D000241:Adenosine / Q000008:administration & dosage / Q000031:analogs & derivatives*; D000293:Adolescent; D000328:Adult; D000368:Aged; D001792:Blood Platelets / Q000378:metabolism*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000097:blood / Q000188:drug therapy*; D010879:Piperazines / Q000008:administration & dosage*; D015539:Platelet Activation / Q000187:drug effects*; D010979:Platelet Function Tests; D000068799:Prasugrel Hydrochloride; D058921:Purinergic P2Y Receptor Antagonists / Q000008:administration & dosage*; D013876:Thiophenes / Q000008:administration & dosage*; D000077486:Ticagrelor; D013997:Time Factors
chemical_list: D010879:Piperazines; D058921:Purinergic P2Y Receptor Antagonists; D013876:Thiophenes; D000068799:Prasugrel Hydrochloride; D000077486:Ticagrelor; D000241:Adenosine
references.citation: J Am Coll Cardiol. 2014 Feb 18;63(6):513-7
references.pmid: 24148715
references.citation: N Engl J Med. 2009 Sep 10;361(11):1045-57
references.pmid: 19717846
references.citation: JAMA. 2011 Sep 21;306(11):1215-23
references.pmid: 21934054
references.citation: J Am Coll Cardiol. 2010 Sep 14;56(12):919-33
references.pmid: 20828644
references.citation: N Engl J Med. 2012 Nov 29;367(22):2100-9
references.pmid: 23121439
references.citation: Eur Heart J. 2009 Jul;30(14):1744-52
references.pmid: 19429918
references.citation: N Engl J Med. 2007 Nov 15;357(20):2001-15
references.pmid: 17982182
references.citation: J Am Coll Cardiol. 2011 Nov 1;58(19):1945-54
references.pmid: 22032704
references.citation: Circulation. 2011 Sep 6;124(10):1132-7
references.pmid: 21875913
references.citation: J Am Coll Cardiol. 2012 Jul 17;60(3):193-9
references.pmid: 22789884
references.citation: Thromb Haemost. 2013 Jul;110(1):131-40
references.pmid: 23615745
references.citation: Circ Cardiovasc Interv. 2012 Dec;5(6):797-804
references.pmid: 23169985
references.citation: J Thromb Haemost. 2007 Dec;5(12):2429-36
references.pmid: 17900275
references.citation: Circ Cardiovasc Genet. 2010 Dec;3(6):556-66
references.pmid: 21079055
references.citation: Arterioscler Thromb Vasc Biol. 2011 Dec;31(12):2957-64
references.pmid: 21921262
references.citation: J Cardiovasc Transl Res. 2014 Feb;7(1):91-100
references.pmid: 24371012
references.citation: Am J Clin Pathol. 1992 Dec;98(6):637-46
references.pmid: 1281383
references.citation: Am J Cardiol. 2013 Jul 15;112(2):212-6
references.pmid: 23566542
references.citation: J Thromb Haemost. 2010 Feb;8(2):250-6
references.pmid: 19943882
references.citation: JACC Cardiovasc Interv. 2012 Dec;5(12):1280-7
references.pmid: 23257377
references.citation: Am J Cardiol. 2011 Nov 15;108(10):1411-6
references.pmid: 21872198
references.citation: PLoS One. 2010 Oct 14;5(10):e13404
references.pmid: 20976234
references.citation: Lancet. 2010 Oct 16;376(9749):1320-8
references.pmid: 20801498
references.citation: J Am Coll Cardiol. 2013 Apr 16;61(15):1601-6
references.pmid: 23500251
references.citation: Eur Heart J. 2012 May;33(10):1241-9
references.pmid: 22067090
references.citation: Thromb Haemost. 2014 Feb;111(2):273-8
references.pmid: 24154787
references.citation: Eur Heart J. 2006 May;27(10):1166-73
references.pmid: 16621870
references.citation: Thromb Haemost. 2008 Feb;99(2):409-15
references.pmid: 18278193
references.citation: Thromb Haemost. 2010 Apr;103(4):841-8
references.pmid: 20135063
references.citation: J Am Coll Cardiol. 2011 Jul 26;58(5):467-73
references.pmid: 21777742
references.citation: J Am Coll Cardiol. 2013 Dec 17;62(24):2261-73
references.pmid: 24076493
references.citation: Platelets. 2012;23(4):290-8
references.pmid: 21942752