title: Diabetes mellitus and platelet reactivity in patients under prasugrel or ticagrelor treatment: an observational study.
abstract: BACKGROUND
  The influence of diabetes mellitus (DM) on platelet reactivity (PR) in prasugrel or ticagrelor treated patients is not well studied.
  
  
  METHODS
  In an observational study involving 777 patients with acute coronary syndrome undergoing percutaneous coronary intervention treated by either prasugrel 10 mg od (n = 315) or ticagrelor 90 mg bid (n = 462), platelet function was assessed using the VerifyNow P2Y12 function assay (in PRU) at one month post intrvention.
  
  
  RESULTS
  In the overall population, ticagrelor and insulin-treated DM affected PR, with a decrease in log by 0.88 (corresponding to a 58 % decrease in PR) compared to prasugrel-treated patients (p < 0.001), and an increase in log by 0.26 (corresponding to a 30 % increase in PR) compared to non-diabetic patients (p = 0.01), respectively. PR in prasugrel-treated patients differed significantly by DM status: 70.0 (36.3-113.0) in non-diabetic vs 69.0 (44.5-115.3) in non insulin-treated diabetic vs 122.0 (69.0-161.0) in insulin-treated diabetic patients, p for trend = 0.01. No differences were observed in ticagrelor-treated patients. By multivariate analysis, in prasugrel-treated patients insulin-treated DM was the only factor predicting PR, with log of PR increased by 0.42 (corresponding to a 52 % increase in PR) compared to non-diabetic patients (p = 0.001). No factor was found to affect PR in ticagrelor-treated patients.
  
  
  CONCLUSIONS
  Patients with insulin-treated DM treated with prasugrel post PCI have higher PR, than patients without DM or non insulin-treated diabetic patients treated with this drug. Ticagrelor treated patients have overall lower PR than patients on prasugrel, independent of DM status or insulin treatment.
  
  
  BACKGROUND
  Clinical Trials Gov. NCT01774955.
authors.affiliation: Department of Cardiology, Patras University Hospital, University of Patras, Rion, Patras, Greece. dalex@med.upatras.gr.
authors.forename: Dimitrios
authors.initials: D
authors.lastname: Alexopoulos
authors.affiliation: Department of Cardiology, Patras University Hospital, University of Patras, Rion, Patras, Greece. svog9090@gmail.com.
authors.forename: Chrysoula
authors.initials: C
authors.lastname: Vogiatzi
authors.affiliation: Department of Cardiology, Patras University Hospital, University of Patras, Rion, Patras, Greece. Katerinastavrou1811@yahoo.com.
authors.forename: Katerina
authors.initials: K
authors.lastname: Stavrou
authors.affiliation: Department of Cardiology, Patras University Hospital, University of Patras, Rion, Patras, Greece. nvlasopoulou@upatras.gr.
authors.forename: Niki
authors.initials: N
authors.lastname: Vlassopoulou
authors.affiliation: Department of Cardiology, Patras University Hospital, University of Patras, Rion, Patras, Greece. angelosperperis@msn.com.
authors.forename: Angelos
authors.initials: A
authors.lastname: Perperis
authors.affiliation: Department of Cardiology, Patras University Hospital, University of Patras, Rion, Patras, Greece. joanpen2@yahoo.gr.
authors.forename: Ioanna
authors.initials: I
authors.lastname: Pentara
authors.affiliation: Department of Cardiology, Patras University Hospital, University of Patras, Rion, Patras, Greece. jxanthop@yahoo.gr.
authors.forename: Ioanna
authors.initials: I
authors.lastname: Xanthopoulou
mesh_terms: D054058:Acute Coronary Syndrome / Q000150:complications / Q000628:therapy*; D000241:Adenosine / Q000031:analogs & derivatives* / Q000627:therapeutic use; D000368:Aged; D003430:Cross-Sectional Studies; D048909:Diabetes Complications; D003920:Diabetes Mellitus / Q000188:drug therapy*; D005260:Female; D006801:Humans; D007004:Hypoglycemic Agents / Q000627:therapeutic use*; D007328:Insulin / Q000627:therapeutic use*; D008297:Male; D008875:Middle Aged; D062645:Percutaneous Coronary Intervention / Q000379:methods*; D015539:Platelet Activation; D010975:Platelet Aggregation Inhibitors / Q000627:therapeutic use; D010979:Platelet Function Tests; D000068799:Prasugrel Hydrochloride / Q000627:therapeutic use*; D058921:Purinergic P2Y Receptor Antagonists / Q000627:therapeutic use*; D000077486:Ticagrelor; D016896:Treatment Outcome
chemical_list: D007004:Hypoglycemic Agents; D007328:Insulin; D010975:Platelet Aggregation Inhibitors; D058921:Purinergic P2Y Receptor Antagonists; D000068799:Prasugrel Hydrochloride; D000077486:Ticagrelor; D000241:Adenosine