title: Platelet effect of prasugrel and ticagrelor in patients with ST-segment elevation myocardial infarction.
abstract: BACKGROUND
  Recent studies have suggested that ticagrelor 90mg twice daily provides stronger platelet inhibition than prasugrel 10mg once daily in acute coronary syndrome patients undergoing percutaneous coronary intervention.
  
  
  OBJECTIVE
  To compare the effects of ticagrelor 90 mg twice daily and prasugrel 10mg once daily on platelet reactivity in patients with ST-segment elevation myocardial infarction (STEMI), using: the VerifyNow(®) P2Y12 (VN-P2Y12) assay, expressed in P2Y12 reaction units (PRU); measurement of the vasodilator-stimulated phosphoprotein platelet reactivity index (VASP-PRI; %); and light transmission aggregometry (LTA), expressed as residual platelet aggregation (RPA; %).
  
  
  METHODS
  Platelet reactivity was evaluated prospectively using the three assays 30 days after primary PCI in 118 patients with STEMI on a maintenance dose of prasugrel 10mg once daily (n=60) or ticagrelor 90mg twice daily (n=58).
  
  
  RESULTS
  On-treatment platelet reactivity, assessed by the VN-P2Y12 assay, was lower for ticagrelor compared with prasugrel (20.91 ± 4.59 PRU vs. 43.50±6.98 PRU; P=0.008) but was not significantly different when using the more specific VASP-PRI assay (13.05 ± 1.61% vs. 17.44 ± 1.97%; P=0.09) or RPA assessed by LTA (10.49 ± 1.44% vs. 7.20 ± 1.27%; P=0.09).
  
  
  CONCLUSIONS
  The difference in platelet reactivity between ticagrelor and prasugrel varies according to the platelet function test in patients with STEMI. The differences observed may be related more to the tests than to the drugs used.
authors.affiliation: ACTION Study Group, Institut de Cardiologie, INSERM UMRS-1166, Pitié-Salpêtrière Hospital, AP-HP, Université Paris 6, Paris, France.
authors.forename: Mathieu
authors.initials: M
authors.lastname: Kerneis
authors.affiliation: ACTION Study Group, Institut de Cardiologie, INSERM UMRS-1166, Pitié-Salpêtrière Hospital, AP-HP, Université Paris 6, Paris, France.
authors.forename: Johanne
authors.initials: J
authors.lastname: Silvain
authors.affiliation: ACTION Study Group, Institut de Cardiologie, INSERM UMRS-1166, Pitié-Salpêtrière Hospital, AP-HP, Université Paris 6, Paris, France.
authors.forename: Jérémie
authors.initials: J
authors.lastname: Abtan
authors.affiliation: ACTION Study Group, Institut de Cardiologie, INSERM UMRS-1166, Pitié-Salpêtrière Hospital, AP-HP, Université Paris 6, Paris, France.
authors.forename: Marie
authors.initials: M
authors.lastname: Hauguel
authors.affiliation: ACTION Study Group, Institut de Cardiologie, INSERM UMRS-1166, Pitié-Salpêtrière Hospital, AP-HP, Université Paris 6, Paris, France.
authors.forename: Olivier
authors.initials: O
authors.lastname: Barthélémy
authors.affiliation: ACTION Study Group, Institut de Cardiologie, INSERM UMRS-1166, Pitié-Salpêtrière Hospital, AP-HP, Université Paris 6, Paris, France.
authors.forename: Laurent
authors.initials: L
authors.lastname: Payot
authors.affiliation: ACTION Study Group, Institut de Cardiologie, INSERM UMRS-1166, Pitié-Salpêtrière Hospital, AP-HP, Université Paris 6, Paris, France.
authors.forename: Delphine
authors.initials: D
authors.lastname: Brugier
authors.affiliation: ACTION Study Group, Institut de Cardiologie, INSERM UMRS-1166, Pitié-Salpêtrière Hospital, AP-HP, Université Paris 6, Paris, France.
authors.forename: Sophie
authors.initials: S
authors.lastname: Galier
authors.affiliation: ACTION Study Group, Institut de Cardiologie, INSERM UMRS-1166, Pitié-Salpêtrière Hospital, AP-HP, Université Paris 6, Paris, France.
authors.forename: Jean-Philippe
authors.initials: JP
authors.lastname: Collet
authors.affiliation: ACTION Study Group, Institut de Cardiologie, INSERM UMRS-1166, Pitié-Salpêtrière Hospital, AP-HP, Université Paris 6, Paris, France. Electronic address: gilles.montalescot@psl.aphp.fr.
authors.forename: Gilles
authors.initials: G
authors.lastname: Montalescot
mesh_terms: D000241:Adenosine / Q000008:administration & dosage / Q000031:analogs & derivatives*; D001792:Blood Platelets / Q000187:drug effects* / Q000378:metabolism; D015815:Cell Adhesion Molecules / Q000097:blood; D004334:Drug Administration Schedule; D005260:Female; D006801:Humans; D008297:Male; D008840:Microfilament Proteins / Q000097:blood; D008875:Middle Aged; D009203:Myocardial Infarction / Q000097:blood / Q000175:diagnosis / Q000628:therapy*; D062645:Percutaneous Coronary Intervention / Q000009:adverse effects; D010750:Phosphoproteins / Q000097:blood; D010974:Platelet Aggregation / Q000187:drug effects; D010975:Platelet Aggregation Inhibitors / Q000008:administration & dosage*; D010979:Platelet Function Tests; D000068799:Prasugrel Hydrochloride / Q000008:administration & dosage*; D011237:Predictive Value of Tests; D011446:Prospective Studies; D058921:Purinergic P2Y Receptor Antagonists / Q000008:administration & dosage*; D058925:Receptors, Purinergic P2Y12 / Q000097:blood / Q000187:drug effects; D000077486:Ticagrelor; D013997:Time Factors; D016896:Treatment Outcome; D000098662:Vasodilator-Stimulated Phosphoprotein
chemical_list: D015815:Cell Adhesion Molecules; D008840:Microfilament Proteins; C548576:P2RY12 protein, human; D010750:Phosphoproteins; D010975:Platelet Aggregation Inhibitors; D058921:Purinergic P2Y Receptor Antagonists; D058925:Receptors, Purinergic P2Y12; D000098662:Vasodilator-Stimulated Phosphoprotein; D000068799:Prasugrel Hydrochloride; D000077486:Ticagrelor; D000241:Adenosine
keywords: Antagoniste du récepteur P2Y(12); P2Y(12) receptor antagonist; Platelet function testing; Prasugrel; SCA; STEMI; Tests de fonction plaquettaire; Ticagrelor