title: Platelet reactivity in patients receiving a maintenance dose of P2Y12-ADP receptor antagonists undergoing elective percutaneous coronary intervention.
abstract: BACKGROUND
  P2Y12-ADP receptor blockade during percutaneous coronary intervention (PCI) is critical to prevent thrombotic events. In patients under chronic P2Y12 blockers, the use of additional loading dose (LD) before an elective PCI is debated. We aimed to investigate the rate of high on-treatment platelet reactivity (HTPR) in patients undergoing elective PCI during chronic clopidogrel or ticagrelor therapy.
  
  
  RESULTS
  We performed a sub-group analysis of a randomized trial comparing ticagrelor and clopidogrel in acute coronary syndrome (ACS) patients undergoing PCI. Multi-vessel disease patients requiring a staged PCI one month after the ACS were included. The VASP (vasodilatatory phosphoprotein) index, which is a specific and reproducible platelet assay to measure P2Y12-ADP receptor activity, was used to assess the biological efficacy of the maintenance dose (MD) of ticagrelor and clopidogrel before PCI. Forty-one patients in each group of randomization required a staged PCI. They were similar regarding the baseline demographic, clinical and angiographic characteristics. The mean VASP index in the ticagrelor group was 20.7±8.8% compared to 51.8±17% in the clopidogrel group (p<0.001) before PCI. No patients had a VASP index ≥50% in the ticagrelor group compared to 56% in the clopidogrel group (p<0.001). Following PCI the rate of peri-procedural MI was higher in the clopidogrel group (p=0.02).
  
  
  CONCLUSIONS
  Unlike clopidogrel MD, ticagrelor MD achieves an optimal PR inhibition in all patients during a staged PCI.
authors.affiliation: Département de Cardiologie, Hôpital Universitaire Nord de Marseille, Assistance-Publique Hôpitaux de Marseille, Marseille, France; Vascular Research Center of Marseille, INSERM UMR-S 1076, Aix-Marseille Université, Marseille, France; MARS Cardio, Mediterranean Academic association for Research and Studies in Cardiology, Marseille, France. Electronic address: laurentbonello@yahoo.fr.
authors.forename: Laurent
authors.initials: L
authors.lastname: Bonello
authors.affiliation: Département de Cardiologie, Hôpital Universitaire Nord de Marseille, Assistance-Publique Hôpitaux de Marseille, Marseille, France; MARS Cardio, Mediterranean Academic association for Research and Studies in Cardiology, Marseille, France.
authors.forename: Marc
authors.initials: M
authors.lastname: Laine
authors.affiliation: Département de Cardiologie, Hôpital Universitaire Nord de Marseille, Assistance-Publique Hôpitaux de Marseille, Marseille, France; Vascular Research Center of Marseille, INSERM UMR-S 1076, Aix-Marseille Université, Marseille, France; MARS Cardio, Mediterranean Academic association for Research and Studies in Cardiology, Marseille, France.
authors.forename: Franck
authors.initials: F
authors.lastname: Thuny
authors.affiliation: Département de Cardiologie, Hôpital Universitaire Nord de Marseille, Assistance-Publique Hôpitaux de Marseille, Marseille, France; Vascular Research Center of Marseille, INSERM UMR-S 1076, Aix-Marseille Université, Marseille, France.
authors.forename: Franck
authors.initials: F
authors.lastname: Paganelli
authors.affiliation: MARS Cardio, Mediterranean Academic association for Research and Studies in Cardiology, Marseille, France; Département de Cardiologie, Hôpital Universitaire de Lilles, Lilles, France.
authors.forename: Gilles
authors.initials: G
authors.lastname: Lemesle
authors.affiliation: MARS Cardio, Mediterranean Academic association for Research and Studies in Cardiology, Marseille, France; Service d'accueil des Urgences, Assistance Publique-Hôpitaux de Marseille, Nord, Marseille, France.
authors.forename: Antoine
authors.initials: A
authors.lastname: Roch
authors.affiliation: MARS Cardio, Mediterranean Academic association for Research and Studies in Cardiology, Marseille, France; UMR MD2, Aix-Marseille Université, Marseille, France; Pole RUSH, Assistance Publique-Hôpitaux de Marseille, Marseille, France.
authors.forename: François
authors.initials: F
authors.lastname: Kerbaul
authors.affiliation: Vascular Research Center of Marseille, INSERM UMR-S 1076, Aix-Marseille Université, Marseille, France.
authors.forename: Françoise
authors.initials: F
authors.lastname: Dignat-George
authors.affiliation: Department of Biostatistics, Aix-Marseille Université, Marseille, France.
authors.forename: Julie
authors.initials: J
authors.lastname: Berbis
authors.affiliation: Vascular Research Center of Marseille, INSERM UMR-S 1076, Aix-Marseille Université, Marseille, France; MARS Cardio, Mediterranean Academic association for Research and Studies in Cardiology, Marseille, France.
authors.forename: Corinne
authors.initials: C
authors.lastname: Frere
mesh_terms: D054058:Acute Coronary Syndrome / Q000188:drug therapy* / Q000601:surgery; D000241:Adenosine / Q000008:administration & dosage / Q000031:analogs & derivatives / Q000494:pharmacology; D000368:Aged; D000077144:Clopidogrel; D017558:Elective Surgical Procedures / Q000379:methods; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D062645:Percutaneous Coronary Intervention / Q000379:methods*; D010865:Pilot Projects; D015539:Platelet Activation / Q000187:drug effects*; D010979:Platelet Function Tests; D058921:Purinergic P2Y Receptor Antagonists / Q000008:administration & dosage* / Q000494:pharmacology; D016032:Randomized Controlled Trials as Topic; D000077486:Ticagrelor; D013988:Ticlopidine / Q000008:administration & dosage / Q000031:analogs & derivatives / Q000494:pharmacology; D016896:Treatment Outcome
chemical_list: D058921:Purinergic P2Y Receptor Antagonists; D000077144:Clopidogrel; D000077486:Ticagrelor; D000241:Adenosine; D013988:Ticlopidine
keywords: High on-treatment platelet reactivity; Loading dose; Myocardial infarction; P2Y12-ADP receptor; Percutaneous coronary intervention