title: Chewed ticagrelor tablets provide faster platelet inhibition compared to integral tablets: The inhibition of platelet aggregation after administration of three different ticagrelor formulations (IPAAD-Tica) study, a randomised controlled trial.
abstract: OBJECTIVE
  To provide pharmacodynamic data of crushed and chewed ticagrelor tablets, in comparison with standard integral tablets.
  
  
  METHODS
  Ninety nine patients with stable angina were randomly assigned, in a 3:1:1 fashion, to one of the following 180mg ticagrelor loading dose (LD) formulations: A) Integral B) Crushed or C) Chewed tablets. Platelet reactivity (PR) was assessed with VerifyNow before, 20 and 60min after LD. High residual platelet reactivity (HRPR) was defined as >208 P2Y12 reaction units (PRU).
  
  
  RESULTS
  There was no significant difference in PRU values at baseline. PRU 20min after LD were 237 (182-295), 112 (53-238) and 84 (29-129) and 60min after LD, 56 (15-150), 51 (18-85) and 9 (7-34) in integral, crushed and chewed ticagrelor LD, respectively (p<0.01 for both). Chewed ticagrelor tablets resulted in significantly lower PRU values compared to crushed or integral tablets at 20 and 60min. Crushed ticagrelor LD resulted in significantly lower PRU values compared to integral tablets at 20min whereas no difference was observed at 60min. At 20min, no patients had HRPR with chewed ticagrelor compared to 68% with integral and 30% with crushed ticagrelor LD (p<0.01).
  
  
  CONCLUSIONS
  With crushed or chewed ticagrelor tablets a more rapid platelet inhibition may be achieved, compared to standard integral tablets. We also show that administration of chewed tablets is feasible and provides faster inhibition than either crushed or integral tablets.
  
  
  BACKGROUND
  European Clinical Trial Database (EudraCT number 2014-002227-96).
authors: Department of Cardiology, Department of Medical and Health Sciences, Linköping University, Linköping, Sweden. Electronic address: dimitrios.venetsanos@liu.se.
authors: Dimitrios
authors: D
authors: Venetsanos
authors: Department of Cardiology, Department of Medical and Health Sciences, Linköping University, Linköping, Sweden. Electronic address: sofia.lawesson@liu.se.
authors: Sofia
authors: S
authors: Sederholm Lawesson
authors: Department of Cardiology, Department of Medical and Health Sciences, Linköping University, Linköping, Sweden. Electronic address: eva.swahn@liu.se.
authors: Eva
authors: E
authors: Swahn
authors: Department of Cardiology, Department of Medical and Health Sciences, Linköping University, Linköping, Sweden. Electronic address: joakim.alfredsson@liu.se.
authors: Joakim
authors: J
authors: Alfredsson
mesh_terms: D000241:Adenosine / Q000008:administration & dosage / Q000031:analogs & derivatives* / Q000494:pharmacology / Q000627:therapeutic use; D001792:Blood Platelets / Q000187:drug effects; D006801:Humans; D008409:Mastication; D010974:Platelet Aggregation / Q000187:drug effects; D010975:Platelet Aggregation Inhibitors / Q000008:administration & dosage / Q000494:pharmacology / Q000627:therapeutic use*; D058921:Purinergic P2Y Receptor Antagonists / Q000008:administration & dosage / Q000494:pharmacology / Q000627:therapeutic use*; D013607:Tablets; D000077486:Ticagrelor; D013997:Time Factors
chemical_list: D010975:Platelet Aggregation Inhibitors; D058921:Purinergic P2Y Receptor Antagonists; D013607:Tablets; D000077486:Ticagrelor; D000241:Adenosine
keywords: Aggregation; Chewed; Crushed; Pharmacodynamic; Platelet; VerifyNow