title: P2Y12receptor inhibition with prasugrel and ticagrelor in STEMI patients after fibrinolytic therapy: Analysis from the SAMPA randomized trial.
abstract: BACKGROUND
  A pharmacodynamic comparison between ticagrelor and prasugrel after fibrinolytic therapy has not yet been performed.
  
  
  METHODS
  In the single-center SAMPA trial, 50 consecutive STEMI patients previously treated with clopidogrel and undergoing a pharmacoinvasive strategy were randomized to either a ticagrelor (n=25) 180mg loading dose followed by 90mg bid, or a prasugrel (n=25) 60mg loading dose followed by 10mg/day, initiated after fibrinolytic therapy but before angiography. Platelet reactivity was assessed with the VerifyNow P2Y12assay at 0, 2, 6, and 24h after randomization.
  
  
  RESULTS
  Mean times from fibrinolysis to prasugrel or ticagrelor administration were 11.1±6.9 and 13.3±6.3h, respectively (p=0.24). The values of PRU decreased significantly from baseline to 2h (all p<0.001) and from 2h to 6h (all p<0.001) in both groups. There was no difference in PRU values between 6h and 24h. The mean PRU values at 0, 2, 6, and 24h were 234.9, 127.8, 45.4, and 48.0 in the prasugrel group and 233.1, 135.1, 67.7, and 56.9 in the ticagrelor group, respectively. PRU values did not significantly differ between groups at any time period of the study.
  
  
  CONCLUSIONS
  In patients with STEMI treated with fibrinolytic therapy, platelet inhibition after clopidogrel is suboptimal and can be further increased with more potent agents. Ticagrelor and prasugrel demonstrated a similar extent of P2Y12receptor inhibition within 24h, although maximal platelet inhibition after these potent agents was not achieved for 6h.
authors.affiliation: Escola Paulista de Medicina, Universidade Federal de São Paulo, São Paulo, Brazil.
authors.forename: Leonardo de F C
authors.initials: LF
authors.lastname: Guimarães
authors.affiliation: Clinical Trials Center, Cardiovascular Research Foundation, New York, New York, United States; New York-Presbyterian Hospital/Columbia University Medical Center, New York, New York, United States; Hôpital du Sacré-Coeur de Montréal, Université de Montréal, Montréal, Quebec, Canada; Morristown Medical Center, Morristown, New Jersey, United States.
authors.forename: Philippe
authors.initials: P
authors.lastname: Généreux
authors.affiliation: Escola Paulista de Medicina, Universidade Federal de São Paulo, São Paulo, Brazil.
authors.forename: Diego
authors.initials: D
authors.lastname: Silveira
authors.affiliation: Hospital Israelita Albert Einstein, São Paulo, Brazil.
authors.forename: Antonio Eduardo
authors.initials: AE
authors.lastname: Pesaro
authors.affiliation: Escola Paulista de Medicina, Universidade Federal de São Paulo, São Paulo, Brazil.
authors.forename: Felipe
authors.initials: F
authors.lastname: Falcão
authors.affiliation: Escola Paulista de Medicina, Universidade Federal de São Paulo, São Paulo, Brazil.
authors.forename: Bruno Robalinho C
authors.initials: BR
authors.lastname: Barbosa
authors.affiliation: Escola Paulista de Medicina, Universidade Federal de São Paulo, São Paulo, Brazil.
authors.forename: Cristiano Freitas
authors.initials: CF
authors.lastname: de Souza
authors.affiliation: Escola Paulista de Medicina, Universidade Federal de São Paulo, São Paulo, Brazil.
authors.forename: Francisco A H
authors.initials: FA
authors.lastname: Fonseca
authors.affiliation: Escola Paulista de Medicina, Universidade Federal de São Paulo, São Paulo, Brazil.
authors.forename: Cláudia Maria Rodrigues
authors.initials: CM
authors.lastname: Alves
authors.affiliation: Escola Paulista de Medicina, Universidade Federal de São Paulo, São Paulo, Brazil.
authors.forename: Antônio Carlos de Camargo
authors.initials: AC
authors.lastname: Carvalho
authors.affiliation: Clinical Trials Center, Cardiovascular Research Foundation, New York, New York, United States; New York-Presbyterian Hospital/Columbia University Medical Center, New York, New York, United States.
authors.forename: Gregg W
authors.initials: GW
authors.lastname: Stone
authors.affiliation: Escola Paulista de Medicina, Universidade Federal de São Paulo, São Paulo, Brazil; Hospital Israelita Albert Einstein, São Paulo, Brazil. Electronic address: adriano.caixeta@einstein.br.
authors.forename: Adriano
authors.initials: A
authors.lastname: Caixeta
mesh_terms: D000241:Adenosine / Q000008:administration & dosage / Q000031:analogs & derivatives*; D017023:Coronary Angiography; D004305:Dose-Response Relationship, Drug; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D010975:Platelet Aggregation Inhibitors / Q000008:administration & dosage; D000068799:Prasugrel Hydrochloride / Q000008:administration & dosage*; D011446:Prospective Studies; D058921:Purinergic P2Y Receptor Antagonists / Q000008:administration & dosage; D000072657:ST Elevation Myocardial Infarction / Q000175:diagnosis / Q000188:drug therapy*; D015912:Thrombolytic Therapy / Q000379:methods*; D000077486:Ticagrelor; D013997:Time Factors; D016896:Treatment Outcome
chemical_list: D010975:Platelet Aggregation Inhibitors; D058921:Purinergic P2Y Receptor Antagonists; D000068799:Prasugrel Hydrochloride; D000077486:Ticagrelor; D000241:Adenosine
keywords: Acute myocardial infarction; Fibrinolysis; Prasugrel; Ticagrelor