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August 24, 2016CirculationOpen Access

At 1 week, P2Y12 reaction units were significantly lower with ticagrelor than with prasugrel (52 [32-72] versus 83 [63-103]; least-square means difference: -31; 95% CI, -57 to -4; P=0.022).

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Why the study?

Does ticagrelor improve platelet inhibition compared to prasugrel in aspirin-treated patients with type 2 diabetes mellitus and coronary artery disease?

Population

50 aspirin-treated patients with type 2 diabetes mellitus and coronary artery disease

Comparison

Ticagrelor for 1 week vs Prasugrel for 1 week

Design

RCT, randomly assigned (crossover), double-blind, double-dummy

Follow-up

1 week

Authors

FFFrancesco FranchiFRFabiana RolliniNANiti R. Aggarwal

Discussion

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Overview

Ticagrelor may yield greater platelet inhibition than prasugrel in T2DM-CAD; leaves open translation to clinical outcomes.

Key Points

  • To compare the acute and maintenance pharmacodynamic profiles of prasugrel versus ticagrelor in aspirin-treated patients with type 2 diabetes mellitus and coronary artery disease.
  • Prospective, randomized, double-blind, double-dummy, crossover pharmacodynamic trial (NCT01852214) enrolling 50 aspirin-treated diabetic patients with coronary artery disease.
  • Participants received prasugrel (60 mg loading dose, 10 mg daily maintenance) or ticagrelor (180 mg loading dose, 90 mg twice-daily maintenance) for 1 week.
  • Platelet reactivity was evaluated acutely (baseline, 30 minutes, 2 hours post-loading dose) and at 1 week using VerifyNow P2Y12, vasodilator-stimulated phosphoprotein, light transmittance aggregometry, and Multiplate assays.
  • At 1 week, the primary endpoint of VerifyNow P2Y12 reaction units was significantly lower with ticagrelor than prasugrel (52 [32–72] vs. 83 [63–103]; least-square means difference: –31; 95% CI, –57 to –4; P=0.022).
  • VerifyNow P2Y12 reaction units showed similar acute platelet inhibition at 30 minutes and 2 hours post-loading dose, and vasodilator-stimulated phosphoprotein, aggregometry, and Multiplate measures did not differ significantly between treatments at any time point.

Structured PICO

Does ticagrelor improve platelet inhibition compared to prasugrel in aspirin-treated patients with type 2 diabetes mellitus and coronary artery disease?

P
Population
50 aspirin-treated patients with type 2 diabetes mellitus and coronary artery disease
I
Intervention
Ticagrelor (180 mg loading dose, then 90 mg maintenance dose twice daily) for 1 week
C
Comparator
Prasugrel (60 mg loading dose, then 10 mg maintenance dose once daily) for 1 week (crossover design)
O
Outcome
P2Y12 reaction units determined by VerifyNow P2Y12 at 1 weeksurrogate

In diabetic patients with coronary artery disease, ticagrelor provides similar or greater inhibition of ADP-induced platelet reactivity compared to prasugrel at 1 week.

Cite This Study

Franchi et al. (2016) studied this question.

synapsesocial.com/papers/698f42f8e5841823068e9c1bhttps://doi.org/10.1161/circulationaha.116.023402
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