Key result
Aspirin plus prasugrel or ticagrelor maintains low high on-treatment platelet reactivity rates below ~4%.
Why the study?
The study was conducted to investigate patterns of platelet reactivity and discriminators of therapeutic response to DAPT with aspirin and ticagrelor or prasugrel in patients with ACS.
What factors influence platelet reactivity and therapeutic response to dual antiplatelet therapy with aspirin and ticagrelor or prasugrel in patients with acute coronary syndrome?
Cohort (n=492)
Open-label
Yes
What factors influence platelet reactivity and therapeutic response to dual antiplatelet therapy with aspirin and ticagrelor or prasugrel in patients with acute coronary syndrome?
High on-treatment platelet reactivity is rare (2%) when potent P2Y12 inhibitors like prasugrel or ticagrelor are combined with aspirin in ACS patients.
Answers are grounded in this paper and cite their sources.
Effective platelet inhibition common with potent P2Y12 inhibitors plus aspirin in ACS; leaves open whether reactivity testing improves outcomes.
AIM: The aim of the present study was to investigate the patterns of platelet reactivity and discriminators of therapeutic response to dual antiplatelet therapy (DAPT) with aspirin and ticagrelor or prasugrel in patients with acute coronary syndrome (ACS). DESIGN: In this multicentre prospective observational study, 492 patients with ACS were enrolled. Platelet aggregation was determined by multiple electrode aggregometry after stimulation with adenosine diphosphate (ADP) or arachidonic acid (AA) as agonists in the maintenance phase of treatment with prasugrel or ticagrelor. RESULTS: Age emerged as the strongest variable influencing aspirin response status: The mean AA-induced platelet aggregation in patients <49 years of age was 49% higher than in those >49 years (13.1 U vs 8.8 U; P = 0.011). The second strongest discriminator of aspirin response was sex: Male patients had a 40% higher AA-induced platelet aggregation values than female patients (9.5 U vs 6.8 U; P = 0.026). Platelet count emerged as the only variable influencing ADP antagonists response status showing that patients with platelet count >320 g/L displayed higher ADP-induced platelet aggregation. About 12% of patients had high on-treatment platelet reactivity (HTPR) to aspirin, 3% and 4% a HTPR to prasugrel and ticagrelor, respectively, and only 2% displayed HTPR to dual antiplatelet therapy. CONCLUSION: When potent platelet inhibitors as prasugrel and ticagrelor are administered with aspirin, HTPR to DAPT plays only a marginal role.
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Winter et al. (2019) conducted a cohort in Acute coronary syndrome (n=492). Dual antiplatelet therapy with aspirin and prasugrel vs. Dual antiplatelet therapy with aspirin and ticagrelor was evaluated on High on-treatment platelet reactivity (HTPR) to ADP-induced platelet aggregation. Dual antiplatelet therapy with aspirin plus prasugrel or ticagrelor resulted in low rates of high on-treatment platelet reactivity to P2Y12 inhibitors (3% vs 4%) and to both agents combined (2%).
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