Key result
Ticagrelor achieved significantly higher drug sensitivity (99.15%) and mean platelet inhibition (89.9%) at 24 hours post-PCI compared with prasugrel (94.23%, 85.2%) and clopidogrel (72.15%, 67.4%; p=0.00001).
Why the study?
Does ticagrelor provide higher platelet inhibition and lower antiplatelet resistance compared with clopidogrel and prasugrel in patients with coronary artery disease undergoing percutaneous coronary intervention?
Cohort (n=539)
No
Does ticagrelor provide higher platelet inhibition and lower antiplatelet resistance compared with clopidogrel and prasugrel in patients with coronary artery disease undergoing percutaneous coronary intervention?
In a real-world Indian cohort undergoing PCI, ticagrelor provided more potent and consistent platelet inhibition with near-zero resistance (<1%) compared with prasugrel and clopidogrel, including in patients who were nonresponsive to clopidogrel or prasugrel.
Answers are grounded in this paper and cite their sources.
Ticagrelor may favor reliable platelet inhibition post-PCI; leaves open net clinical benefit versus alternatives in randomized trials.
AIMS AND OBJECTIVES: Although clopidogrel combined with aspirin is the most commonly used dual drug combination to avert thrombotic events in patients with coronary artery disease, the poor responsiveness to clopidogrel remains a concern. The objective of the current study is to assess the extent of resistance to clopidogrel, prasugrel, and ticagrelor in a real life set of patients with coronary artery disease who underwent percutaneous coronary intervention (PCI). MATERIALS AND METHODS: A total of 539 patients, who underwent PCI and were on aspirin and on any of the three drugs, namely, clopidogrel, prasugrel and ticagrelor, were followed up regularly in the outpatient department. After 24h of initiation of antiplatelet medication, response to the treatment in all the patients was assessed using thrombelastography. The average percentage platelet inhibition was assessed along with the resistance and sensitivity to the drug in each patient. Sensitivity and resistance to the specific drug was defined as >50% and <50% of mean platelet inhibition, respectively. RESULTS: About 99.15% of the patients treated with ticagrelor were sensitive to the drug and the difference between ticagrelor, clopidogrel, and prasugrel groups for sensitivity was significant with a p value of 0.00001, in favor of ticagrelor. It was also found that ticagrelor was significantly (p value of 0.001) associated with least resistance as compared with the other drugs assessed in the study. CONCLUSIONS: Use of ticagrelor as dual therapy along with aspirin in patients with coronary artery disease (CAD) and undergoing PCI was associated with a significantly higher mean percentage platelet inhibition, higher sensitivity, and lower resistance as compared with the usage of clopidogrel or prasugrel.
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Dalal et al. (2016) conducted a cohort in Coronary artery disease undergoing percutaneous coronary intervention (PCI) (n=539). Ticagrelor plus aspirin vs. Clopidogrel (300 mg loading, 75 mg daily) or prasugrel plus aspirin was evaluated on Drug sensitivity (>50% mean platelet inhibition measured by thrombelastography at 24 hours) (p=0.00001). Ticagrelor achieved significantly higher drug sensitivity (99.15%) and mean platelet inhibition (89.9%) at 24 hours post-PCI compared with prasugrel (94.23%, 85.2%) and clopidogrel (72.15%, 67.4%; p=0.00001).
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