January 1, 2014Thrombosis and Haemostasis47 citations
Ticagrelor vs prasugrel one-month maintenance therapy: Impact on platelet reactivity and bleeding events
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Key Result
One-month maintenance therapy with ticagrelor in ACS patients undergoing PCI resulted in significantly lower platelet reactivity compared to prasugrel (33.3 vs 84.6 PRU; p<0.001).
Study Design
Type
Cohort (n=512)
Structured PICO
Does ticagrelor 90 mg bid compared to prasugrel 10 mg reduce platelet reactivity and affect bleeding events in patients with ACS undergoing PCI at one month?
P
Population
512 patients with acute coronary syndrome undergoing PCI discharged on ticagrelor or prasugrel maintenance therapy, evaluated at one month.
E
Exposure
Ticagrelor 90 mg bid maintenance dose for one month
C
Comparator
Prasugrel 10 mg maintenance dose for one month
O
Outcome
Platelet reactivity (PR) at one month measured by VerifyNow (in PRU) and bleeding events (BARC classification)surrogate
In ACS patients undergoing PCI, one-month maintenance therapy with ticagrelor produces significantly higher platelet inhibition than prasugrel, which may be associated with more nuisance bleeding.
Main Result
Absolute Event Rate: 33.3% vs 84.6%
p-value: p=<0.001
Abstract
Platelet reactivity (PR) and bleeding events following therapy with ticagrelor vs prasugrel have not been adequately studied. We aimed to compare PR and bleeding events in patients with acute coronary syndrome (ACS) undergoing percutaneous coronary intervention (PCI) while on ticagrelor vs prasugrel for one month. Consecutive patients who were discharged either on ticagrelor 90 mg bid maintenance dose (MD) or prasugrel 10 mg MD were invited for PR assessment (VerifyNow, in PRU) at one month. High PR (HPR) was defined as >208 PRU. Bleeding events Bleeding Academic Research Consortium (BARC) classification were monitored. Out of 937 screened patients, 512 were analysed, 278 under ticagrelor MD and 234 under prasugrel MD. PR at 30 days (C-statistic of the propensity score model 0.63, 0.58-0.67 95% CI, p<0.001) was lower when on ticagrelor compared with prasugrel (33.3, 95% CI 29.3-37.3 vs 84.6, 95% CI 73.6-95.6, p<0.001). In the analysed population more BARC type 1 bleeding events were observed with ticagrelor compared to prasugrel (36.7% vs 28.2%, p=0.047). In 221 propensity score matched pairs, BARC type 1 bleeding rate was marginally higher in ticagrelor vs prasugrel treated patients (35.7% vs 27.1%, p=0.05). BARC type ≥2 events did not differ between groups 5 (2.3%) vs 5 (2.3%). HPR rate was higher for prasugrel-treated patients (5.4% vs 0%, p<0.001). In conclusion, in patients with ACS undergoing PCI, ticagrelor MD produces a significantly higher platelet inhibition compared to prasugrel MD. This pharmacodynamic difference might be associated with more nuisance bleeding events with ticagrelor use.