Ticagrelor treatment was associated with a 58% decrease in platelet reactivity compared to prasugrel, while insulin-treated diabetes mellitus was associated with a 30% increase compared to non-diabetic patients.
Cross-Sectional (n=777)
No
Does ticagrelor compared to prasugrel reduce platelet reactivity in patients with acute coronary syndrome undergoing PCI, and how does diabetes mellitus status affect this?
Ticagrelor provides stronger and more consistent platelet inhibition than prasugrel in ACS patients post-PCI, independent of diabetes status, whereas prasugrel's efficacy is attenuated in insulin-treated diabetic patients.
Effect estimate: 58% decrease in PR (ticagrelor vs prasugrel)
p-value: p=<0.001
BACKGROUND: The influence of diabetes mellitus (DM) on platelet reactivity (PR) in prasugrel or ticagrelor treated patients is not well studied. METHODS: In an observational study involving 777 patients with acute coronary syndrome undergoing percutaneous coronary intervention treated by either prasugrel 10 mg od (n = 315) or ticagrelor 90 mg bid (n = 462), platelet function was assessed using the VerifyNow P2Y12 function assay (in PRU) at one month post intrvention. RESULTS: In the overall population, ticagrelor and insulin-treated DM affected PR, with a decrease in log by 0.88 (corresponding to a 58 % decrease in PR) compared to prasugrel-treated patients (p < 0.001), and an increase in log by 0.26 (corresponding to a 30 % increase in PR) compared to non-diabetic patients (p = 0.01), respectively. PR in prasugrel-treated patients differed significantly by DM status: 70.0 (36.3-113.0) in non-diabetic vs 69.0 (44.5-115.3) in non insulin-treated diabetic vs 122.0 (69.0-161.0) in insulin-treated diabetic patients, p for trend = 0.01. No differences were observed in ticagrelor-treated patients. By multivariate analysis, in prasugrel-treated patients insulin-treated DM was the only factor predicting PR, with log of PR increased by 0.42 (corresponding to a 52 % increase in PR) compared to non-diabetic patients (p = 0.001). No factor was found to affect PR in ticagrelor-treated patients. CONCLUSIONS: Patients with insulin-treated DM treated with prasugrel post PCI have higher PR, than patients without DM or non insulin-treated diabetic patients treated with this drug. Ticagrelor treated patients have overall lower PR than patients on prasugrel, independent of DM status or insulin treatment. TRIAL REGISTRATION: Clinical Trials Gov. NCT01774955.
Alexopoulos et al. (2015) conducted a cross-sectional in Acute coronary syndrome (n=777). Ticagrelor and insulin-treated diabetes mellitus vs. Prasugrel and non-diabetic status was evaluated on Platelet reactivity (PRU) at 1 month (58% decrease in PR (ticagrelor vs prasugrel), p=<0.001). Ticagrelor treatment was associated with a 58% decrease in platelet reactivity compared to prasugrel, while insulin-treated diabetes mellitus was associated with a 30% increase compared to non-diabetic patients.