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).
Cohort (n=512)
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?
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.
Absolute Event Rate: 33.3% vs 84.6%
p-value: p=<0.001
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.
Stavrou et al. (2014) conducted a cohort in Acute coronary syndrome (ACS) undergoing percutaneous coronary intervention (PCI) (n=512). Ticagrelor vs. Prasugrel 10 mg was evaluated on Platelet reactivity (PR) at 30 days (p=<0.001). 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).