Ticagrelor versus prasugrel in diabetic patients with an acute coronary syndrome

2014 ◽  
Vol 111 (02) ◽  
pp. 273-278 ◽  
Author(s):  
Marc Laine ◽  
Corinne Frere ◽  
Richard Toesca ◽  
Julie Berbis ◽  
Pierre Barnay ◽  
...  
Keyword(s):  
Diabetes Mellitus ◽  
Acute Coronary Syndrome ◽  
Platelet Reactivity ◽  
Statistical Significance ◽  
Randomised Trial ◽  
Diabetic Patients ◽  
Loading Dose ◽  
Open Label ◽  
Coronary Syndrome ◽  
Patients With Diabetes

SummaryOptimal P2Y12 receptor blockade is critical to prevent ischaemic recurrence in patients undergoing percutaneous coronary intervention (PCI). We aimed to compare the level of platelet reactivity (PR) inhibition achieved by prasugrel and ticagrelor loading dose (LD) in diabetic acute coronary syndrome (ACS) patients undergoing PCI. We performed a single-center prospective open-label randomised trial. Patients with diabetes mellitus undergoing PCI for an ACS were randomised to receive prasugrel 60 mg or ticagrelor 180 mg. The primary endpoint of the study was the level of platelet reactivity (PR) assessed between 6 and 18 hours post-LD using the VASP index. We randomised 100 diabetic patients undergoing PCI for an ACS. No difference was observed in baseline characteristics between the two groups. In particular, the rate of patient receiving insulin therapy was identical (25 vs 28.6%; p =0.7). Ticagrelor achieved a significantly lower PR compared to prasugrel loading dose (17.3 ± 14.2 vs 27.7 ± 23.3%; p=0.009). In addition the rate of high on-treatment platelet reactivity, defined by a VASP ≥50%, tend to be lower in the ticagrelor group although the difference did not reach statistical significance (6 vs 16%; p=0.2). The rate of low on treatment PR was identical (60 vs 54%; p=0.8). The present study demonstrates that ticagrelor LD is superior to prasugrel LD to reduce PR in ACS patients with diabetes mellitus. Whether the higher potency of ticagrelor could translate into a clinical benefit should be investigated.

scholarly journals Increased Atherothrombotic Burden in Patients with Diabetes Mellitus and Acute Coronary Syndrome: A Review of Antiplatelet Therapy

2012 ◽  
Vol 2012 ◽  
pp. 1-18 ◽  
Author(s):  
Karthik Balasubramaniam ◽  
Girish N. Viswanathan ◽  
Sally M. Marshall ◽  
Azfar G. Zaman
Keyword(s):  
Diabetes Mellitus ◽  
Acute Coronary Syndrome ◽  
Platelet Inhibition ◽  
Cardiovascular Complications ◽  
Diabetic Patients ◽  
Coronary Syndrome ◽  
Patients With Diabetes ◽  
Thrombotic Complications ◽  
Underlying Pathophysiology ◽  
Ischemic Events

Patients with diabetes mellitus presenting with acute coronary syndrome have a higher risk of cardiovascular complications and recurrent ischemic events when compared to nondiabetic counterparts. Different mechanisms including endothelial dysfunction, platelet hyperactivity, and abnormalities in coagulation and fibrinolysis have been implicated for this increased atherothrombotic risk. Platelets play an important role in atherogenesis and its thrombotic complications in diabetic patients with acute coronary syndrome. Hence, potent platelet inhibition is of paramount importance in order to optimise outcomes of diabetic patients with acute coronary syndrome. The aim of this paper is to provide an overview of the increased thrombotic burden in diabetes and acute coronary syndrome, the underlying pathophysiology focussing on endothelial and platelet abnormalities, currently available antiplatelet therapies, their benefits and limitations in diabetic patients, and to describe potential future therapeutic strategies to overcome these limitations.

scholarly journals Predictive value of the N-terminal prohormone of brain natriuretic peptide in the long-term prognosis of ventricular arrhythmia in diabetic patients with acute coronary syndrome of young and middle age

2020 ◽  
Vol 43 (4) ◽  
pp. 522-538
Author(s):  
Zheming Wang ◽  
◽  
Elena A. Asafieva ◽  
Tatiana I. Makeeva ◽  
◽  
...  
Keyword(s):  
Diabetes Mellitus ◽  
Acute Coronary Syndrome ◽  
Ventricular Arrhythmia ◽  
Natriuretic Peptide ◽  
Middle Age ◽  
Diabetic Patients ◽  
Coronary Syndrome ◽  
Patients With Diabetes ◽  
Long Term Prognosis

The article investigates the prognostic value of pro-B-type N-terminal natriuretic peptide (NTproBNP) in connection with ventricular extrasystoles (VES) in a population of patients with diabetes mellitus with acute coronary syndrome (ACS) after successful coronary reperfusion by percutaneous coronary intervention (PCI). Patients with ACS were examined by defining biomarkers and performing echocardiography (EchoCG) on the first day of ACS after PCI with stenting of the infarction-related coronary artery, and Holter monitoring of electrocardiography (HM-ECG) on the second day after PCI; 12 months later, EchoCG, HM-ECG and NT-proBNP determination were repeated. It was found that the incidence of VES in the long-term prognosis among ACS patients with diabetes of young and middle age was more frequent than in patients without diabetes. A positive correlation was found between the NTproBNP level and ventricular arrhythmia in ACS patients with diabetes mellitus. It has been proven that a high level of NT-proBNP on the first day in patients with ACS after PCI as an independent indicator of risk to development of VES in long-term prognosis.

scholarly journals In-Hospital Outcome Of Acute Coronary Syndrome In Patients With Diabetes Mellitus

2009 ◽  
Vol 5 (1) ◽  
pp. 24-27
Author(s):  
Dilip Kumar Sarker ◽  
KMHS Sirajul Haque ◽  
Md Abu Siddique ◽  
Md Khurshed Ahmed ◽  
Fazlur Rahman ◽  
...  
Keyword(s):  
Diabetes Mellitus ◽  
Heart Failure ◽  
Congestive Heart Failure ◽  
Acute Coronary Syndrome ◽  
Hospital Mortality ◽  
Cardiogenic Shock ◽  
Diabetic Patients ◽  
Coronary Syndrome ◽  
Recurrent Angina ◽  
Patients With Diabetes

Diabetes mellitus adversely influences the outcome of acute coronary syndrome. This study evaluated the in-hospital outcome of acute coronary syndrome in patients with diabetes mellitus. In this prospective observation study 130 patients with acute coronary syndrome were enrolled. They were divided into diabetic and nondiabetic group. Diabetic patients were taken as case and nondiabetic patients as control. Outcome parameter studied were in-hospital mortality, cardiogenic shock, congestive heart failure, different arrhythmias and recurrent angina. In this study, one third (32%) of the patients were diabetic with mean age 58±10.0 years vs. 53.0±13.6 years in diabetic and nondiabetic group, respectively. Majority of the patients in both groups were male. Congestive heart failure and arrhythmias were more common in case group compared to those in control group (19% vs. 13.6% p=0.424; 23.8% vs. 13.6%, p= 0.148, respectively). Cardiogenic shock developed in 7.1% of diabetic patients and 8% of nondiabetic patients. In hospital mortality was 7.1% and 5.7% in diabetic and nondiabetic group, respectively. Recurrent angina developed only in diabetic patients. Therefore, diabetic patients with acute coronary syndrome encountered more in- hospital adverse outcome.   doi: 10.3329/uhj.v5i1.3437 University Heart Journal Vol. 5, No. 1, January 2009 24-27

A Prospective, Randomized, Open-Label, Blinded, Endpoint Study Exploring Platelet Response to Half-Dose Prasugrel and Ticagrelor in Patients with the Acute Coronary Syndrome: HOPE-TAILOR Study

Cardiology ◽  
2017 ◽  
Vol 138 (4) ◽  
pp. 201-206 ◽  
Author(s):  
Cai De Jin ◽  
Moo Hyun Kim ◽  
Junghee Bang ◽  
Victor Serebruany
Keyword(s):  
Acute Coronary Syndrome ◽  
Platelet Reactivity ◽  
Academic Research ◽  
P2y12 Receptor ◽  
Drug Eluting Stent ◽  
Platelet Response ◽  
Open Label ◽  
Korean Patients ◽  
Coronary Syndrome ◽  
Half Dose

Background: The optimal dosing of novel oral P2Y12 receptor platelet inhibitors such as prasugrel or ticagrelor is unclear and especially challenging in East Asians. We hypothesize that half-dose prasugrel and ticagrelor may be sufficient for long-term maintenance management in Korean patients with the acute coronary syndrome (ACS) compared with conventional dosages. Design: HOPE-TAILOR (Half Dose of Prasugrel and Ticagrelor in Platelet Response after Acute Coronary Syndromes) is a prospective, randomized, open-label, blinded, endpoint (PROBE) single-center, clinical trial. A total of 100 patients with ACS undergoing drug-eluting stent implantation will be randomly assigned to prasugrel, ticagrelor, or clopidogrel, and the patients in each treatment group will receive 1-month therapy with 100 mg q.d. aspirin plus prasugrel 10 mg q.d., ticagrelor 90 mg b.i.d., or clopidogrel 75 mg q.d., followed by half-dose prasugrel 5 mg q.d. or ticagrelor 45 mg b.i.d. for maintenance treatment but without clopidogrel dose reduction. The primary endpoint will be optimal platelet reactivity 3 months after coronary intervention, defined by VerifyNow Analyzer (PRU: 85-208) and vasodilator-stimulated phosphoprotein P2Y12 flow cytometry assay (platelet reactivity indices: 16-50%). Clinical outcomes will also be assessed, including major efficacy (composite of cardiac death, nonfatal myocardial infarction, repeat revascularization, or stroke) and safety (bleeding ≥2 according to the Bleeding Academic Research Consortium). Conclusion: HOPE-TAILOR is a prospective, randomized, open-label, blinded, endpoint study to explore the efficacy and safety of novel P2Y12 receptor inhibitors administered orally at half the dose in Korean patients with ACS. The results will be available late in 2017.

Physical Activity Frequency on the 10-Year Acute Coronary Syndrome (ACS) Prognosis; The Interaction With Cardiovascular Disease History and Diabetes Mellitus: The GREECS Observational Study

2016 ◽  
Vol 24 (4) ◽  
pp. 624-632 ◽  
Author(s):  
Evangelos Papataxiarchis ◽  
Demosthenes B. Panagiotakos ◽  
Venetia Notara ◽  
Matina Kouvari ◽  
Yannis Kogias ◽  
...  
Keyword(s):  
Physical Activity ◽  
Diabetes Mellitus ◽  
Acute Coronary Syndrome ◽  
Protective Effect ◽  
Protective Factor ◽  
Monthly Basis ◽  
Coronary Syndrome ◽  
Activity Frequency ◽  
Patients With Diabetes ◽  
Greek Hospitals

The association between physical activity, diabetes mellitus (DM), and long-term acute coronary syndrome (ACS) prognosis was evaluated. The GREECS study included 2,172 consecutive ACS patients from six Greek hospitals (2003–2004). In 2013–2014, a 10-year follow up was performed with 1,918 patients. Physical activity was categorized in never, rarely (monthly basis), 1–2 and ≥ 3 times/week. Multi-adjusted analysis revealed that 1–2 and ≥ 3 times/week vs. no physical activity had a protective effect on ACS incidence (OR = 0.63 95% CI 0.38, 1.05) and (OR = 0.63 95% CI 0.40, 0.99) respectively, only in patients without prior baseline CVD event. In a subgroup analysis, with DM as strata in these patients, engagement in physical activity (i.e., 1–2 times/week) had a significant protective effect among patients with diabetes (OR = 0.51, 95% CI 0.27, 0.96, p = .037). These findings revealed the beneficial role of exercise in secondary ACS prevention, even in DM patients. Public health-oriented policies should incorporate regular physical activity as a key protective factor in disease prognosis.

Effects of oral administration of ticagrelor on the plasma level of adrenaline, histamine, serotonin, and acetylcholine in rat

2020 ◽  
Author(s):  
Xiuling Yang ◽  
Xue Guo ◽  
Li Yanan ◽  
Li Jiaxi ◽  
Liu Yue
Keyword(s):  
Acute Coronary Syndrome ◽  
Plasma Concentration ◽  
Plasma Level ◽  
Adverse Reactions ◽  
Statistical Significance ◽  
Loading Dose ◽  
Time Points ◽  
Coronary Syndrome ◽  
P2y12 Receptor Antagonist ◽  
First Time

Abstract Background: Ticagrelor as a reversible P2Y12 receptor antagonist which plays an important role in the treatment of acute coronary syndrome (ACS). Dyspnea is one of the main adverse reactions of ticagrelor, however the mechanism is not clearly now. The aim of this study was to assess the possible relationship between ticagrelor-related dyspnea and some neurotransmitter in plasma which can contract the bronchial smooth muscle.Methods: The effects of ticagrelor on the plasma level of adrenaline, histamine, serotonin, and acetylcholine was studied in rats. Ticagrelor was administered at a loading dose of 24 mg/kg for the first time, and then maintenance dose 12 mg/kg, twice a day for 6 days. The plasma level of adrenaline, histamine, serotonin, and acetylcholine was determined by LC-MS/MS.Results: The plasma level of serotonin increased after ticagrelor administrating, especially at 1.5h ( p <0.05) reach the level of statistical significance. The level of serotonin in plasma was consistent with ticagrelor blood concentration. Meanwhile, ticagrelor can cause a decrease in the plasma concentration of histamine, and the change was statistically significant at time points of 1.5h, 3.5h and 10.5h respectively. The concentration of the adrenaline and acetylcholine had no change.Conclusions: The results of this study reveal that ticagrelor can increases blood serotonin levels and this may be a cause of dyspnea ticagrelor-related.

P3606Impact of diabetes mellitus on the selection of antiplatelet treatment and medium-term prognosis after acute coronary syndrome

2019 ◽  
Vol 40 (Supplement_1) ◽  
Author(s):  
L Nunez Martinez ◽  
N V-Ibarra ◽  
F Marin Ortuno ◽  
V Pernias Escrig ◽  
M Sandin Rollan ◽  
...  
Keyword(s):  
Diabetes Mellitus ◽  
Acute Coronary Syndrome ◽  
Antiplatelet Therapy ◽  
Coronary Disease ◽  
Cardiovascular Events ◽  
Diabetic Patients ◽  
Medium Term ◽  
Coronary Syndrome ◽  
Diabetic Population ◽  
One Year

Abstract Introduction Patients with diabetes mellitus (DM) have a higher atherothrombotic risk and higher rates of recurrent ischemic events compared with the non-diabetic population. Although current antiplatelet therapy strategies have been shown to be successful in improving outcomes in acute coronary syndrome (ACS), patients with DM continue to experience high rates of adverse cardiovascular events. Today, it is known that diabetic patients are characterized by a deregulation in different intracellular signaling pathways, which leads to an inadequate or suboptimal response to antiplatelets agents. The purpose of this study is to analyze the different therapeutic strategies, the use of new antiplatelet drugs and medium-term prognosis in diabetic patients compared with non-diabetic patients who have suffered an ACS. Methods It is an observational, prospective and multicenter registry of patients with ACS. The objective is to analyze the differences in the management of DM patients vs non-DM patients in the acute phase and their evolution during the first year after coronary event. Antiplatelet therapy administered will be evaluated, type of coronary injury and treatment performed, major adverse events as well as cardiovascular complications and mortality at one year of follow-up. Results Of a total of 1717 patients, 38% were diabetic. The diabetic population was older, with a higher prevalence of cardiovascular risk factors and higher rate of previous cardiovascular events (cerebrovascular, peripheral arterial disease and coronary disease). Patients with DM received less new antiplatelets drugs at admission (15.5% DM vs 26.5% non DM, p<0.001) and less in-hospital switch to new antiplatelet agents was performed. They were subjected to a lower number of catheterizations and at the time of revascularization, the drug-eluting stent was of choice. During admission, they developed more complications, both ischemic (refractory angina, reinfarction or CVA) and hemorrhagic. Following one year, DM had higher major cardiovascular events (MACE) and higher mortality (7.72% vs 5.14%, p=0.0039). Non-coronary revascularization, renal failure, and reduced ejection fraction were predictive variables of death in diabetic population. Treatment with new antiplatelet drugs was associated with a statistically significant decrease in total mortality an MACE without differences in major bleeding. Conclusion More than a third of patients with ACS are diabetic. These patients present with more severe coronary disease associating a greater number of cardiovascular events and a higher mortality rate after one year of ACS. However, despite this, they undergo less invasive tests and they were undertreated with the new antiplatelets therapies. Acknowledgement/Funding SEC

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