Abstract 339: Comparison of the Antiplatelet Effect Between Ticagrelor and Clopidogrel in Chinese Patients with Acute Myocardial Infarction After Primary Percutaneous Coronary Intervention

Background: Ticagrelor can provide effective platelet inhibition 2 hours after a loading dose, but it will take 6 hours for clopidogrel. It is not very clear whether the anthplatelet agents treated patients with AMI undergoing primary PCI can achieve ideal antiplatelet effect after 24 to 48 hours. Purpose: The aim is to compare the antiplatelet action between ticagrelor and clopidogrel in Chinese patients with AMI after primary PCI. Methods: 189 patients with AMI after primary PCI were enrolled in this single center registry. All patients received loading and maintenance dose of dual antiplatelet therapy (aspirin+clopidogrel/ticagrelor). 58 cases were included in ticagrelor group. 131 patients were included in clopidogrel group. Residual platelet reactivity was assessed by VerifyNow 24-48 hours after PCI. All patients were followed-up for 30 days and 6 months after discharge. Results: The baseline data were well matched between the two groups. After 24-48 hours, 51 cases existed of high residual platelet response(HRPR)(platelet response unit ,PRU≥230), the ratio was 26.98%. In clopidogrel group, the average PRU was 195.8 (26~329), and 43 patients existed HRPR, ratio was 32.82%. For ticagrelor group, the average PRU was 101.8 (6~322), and 8 patients existed HRPR, ratio was 14.04%. The incidence of HRPR was significantly lower in ticagrelor group ( p < 0.0001). Within 30 days, the incidence of MI in clopidogrel group and ticagrelor group were respectively 0.8% and 0, p =0.693; target lesion revascularization were 1.7% and 1.5%, p =0.669; death were 0.8% and 0, p =0.693; stroke were 0 and 0, p =1.000; bleeding were 2.3% and 0, p =0.331. In 6 months, the incidence of MI were 0.8% and 0, p =0.693; target lesion revascularization were 0.8% and 0, p =0.693; death were 0 and 0, p =1.000. The incidence of MACE, bleeding and stroke had no obvious difference between the two groups. Conclusion: 24 hours after primary PCI, there are still a large proportion of Chinese patients with AMI existing insufficient platelet inhibition, no matter they take clopidogrel or ticagrelor, but ticagrelor has a significant stronger antiplatelet effect than clopidogrel. There is no obvious difference between the incidences of clinical events.

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Use of Thromboelastography Platelet Mapping for Assessment of Individual Platelet Response Secondary to Oral Antiplatelet Therapy after Percutaneous Coronary Intervention: An Attempt to Start Personalized Antiplatelet Therapy in India

Journal of Cardiac Critical Care TSS ◽

10.1055/s-0041-1724225 ◽

2021 ◽

Author(s):

Suvro Sankha Datta ◽

Dibyendu De ◽

Nadeem Afroz Muslim

Keyword(s):

Percutaneous Coronary Intervention ◽

Antiplatelet Therapy ◽

Platelet Reactivity ◽

Coronary Intervention ◽

Platelet Inhibition ◽

P Value ◽

Platelet Response ◽

Percutaneous Coronary ◽

The Individual ◽

Platelet Functions

AbstractHigh on-treatment platelet reactivity (HPR) with P2Y12 receptor antagonists in patients treated with dual antiplatelet therapy (DAPT) is strongly associated with adverse ischemic events after percutaneous coronary intervention (PCI). This prospective study was conducted to assess individual platelet response and HPR to antiplatelet medications in post-PCI cases by thromboelastography platelet mapping (TEG-PM). Total 82 patients who were on aspirin and on either clopidogrel, prasugrel, or ticagrelor were evaluated. The percentage of platelet inhibition to arachidonic acid (AA) and adenosine disdiphosphate (ADP) was calculated by [100-{(MA ADP/AA–MA Fibrin) / (MA Thrombin–MA Fibrin) × 100}], taking 50% response as cut-off for HPR. HPR to clopidogrel and prasugrel was 14.29 and 12.5%, respectively. No HPR was detected to aspirin and ticagrelor. The mean percentage of platelet inhibition was significantly higher in patients with ticagrelor 82.99, 95% confidence interval (CI) of [77.3, 88.7] as compared with clopidogrel 72.21, 95% CI of [65.3, 79.1] and prasugrel 64.2, 95% CI of [52.5, 75.9] (p-value of 0.041 and 0.003, respectively). Aspirin along with ticagrelor is associated with a higher mean percentage of platelet inhibition, and lower HPR as compared with the usage of aspirin combined with clopidogrel or prasugrel. Additionally, it might also be concluded that TEG-PM could be used effectively to measure the individual platelet functions which would make oral antiplatelet therapy more personalized for cardiac patients.

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Impact of opioids on P2Y12 receptor inhibition in patients with ST-elevation myocardial infarction who are pre-treated with crushed ticagrelor: Opioids aNd crushed Ticagrelor In Myocardial infarction Evaluation (ON-TIME 3) trial

European Heart Journal - Cardiovascular Pharmacotherapy ◽

10.1093/ehjcvp/pvaa095 ◽

2020 ◽

Cited By ~ 2

Author(s):

Anne H Tavenier ◽

Renicus S Hermanides ◽

Jan Paul Ottervanger ◽

Rudolf Tolsma ◽

Antony van Beurden ◽

...

Keyword(s):

Myocardial Infarction ◽

Pain Relief ◽

Platelet Reactivity ◽

Coronary Intervention ◽

Platelet Inhibition ◽

St Elevation Myocardial Infarction ◽

P2y12 Receptor ◽

Primary Pci ◽

Receptor Inhibition ◽

St Elevation

Abstract Aims Platelet inhibition induced by P2Y12 receptor antagonists in patients with ST-elevation myocardial infarction (STEMI) can be affected by concomitant use of opioids. The aim of this trial was to examine the effect of intravenous (iv) acetaminophen compared with iv fentanyl on P2Y12 receptor inhibition in patients with STEMI. Methods and results The Opioids aNd crushed Ticagrelor In Myocardial infarction Evaluation (ON-TIME 3) trial randomized 195 STEMI patients who were scheduled to undergo primary percutaneous coronary intervention (PCI) and were pre-treated with crushed ticagrelor to iv acetaminophen (N = 98) or iv fentanyl (N = 97) in the ambulance. The primary endpoint, consisting of the level of platelet reactivity units (PRU) measured immediately after primary PCI, was not significantly different between the study arms [median PRU 104 (IQR 37–215) vs. 175 (63–228), P = 0.18]. However, systemic levels of ticagrelor were significantly higher in the acetaminophen arm at the start of primary PCI [151 ng/mL (32–509) vs. 60 ng/mL (13–206), P = 0.007], immediately after primary PCI [326 ng/mL (94–791) vs. 115 ng/mL (38–326), P = 0.002], and at 1 h after primary PCI [488 ng/mL (281–974) vs. 372 ng/mL (95–635), P = 0.002]. Acetaminophen resulted in the same extent of pain relief when compared with fentanyl [reduction of 3 points on 10-step-pain scale before primary PCI (IQR 1–5)] in both study arms (P = 0.67) and immediately after PCI [reduction of 5 points (3–7); P = 0.96]. Conclusion The iv acetaminophen in comparison with iv fentanyl was not associated with significantly lower platelet reactivity in STEMI patients but resulted in significantly higher ticagrelor plasma levels and was effective in pain relief.

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Use of Thromboelastography Platelet Mapping for Assessment of Individual Platelet Response Secondary to Oral Antiplatelet Therapy after Percutaneous Coronary Intervention: An Attempt to Start Personalized Antiplatelet Therapy in India

Journal of Cardiac Critical Care TSS ◽

10.1055/s-0041-1735667 ◽

2021 ◽

Vol 5 (02) ◽

pp. 108-113

Author(s):

Suvro Sankha Datta ◽

Dibyendu De ◽

Nadeem Afroz Muslim

Keyword(s):

Percutaneous Coronary Intervention ◽

Antiplatelet Therapy ◽

Platelet Reactivity ◽

Adenosine Diphosphate ◽

Coronary Intervention ◽

Platelet Inhibition ◽

P Value ◽

Platelet Response ◽

Percutaneous Coronary ◽

The Individual

AbstractHigh on-treatment platelet reactivity (HPR) with P2Y12 receptor antagonists in patients treated with dual antiplatelet therapy (DAPT) is strongly associated with adverse ischemic events after percutaneous coronary intervention (PCI). This prospective study was conducted to assess individual platelet response and HPR to antiplatelet medications in post-PCI cases by thromboelastography platelet mapping (TEG-PM). Total 82 patients who were on aspirin and on either clopidogrel, prasugrel, or ticagrelor were evaluated. The percentage of platelet inhibition to arachidonic acid (AA) and adenosine diphosphate (ADP) was calculated by [100-{(MA ADP/AA–MA Fibrin) / (MA Thrombin–MA Fibrin) × 100}], taking 50% response as cut-off for HPR. HPR to clopidogrel and prasugrel was 14.29 and 12.5%, respectively. No HPR was detected to aspirin and ticagrelor. The mean percentage of platelet inhibition was significantly higher in patients with ticagrelor 82.99, 95% confidence interval (CI) of [77.3, 88.7] as compared with clopidogrel 72.21, 95% CI of [65.3, 79.1] and prasugrel 64.2, 95% CI of [52.5, 75.9] (p-value of 0.041 and 0.003, respectively). Aspirin along with ticagrelor is associated with a higher mean percentage of platelet inhibition, and lower HPR as compared with the usage of aspirin combined with clopidogrel or prasugrel. Additionally, it might also be concluded that TEG-PM could be used effectively to measure the individual platelet functions which would make oral antiplatelet therapy more personalized for cardiac patients.

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TCT-206 Effect of the α2A-Adrenergic Receptor Genetic Variants on Platelet Reactivity and Adverse Clinical Events in Chinese Patients with Dual Antiplatelet Therapy after Percutaneous Coronary Intervention

Journal of the American College of Cardiology ◽

10.1016/j.jacc.2015.08.221 ◽

2015 ◽

Vol 66 (15) ◽

pp. B79

Author(s):

Ying Song ◽

Xiao-Fang Tang ◽

Jia-Hui Zhang ◽

Yi Yao ◽

Jing-Jing Xu ◽

...

Keyword(s):

Percutaneous Coronary Intervention ◽

Antiplatelet Therapy ◽

Genetic Variants ◽

Adrenergic Receptor ◽

Dual Antiplatelet Therapy ◽

Platelet Reactivity ◽

Coronary Intervention ◽

Chinese Patients ◽

Clinical Events ◽

Percutaneous Coronary

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An Observational Study of the Relationship Between Outcome and Platelet Reactivity in Chinese Patients Undergoing PCI Loading with 600 mg Clopidogrel

Cardiovascular Innovations and Applications ◽

10.15212/cvia.2019.0580 ◽

2020 ◽

Vol 5 (1) ◽

pp. 27-35

Author(s):

Jing-xiu Li ◽

Ling Weng ◽

Xue-qi Li ◽

Yang Li ◽

Shu-jun Yan ◽

...

Keyword(s):

Standard Deviation ◽

Unstable Angina ◽

Cardiac Death ◽

Platelet Reactivity ◽

Target Lesion ◽

Hemoglobin Level ◽

Target Lesion Revascularization ◽

Chinese Patients ◽

Observational Research ◽

Loading Dose

Objectives: We sought to determine whether high posttreatment platelet reactivity (HPPR) to a 600 mg loading dose of clopidogrel affects outcomes in Chinese patients with acute coronary syndrome (ACS) following percutaneous coronary intervention (PCI) and to investigate whether there is a relationship between the number of platelet reactivity units (PRUs) and the characteristics of the patients.Background: Although impaired platelet response to clopidogrel is a strong predictor of unfavorable outcome after PCI, the impact of HPPR to a 600 mg loading dose of clopidogrel in Chinese patients with ACS undergoing PCI is still unknown.Methods: We performed observational research on 134 unselected patients with ACS undergoing urgent or planned PCI with a 600 mg loading dose of clopidogrel. Platelet activation was expressed as the PRU value measured by the VerifyNow assay.Results: Among the 134 patients (mean age 60.62 years [standard deviation 9.13 years], 60.4% male), there were 46 patients with HPPR (34.3%) and 88 patients without HPPR (65.7%). At a mean follow-up of 6 months (standard deviation 1 month), the rates of cardiac death, unstable angina, and rehospitalization for target lesion revascularization were higher in the HPPR group (19.6% vs. 6.8%, P=0.029). Multivariate analysis identified hemoglobin level and sex as independent predictors of the PRU value (y=456.355−1.736x1−31.880x2, P<0.05). On receiver operating characteristic curve analysis, PRU values could significantly discriminate between patients with and patients without cardiac death, unstable angina, and rehospitalization for target lesion revascularization (area under the curve 0.758, 95% confidence interval 0.62‐0.85, P=0.001, P<0.05).Conclusion: In patients with ACS, HPPR to a 600 mg loading dose of clopidogrel is associated with worse outcomes after PCI. There is some relationship between the PRU value and the hemoglobin level and sex. PRU values can predict the prognosis.

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Clopidogrel pretreatment in primary percutaneous coronary intervention: Prevalence of high on-treatment platelet reactivity and impact on preprocedural patency of the infarct-related artery

Thrombosis and Haemostasis ◽

10.1160/th13-01-0057 ◽

2013 ◽

Vol 110 (07) ◽

pp. 110-117 ◽

Cited By ~ 15

Author(s):

Javier Berdejo ◽

Gerard Roura ◽

Josep Gómez-Lara ◽

Rafael Romaguera ◽

Luis Teruel ◽

...

Keyword(s):

Percutaneous Coronary Intervention ◽

Primary Percutaneous Coronary Intervention ◽

Light Transmission ◽

Platelet Reactivity ◽

Poor Response ◽

Antiplatelet Agents ◽

Coronary Intervention ◽

Platelet Inhibition ◽

Percutaneous Coronary ◽

Infarct Related Artery

SummaryTo date, there is limited data on levels of platelet inhibition achieved in patients with ST-elevation myocardial infarction (STEMI) who are loaded with clopidogrel and aspirin (ASA) prior to undergoing primary percutaneous coronary intervention (P-PCI). The aim of this investigation was to evaluate the percentage of STEMI patients with high on-treatment platelet reactivity (HPR) to clopidogrel at the time of initiating P-PCI and its association with the initial patency of the infarct-related artery (IRA). This prospective pharmacodynamic study included 50 STEMI patients, previously naïve to oral antiplatelet agents, who received 500-mg ASA and 600-mg clopidogrel loading doses prior to P-PCI. Platelet function assessment was performed at the beginning of the procedure using various assays, including VerifyNow™ system (primary endpoint), light transmission aggregometry and multiple electrode aggregometry. The percentage of patients with suboptimal response to clopidogrel and ASA assessed with the VerifyNow™ system was 88.0% and 28.6%, respectively. Similar results were obtained with the other assays used. A higher percentage of patients with initial patency of the IRA was observed among those patients without HPR compared with those with HPR to clopidogrel (66.7% vs 15.9%; p=0.013), while no differences were observed regarding postprocedural angiographic or electrocardiographic outcomes. In conclusion, this study shows that a high percentage of STEMI patients have inadequate levels of clopidogrel-induced and, to a lesser extent, aspirin-mediated platelet inhibition when starting a P-PCI procedure, and suggests that a poor response to clopidogrel might be associated with impaired initial TIMI flow in the IRA.

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