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Ticagrelor vs prasugrel one-month maintenance therapy: impact on platelet reactivity and bleeding events

D Alexopoulos1, K Stavrou, I Koniari

  • 1Dimitrios Alexopoulos, MD, FACC, FESC, Cardiology Department, Patras University Hospital, Rion 26500, Patras, Greece, Tel/Fax: +30 2610992941,

Thrombosis and Haemostasis
|July 4, 2014
PubMed

Insights

Ticagrelor therapy resulted in significantly lower platelet reactivity (PR) compared to prasugrel in acute coronary syndrome patients. While ticagrelor showed more minor bleeding events (BARC type 1), major bleeding (BARC type ≥2) did not differ between the two antiplatelet therapies.

Area of Science:

  • Cardiology
  • Pharmacology

Background:

  • Platelet reactivity (PR) and bleeding events are critical considerations following antiplatelet therapy in acute coronary syndrome (ACS) patients.
  • Ticagrelor and prasugrel are commonly used P2Y12 inhibitors, but direct comparisons of their effects on PR and bleeding in ACS patients undergoing percutaneous coronary intervention (PCI) are limited.

Purpose of the Study:

  • To compare PR and bleeding events in ACS patients treated with ticagrelor versus prasugrel for one month post-PCI.
  • To assess the pharmacodynamic differences and clinical bleeding outcomes between ticagrelor and prasugrel maintenance doses.

Main Methods:

  • A comparative study involving 512 ACS patients undergoing PCI, with 278 on ticagrelor maintenance dose (MD) and 234 on prasugrel MD.
  • Platelet reactivity assessed using VerifyNow (PRU) at one month; high PR (HPR) defined as >208 PRU.
  • Bleeding events classified according to the Bleeding Academic Research Consortium (BARC) criteria.

Main Results:

  • Ticagrelor group exhibited significantly lower PR at 30 days compared to the prasugrel group (33.3 PRU vs 84.6 PRU, p<0.001).
  • Higher rates of BARC type 1 bleeding events were observed with ticagrelor (36.7%) versus prasugrel (28.2%, p=0.047), particularly in propensity score-matched pairs (35.7% vs 27.1%, p=0.05).
  • No significant difference in BARC type ≥2 bleeding events was found between the groups (2.3% for both); HPR rate was higher with prasugrel (5.4% vs 0%, p<0.001).

Conclusions:

  • Ticagrelor maintenance dose provides superior platelet inhibition compared to prasugrel maintenance dose in ACS patients post-PCI.
  • The enhanced platelet inhibition with ticagrelor may be associated with an increased incidence of minor (nuisance) bleeding events.
  • Clinical decisions should consider these pharmacodynamic and bleeding profile differences between ticagrelor and prasugrel.

Keywords:
Ticagrelorpercutaneous coronary interventionplatelet aggregationprasugrel

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