One-quarter standard-dose ticagrelor better than standard-dose clopidogrel in Chinese patients with stable coronary
Meijiao He1, Bin Liu2, Danghui Sun2
1Cardiovascular Department, the First Hospital of Harbin, PR China.
Insights
A quarter dose of ticagrelor (22.5mg) significantly inhibited platelet aggregation more effectively than standard clopidogrel (75mg) in Chinese patients with stable coronary artery disease (CAD). This suggests a potentially more potent antiplatelet strategy for managing stable CAD.
Area of Science:
- Cardiology
- Pharmacology
- Clinical Trials
Background:
- Ticagrelor demonstrates superior platelet inhibition compared to clopidogrel in coronary artery disease (CAD).
- Previous research indicated half-dose ticagrelor matched standard-dose ticagrelor and surpassed clopidogrel in non-ST-elevation acute coronary syndrome (ACS).
- This study investigates the efficacy of a reduced ticagrelor dosage in stable CAD patients.
Purpose of the Study:
- To compare the antiplatelet efficacy of one-quarter standard-dose ticagrelor versus standard-dose clopidogrel.
- To evaluate platelet function in Chinese patients with stable coronary artery disease (CAD).
- To assess the potential of a lower ticagrelor dose as an effective antiplatelet therapy.
Main Methods:
- A randomized, single-blind, crossover trial involving 30 stable CAD patients.
- Patients received either one-quarter standard-dose ticagrelor (22.5mg BID) or standard-dose clopidogrel (75mg QD) for 7 days, followed by a 2-week washout period and regimen switch.
- Platelet function was measured using Light Transmission Aggregometry (LTA) and VerifyNow assay.
Main Results:
- Ticagrelor significantly reduced the platelet aggregation rate (PAgR) compared to clopidogrel (17.70%±12.67% vs. 27.63%±13.10%, P<0.05).
- Higher percentage inhibition levels were observed with ticagrelor (65.33%±21.31%) versus clopidogrel (36.23%±23.01%, P<0.01).
- Mean Platelet Reactivity Unit (PRU) values were markedly lower with ticagrelor (87.03±51.38 vs. 163.77±58.66, P<0.01), with 0% high-platelet reactivity (HPR) compared to 16.67% with clopidogrel.
Conclusions:
- One-quarter standard-dose ticagrelor achieved a greater degree of platelet inhibition than standard-dose clopidogrel in Chinese patients with stable CAD.
- This finding suggests a potentially more effective antiplatelet strategy with a lower ticagrelor dose.
- Further research may explore the clinical implications of this enhanced platelet inhibition in stable CAD management.
Background:
Ticagrelor has been demonstrated to provide a more rapid and powerful inhibition of platelet aggregation compared with clopidogrel in coronary artery disease (CAD) patients. In our previous study, we found that half-dose ticagrelor produced similar inhibitory effects on platelet aggregation as standard-dose ticagrelor and exerted significantly stronger effects than clopidogrel in Chinese patients with non-ST-elevation ACS. Therefore, we performed this study to observe the efficacy of one-quarter standard-dose ticagrelor in comparison to standard-dose clopidogrel in Chinese patients with stable CAD.
Methods:
In a randomized, single-blind, crossover trial, 30 patients with stable CAD were randomized to one-quarter standard-dose ticagrelor (22.5mg BID for 7days) or standard-dose clopidogrel (75mg QD for 7days). Following a 2-week washout period, patients switched regimens. Light transmission aggregometry (LTA) and VerifyNow assay were used to measure platelet function.
Results:
The platelet aggregation rate (PAgR) was obviously lower with ticagrelor than clopidogrel (17.70%±12.67% versus 27.63%±13.10%, P<0.05). The % inhibition levels in the ticagrelor group exhibited significantly greater than that in the clopidogrel group (65.33%±21.31% versus 36.23%±23.01%, P<0.01). PRU values in the ticagrelor group were dramatically lower than that in the clopidogrel group (87.03±51.38 versus 163.77±58.66, P<0.01). High-platelet reactivity (HPR) (≥208 PRU) was 0% with ticagrelor and 16.67% with clopidogrel.
Conclusions:
One-quarter standard-dose ticagrelor provided greater degree of platelet inhibition than standard-dose clopidogrel in Chinese patients with stable CAD.
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