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Ticagrelor versus prasugrel in patients with high on-clopidogrel treatment platelet reactivity after PCI: The
Isabell Bernlochner1, Katharina Mayer2, Martin Orban3
1a Medizinische Klinik und Poliklinik, Klinikum rechts der Isar , Technische Universität München , Munich , Germany.
Insights
Ticagrelor and prasugrel showed similar antiplatelet efficacy in patients with high on-treatment platelet reactivity after percutaneous coronary intervention. Neither drug demonstrated superiority, and ticagrelor did not meet noninferiority criteria compared to prasugrel.
Area of Science:
- Cardiology
- Pharmacology
- Clinical Trials
Background:
- High on-treatment platelet reactivity (HTPR) on clopidogrel increases cardiovascular event risk post-percutaneous coronary intervention (PCI).
- Effective antiplatelet therapy is crucial for managing patients undergoing PCI.
Purpose of the Study:
- To compare the antiplatelet efficacy of ticagrelor versus prasugrel in patients with HTPR on clopidogrel.
- To assess if ticagrelor is noninferior to prasugrel in inhibiting platelet aggregation.
Main Methods:
- A prospective, randomized clinical study involving 70 patients with HTPR post-PCI.
- Patients received either ticagrelor or prasugrel loading and maintenance doses.
- Adenosine diphosphate-induced platelet aggregation was measured on day 2 post-randomization.
Main Results:
- The mean difference in platelet aggregation between ticagrelor and prasugrel was 6 AU×min, exceeding the noninferiority margin of 18 AU×min (P=0.29).
- No significant difference in absolute platelet reactivity levels was observed between the groups (138 ± 100 AU×min vs. 132 ± 64 AU×min, P=0.77).
Conclusions:
- Neither ticagrelor nor prasugrel showed statistically superior efficacy in inhibiting platelet aggregation in this patient group.
- The study could not formally demonstrate the noninferiority of ticagrelor compared to prasugrel for patients with HTPR post-PCI.
Abstract:
Patients with high on-treatment platelet reactivity (HTPR) on clopidogrel are at high risk for adverse cardiovascular events after percutaneous coronary intervention (PCI). The aim of the ISAR-ADAPT-PF study was to assess the antiplatelet efficacy of ticagrelor versus prasugrel in patients with HTPR on clopidogrel. In a prospective and randomized clinical study, 70 patients with HTPR on clopidogrel loading dose (LD) within 24 h post PCI were assigned to receive either ticagrelor [180 mg LD followed by 90 mg maintenance dose (MD) twice daily] or prasugrel (60 mg LD followed by 10 mg MD once daily). The adenosine diphosphate-induced platelet aggregation assessed on the Multiplate analyzer on day 2 after randomization (primary end point) was as follows: the mean difference between the two treatment groups was 6 aggregation units (AU) × min with an upper 95% confidence interval (CI) of 41 AU × min, which was greater than the predefined noninferiority margin of 18 AU × min (P for noninferiority = 0.29). However, no significant differences in absolute platelet reactivity levels between ticagrelor- versus prasugrel-treated patients at that time point were observed (138 ± 100 AU × min vs. 132 ± 64 AU × min, P for superiority = 0.77). In conclusion, neither drug was statistically more effective for inhibition of platelet aggregation in patients with HTPR on clopidogrel post PCI, although the study could not formally demonstrate the assumed noninferiority of ticagrelor versus prasugrel.
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