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Updated: Feb 10, 2026
Evaluation of Bioenergetic Function in Cerebral Vascular Endothelial Cells
Published on: November 19, 2016
Effects of Ticagrelor, Prasugrel, or Clopidogrel on Endothelial Function and Other Vascular Biomarkers: A Randomized
Sara Ariotti1, Luis Ortega-Paz2, Maarten van Leeuwen3
1Swiss Cardiovascular Center Bern, Bern University Hospital, Bern, Switzerland.
Insights
Ticagrelor did not improve endothelial function or increase adenosine levels compared to prasugrel and clopidogrel in post-acute coronary syndrome patients. This study assessed ticagrelor
Area of Science:
- Cardiovascular Pharmacology
- Platelet Aggregation Inhibition
Background:
- Off-target effects of ticagrelor in post-acute coronary syndrome (ACS) patients are not well understood.
- Evaluating ticagrelor's impact on endothelial function and vascular biomarkers is crucial.
Purpose of the Study:
- To compare the effects of ticagrelor versus prasugrel and clopidogrel on endothelium-dependent dilation in stable ACS patients.
- To assess changes in systemic adenosine plasma levels and other vascular biomarkers with ticagrelor treatment.
Main Methods:
- A crossover study involving 54 stable post-ACS patients treated sequentially with ticagrelor, prasugrel, and clopidogrel.
- Endothelial function assessed via pulse amplitude tonometry (reactive hyperemia index) and flow-mediated dilation.
- Systemic adenosine levels and various vascular biomarkers were measured throughout treatment periods.
Main Results:
- No significant difference in reactive hyperemia index was observed between ticagrelor, prasugrel, and clopidogrel.
- Systemic adenosine plasma levels and vascular biomarkers remained unchanged across all treatment groups.
- Platelet reactivity units were lower with ticagrelor compared to clopidogrel and prasugrel.
Conclusions:
- Ticagrelor did not demonstrate superior endothelial function or increased systemic adenosine levels compared to prasugrel and clopidogrel in stabilized ACS patients.
- The findings suggest ticagrelor's off-target effects on endothelial function are comparable to other P2Y12 inhibitors in this patient population.
Objectives:
The study sought to assess whether treatment with ticagrelor, as compared with prasugrel and clopidogrel, improves endothelium-dependent dilation throughout the course of the treatment and other vascular biomarkers, including systemic adenosine plasma levels.
Background:
The in vivo off-target effects of ticagrelor in post-acute coronary syndrome (ACS) patients remain poorly characterized.
Methods:
Fifty-four stable post-ACS patients were sequentially exposed to each of the 3 oral P2Y12 inhibitors following a 3-period balanced Latin square crossover design with 4 weeks per treatment in 5 European centers. The primary endpoint was the assessment of endothelial function with pulse amplitude tonometry and expressed as reactive hyperemia index at treatment steady state. Secondary endpoints included reactive hyperemia index after loading or before maintenance regimen, systemic adenosine plasma levels, a wide set of vascular biomarkers, and ticagrelor or AR-C124910XX plasma levels throughout each ticagrelor period. In 9 patients, the evaluation of endothelial function was performed simultaneously by pulse amplitude tonometry and flow-mediated dilation.
Results:
Reactive hyperemia index did not differ after ticagrelor (1.970 ± 0.535) as compared with prasugrel (2.007 ± 0.640; p = 0.557) or clopidogrel (2.072 ± 0.646; p = 0.685), nor did systemic adenosine plasma levels or vascular biomarkers at any time points. P2Y12 platelet reactivity units were lower after ticagrelor as compared with clopidogrel at all time points and after maintenance dose as compared with prasugrel. Flow-mediated dilation did not differ after the maintenance dose of ticagrelor as compared with clopidogrel and prasugrel.
Conclusions:
Ticagrelor did not improve endothelial function or increased systemic adenosine plasma levels as compared with prasugrel and clopidogrel in stabilized patients who suffered from an ACS. (Hunting for the Off-Target Properties of Ticagrelor on Endothelial Function in Humans [HI-TECH]; NCT02587260).
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