Antiplatelet effects of ticagrelor versus clopidogrel after coronary artery bypass graft surgery: A single-center randomized controlled trial
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Published on: March 27, 2018
Fei Xu1, Wei Feng1, Zhou Zhou2
1Department of Cardiovascular Surgery, Fuwai Hospital, Chinese Academy of Medical Sciences, and Peking Union Medical College, Beijing, China.
Insights
Ticagrelor demonstrated a faster onset and higher peak inhibition of platelet aggregation compared to clopidogrel in patients undergoing coronary artery bypass grafting. Both treatments showed similar safety profiles regarding bleeding and major adverse cardiac events.
Area of Science:
- Cardiology
- Pharmacology
- Clinical Trials
Background:
- Platelet inhibition is crucial in managing patients post-coronary artery bypass grafting (CABG).
- Ticagrelor and clopidogrel are antiplatelet agents used in cardiovascular care.
- Comparing their efficacy in the perioperative period of CABG is clinically relevant.
Purpose of the Study:
- To compare the onset and degree of platelet inhibition between ticagrelor and clopidogrel in patients undergoing CABG.
- To assess the speed of achieving maximum platelet aggregation inhibition.
- To evaluate safety outcomes, including bleeding and major adverse cardiac events.
Main Methods:
- A single-center, randomized, open-label study involving 140 patients undergoing CABG.
- Patients were assigned to receive aspirin plus ticagrelor or aspirin plus clopidogrel.
- Platelet function was measured at multiple time points up to 30 days post-surgery.
Main Results:
- Ticagrelor showed significantly greater platelet aggregation inhibition at 2 hours and throughout the study period compared to clopidogrel (P < .001).
- A higher percentage of patients achieved maximum platelet inhibition within 24 hours with ticagrelor (52.9% vs 27.5%, P = .006).
- No significant differences in bleeding or major adverse cardiac events were observed between the groups.
Conclusions:
- Ticagrelor offers a faster onset of action and higher peak inhibition of platelet aggregation than clopidogrel in CABG patients.
- The findings suggest ticagrelor may provide more potent antiplatelet effects in this patient population.
- Both agents were associated with comparable safety outcomes in the context of CABG surgery.
Objective:
The study objective was to compare the onset of platelet inhibition (inhibition of platelet aggregation) between ticagrelor 90 mg twice per day and clopidogrel 75 mg once per day in patients receiving coronary artery bypass grafting.
Methods:
In a single-center, randomized, open-label study, 140 patients receiving coronary artery bypass grafting were randomly assigned to the aspirin + ticagrelor group or the aspirin + clopidogrel group in a 1:1 ratio. Participants in the aspirin + ticagrelor group took aspirin 100 mg once per day and ticagrelor 90 mg twice per day. Participants in the aspirin + clopidogrel group took aspirin 100 mg once per day and clopidogrel 75 mg once per day. Platelet function was determined before study treatment (0 hours); at 2 hours, 8 hours, 24 hours, and 72 hours after medication; and during follow-up at 30 days after surgery.
Results:
Inhibition of platelet aggregation at 2 hours after the first drug administration was greater for the aspirin + ticagrelor group than for the aspirin + clopidogrel group (34.2% [interquartile range, 9.1-66.0] vs 5.3% [interquartile range, -14.3-22.0], P < .001) and at all times in the study period (P < .001). More patients reached inhibition of platelet aggregation maximum within 24 hours in the aspirin + ticagrelor group than in the aspirin + clopidogrel group (52.9% vs 27.5%, P = .006). The average inhibition of platelet aggregation maximum from 2 to 24 hours was still greater in the aspirin + ticagrelor group than in the aspirin + clopidogrel group (72.3% ± 15.4% vs 49.2% ± 46.8%, P < .001). There were no differences in terms of bleeding or major adverse cardiac events between the 2 groups.
Conclusions:
In patients receiving coronary artery bypass grafting, the onset of action was faster and the peak inhibition of platelet aggregation was higher with ticagrelor than with clopidogrel.
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