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Microfluidics in Assessing Platelet Function
Published on: November 8, 2024
The effect of antiplatelet drug on coronary endothelial and microvascular function: comparison with ticagrelor and
Woong Gil Choi1, Gi Chang Kim1, Cheol Ho Lee1
1Department of Internal Medicine, Konkuk University School of Medicine, Chungju, Korea.
Insights
Ticagrelor improved coronary microvascular function and demonstrated a potent antiplatelet effect in East-Asian patients. Low-dose ticagrelor showed satisfactory results compared to clopidogrel.
Area of Science:
- Cardiology
- Pharmacology
- Vascular Biology
Background:
- Coronary endothelial and microvascular function are critical in cardiovascular disease pathogenesis.
- Understanding the impact of antiplatelet agents on these functions is essential for patient outcomes.
Purpose of the Study:
- To assess the effect of ticagrelor on coronary artery function in East-Asian patients.
- To evaluate the antiplatelet efficacy of low-dose ticagrelor compared to clopidogrel.
Main Methods:
- A randomized study involving 61 patients with non-significant coronary disease.
- Patients received ticagrelor (90 mg or 45 mg bid) or clopidogrel (75 mg qd).
- Coronary flow reserve (CFR), asymmetric dimethylarginine (ADMA), CD40 ligand, P-selectin, index of microvascular resistance (IMR), and platelet reactivity were measured.
Main Results:
- Ticagrelor significantly reduced the index of microvascular resistance (IMR) compared to clopidogrel.
- P-selectin levels were lower in the ticagrelor group.
- Ticagrelor demonstrated superior platelet inhibition across both dosage groups compared to clopidogrel.
Conclusions:
- Ticagrelor may improve coronary microvascular function.
- Low-dose ticagrelor provides effective antiplatelet activity in East-Asian patients.
- Ticagrelor represents a potential therapeutic option for managing coronary vascular dysfunction.
Background/Aims:
Coronary endothelial and microvascular function play important roles in cardiovascular disease. We aimed to evaluate the effect of ticagrelor on coronary artery function and tested the antiplatelet effect of low dose ticagrelor in East-Asian patients.
Methods:
Sixty-one consecutive patients with non-significant coronary disease were included in the study. Initially, patients were randomized in 1:1:1 ratio to receive drugs: ticagrelor 90 mg twice a day (bid; n = 22), ticagrelor 45 mg bid (n = 19) or clopidogrel 75 mg once a day (qd; n = 20) and then divided into two groups (ticagrelor vs clopidogrel) for evaluation of coronary artery function, and three groups for evaluation of antiplatelet function. Endothelial dysfunction was measured by coronary flow reserve (CFR), and changes in the levels of asymmetric dimethylarginine (ADMA), cluster of differentiation (CD) 40 ligand, and P-selectin. Microvascular function was evaluated as index of microvascular resistance (IMR). Platelet reactivity was assessed by VerifyNow P2Y12 assay.
Results:
The levels of CFR, ADMA, and CD 40 ligand were not different between the two groups. However, P-selectin was lower in the ticagrelor group compared with clopidogrel group. IMR was significantly lower in the ticagrelor group compared with clopidogrel group (median, 15.0 [interquartile range, 12.0 to 21.0] vs. 47.5 [23.0 to 67.5], p = 0.014). There was significant difference in platelet inhibition among the three groups (ticagrelor 90 mg bid vs. ticagrelor 45 mg bid vs. clopidogrel 75 mg qd; 85.57 ± 47.63 vs. 120.33 ± 51.09 vs. 256.42 ± 55.10, p < 0.001).
Conclusion:
It is hypothesized that ticagrelor might ameliorate the coronary microvascular function. When compared with clopidogrel, low dose ticagrelor exhibited satisfactory antiplatelet effect in the present study.
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