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Microfluidics in Assessing Platelet Function
Published on: November 8, 2024
Effects of ticagrelor monotherapy vs. clopidogrel monotherapy on platelet reactivity: a randomized, crossover
Meijiao He1, Wei Yan1, Yun Zhang1
1Department of Cardiology, The First Affiliated Hospital of Harbin Medical University, Harbin Medical University, Harbin, P.R. China.
Insights
Ticagrelor monotherapy demonstrates a stronger platelet inhibition effect than clopidogrel in Chinese patients with chronic coronary syndrome. This finding suggests potential benefits for ticagrelor in reducing bleeding risk while maintaining antithrombotic efficacy.
Area of Science:
- Cardiology
- Pharmacology
- Clinical Trials
Background:
- Discontinuing aspirin with P2Y12 inhibitor monotherapy may reduce bleeding risk without compromising antithrombotic effects.
- Limited data exist on comparative platelet reactivity between ticagrelor and clopidogrel monotherapy.
Purpose of the Study:
- To evaluate and compare the efficacy of ticagrelor monotherapy versus clopidogrel monotherapy in Chinese patients with chronic coronary syndrome.
- To assess platelet reactivity under different P2Y12 inhibitor monotherapies.
Main Methods:
- A randomized, single-blinded, crossover trial involving 50 patients with chronic coronary syndrome.
- Patients received either ticagrelor (90 mg twice daily) or clopidogrel (75 mg once daily) for two weeks, followed by a two-week washout period and crossover.
- Platelet reactivity was assessed using light transmission aggregometry (LTA) and thromboelastography (TEG) assays.
Main Results:
- Ticagrelor significantly reduced the platelet aggregation rate (PAgR) for adenosine diphosphate (ADP) and arachidonic acid (AA) compared to clopidogrel.
- TEG assays indicated a significantly higher inhibition of platelet aggregation induced by ADP and AA with ticagrelor.
- High on-treatment platelet reactivity (HTPR) was notably lower with ticagrelor for both ADP and AA-induced aggregation.
Conclusions:
- Ticagrelor monotherapy exhibits a stronger inhibitory effect on platelet aggregation compared to clopidogrel monotherapy in Chinese patients with chronic coronary syndrome.
- The findings suggest ticagrelor may offer superior antiplatelet efficacy, potentially translating to improved clinical outcomes in managing chronic coronary syndrome.
Abstract:
Increasing clinical trials demonstrated that the discontinuation of aspirin while maintaining a P2Y12 inhibitor monotherapy could decrease the risk of bleeding without losing the antithrombotic effect. However, no data are available on the platelet reactivity of patients undergoing ticagrelor monotherapy vs. clopidogrel. Therefore, we performed this study to observe the efficacy of ticagrelor monotherapy vs. clopidogrel in Chinese patients with chronic coronary syndrome. This randomized, single-blinded, crossover trial enrolled 50 patients who were administered with ticagrelor (90 mg twice daily for 2 weeks) or clopidogrel (75 mg once daily for 2 weeks). Followed by a 2-week washout period, the two groups of patients underwent a crossover trial. Light transmission aggregometry (LTA) and thromboelastography (TEG) assays were used to test platelet reactivity. The platelet aggregation rate (PAgR) of ADP and AA was significantly lower with ticagrelor than clopidogrel (PAgR of ADP, 27.30% (7.30%-42.635%) vs. 35.55% (12.03%-69.25%), P = .0254; PAgR of AA, 77.80% (21.60%-86.43%) vs. 83.10% (67.13%-87.20%), P = .0400). There was no significant difference in PAgR of collagen and epinephrine between the two groups. The TEG assay showed that ADP and AA, which induced the inhibition of platelet aggregation, were significantly higher in the ticagrelor group than those in the clopidogrel group [ADP%, 69.00% (59.68%-88.95%) vs. 60.55% (35.98%-78.35%), P = .0020; AA%, 53.65% (22.75%-79.28%) vs. 15.15% (5.75%-70.25%), P = .0127]. High on-treatment platelet reactivity (HTPR) on ADP was 2.17% with ticagrelor and 19.57% with clopidogrel. HTPR on AA was 50.00% with ticagrelor and 69.57% with clopidogrel. Ticagrelor and clopidogrel caused the inhibition of ADP and AA-induced platelet aggregation. Moreover, ticagrelor monotherapy had a stronger inhibitory effect than clopidogrel monotherapy (except on collagen and epinephrine).
