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Updated: Aug 3, 2025
Microfluidics in Assessing Platelet Function
Published on: November 8, 2024
Impact of renal function on Ticagrelor-induced antiplatelet effects in coronary artery disease patients
Manuel Veas Porlán1, Antonio Tello-Montoliu1, Cecilia López-García1
1Cardiology Department, Hospital Clínico Universitario Virgen de la Arrixaca, University of Murcia, IMIB-Arrixaca, CIBERCV, Murcia, Spain.
Insights
Ticagrelor effectively inhibits platelets in patients with acute coronary syndrome (ACS) regardless of kidney function. However, patients with chronic renal failure (CKD) exhibit higher ticagrelor levels after the loading dose.
Area of Science:
- Pharmacology
- Nephrology
- Cardiology
Background:
- Chronic renal failure (CKD) is linked to increased platelet reactivity.
- Clopidogrel shows reduced clinical benefit in CKD patients.
- Ticagrelor offers a superior pharmacokinetic and pharmacodynamic profile over clopidogrel.
Purpose of the Study:
- To investigate the impact of renal failure on ticagrelor pharmacokinetics and pharmacodynamics in acute coronary syndrome (ACS) patients.
- To compare ticagrelor efficacy in patients with normal renal function versus those with CKD.
Main Methods:
- Prospective mechanistic cohort study.
- Patients stratified by estimated glomerular filtration rate (eGFR ≥ 60 mL/min vs. eGFR < 60 mL/min).
- Platelet function assessed via VerifyNow; drug levels measured post-loading dose.
Main Results:
- No significant difference in platelet inhibition between groups after loading or 7 days.
- Higher ticagrelor and active metabolite (AR-C124910XX) levels observed in CKD patients at 4 and 6 hours post-loading dose.
- 48 patients recruited: 35 with eGFR ≥ 60 mL/min, 13 with eGFR < 60 mL/min.
Conclusions:
- Ticagrelor provides comparable platelet inhibition in ACS patients irrespective of renal function.
- Renal impairment is associated with higher ticagrelor and active metabolite concentrations.
- These findings support ticagrelor's use in ACS patients with varying degrees of kidney function.
Background:
Chronic renal failure (CKD) is associated with the presence of increased platelet reactivity and lower clinical benefit of clopidogrel. Ticagrelor has a more favorable pharmacodynamic and pharmacokinetic profile compared to clopidogrel, which has translated into better clinical outcomes in patients with acute coronary syndrome (ACS). We conducted a prospective mechanistic cohort study in order to investigate the impact of renal failure on the pharmacokinetics and pharmacodynamics of ticagrelor in patients with acute ACS.
Methods:
Patients were divided into two groups based on their estimated renal clearances (eGFR ≥ 60 mL/min and eGFR < 60 mL/min). Platelet function was determined using the VerifyNow system at baseline, after the ticagrelor loading dose and at discharge. In addition, levels of ticagrelor and its active metabolite (AR-C124910XX) were determined in the first hour after loading dose.
Results:
48 patients were recruited (eGFR ≥ 60 mL/min: 35 and eGFR < 60 mL/min: 13). There were no significant differences between the groups in terms of platelet inhibition after the loading or after 7 days of treatment (p = 0.219). However, the levels of ticagrelor and its active metabolite were lower in subjects with normal renal function than in CKD, especially at 4 (p = 0.02 and 0.04 respectively) and 6 h of loading (p = 0.042 and 0.08 respectively).
Conclusion:
No differences in platelet inhibition were observed after treatment with ticagrelor in patients with different renal function, although patients with renal impairment showed higher levels of ticagrelor and AR-C124910XX after 4 h of the loading dose.
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