Platelet effect of prasugrel and ticagrelor in patients with ST-segment elevation myocardial infarction

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• 作者：Mathieu Kerneis ; Johanne Silvain ; Jé ; ré ; mie Abtan ; Marie Hauguel ; Olivier Barthé ; lé ; my ; Laurent Payot ; Delphine Brugier ; Sophie Galier ; Jean-Philippe Collet ; Gilles Montalescot ; ^{gilles.montalescot@psl.aphp.fr" class="auth_mail" title="E-mail the corresponding author}
• 关键词：STEMI ; Platelet function testing ; P2Y12 receptor antagonist ; Ticagrelor ; Prasugrel
• 刊名：Archives of Cardiovascular Diseases
• 出版年：2015
• 出版时间：October 2015
• 年：2015
• 卷：108
• 期：10
• 页码：502-510
• 全文大小：956 K

文摘

Recent studies have suggested that ticagrelor 90 mg twice daily provides stronger platelet inhibition than prasugrel 10 mg once daily in acute coronary syndrome patients undergoing percutaneous coronary intervention.

Objectives

To compare the effects of ticagrelor 90 mg twice daily and prasugrel 10 mg once daily on platelet reactivity in patients with ST-segment elevation myocardial infarction (STEMI), using: the VerifyNow^® P2Y₁₂ (VN-P2Y₁₂) assay, expressed in P2Y₁₂ reaction units (PRU); measurement of the vasodilator-stimulated phosphoprotein platelet reactivity index (VASP-PRI; %); and light transmission aggregometry (LTA), expressed as residual platelet aggregation (RPA; %).

Methods

Platelet reactivity was evaluated prospectively using the three assays 30 days after primary PCI in 118 patients with STEMI on a maintenance dose of prasugrel 10 mg once daily (n = 60) or ticagrelor 90 mg twice daily (n = 58).

Results

On-treatment platelet reactivity, assessed by the VN-P2Y₁₂ assay, was lower for ticagrelor compared with prasugrel (20.91 ± 4.59 PRU vs. 43.50 ± 6.98 PRU; P = 0.008) but was not significantly different when using the more specific VASP-PRI assay (13.05 ± 1.61% vs. 17.44 ± 1.97%; P = 0.09) or RPA assessed by LTA (10.49 ± 1.44% vs. 7.20 ± 1.27%; P = 0.09).

Conclusions

The difference in platelet reactivity between ticagrelor and prasugrel varies according to the platelet function test in patients with STEMI. The differences observed may be related more to the tests than to the drugs used.