Τίτλος:
Platelet inhibition with standard vs. lower maintenance dose of ticagrelor early after myocardial infarction (ELECTRA): A randomized, open-label, active-controlled pharmacodynamic and pharmacokinetic study
Γλώσσες Τεκμηρίου:
Αγγλικά
Περίληψη:
Aims: Currently available data indicate that reduction of ticagrelor maintenance dose (MD) 1-3 years after acute myocardial infarction (AMI) not only provides sufficient platelet inhibition but also can improve ticagrelor's safety profile. The aim of this study was to compare the antiplatelet effect of reduced and standard ticagrelor MD in stable patients beginning 1 month after AMI. Methods and results: In a single-centre, randomized, open-label, active-controlled trial, on Day 30 following AMI, 52 patients (26 in each study arm) were assigned in a 1:1 ratio to receive either reduced (60 mg b.i.d) or standard (90 mg b.i.d) ticagrelor MD for the following 2 weeks. On Day 45 after AMI the antiplatelet effect of ticagrelor was evaluated with the VASP assay and Multiplate, and there were no significant differences in platelet inhibition between patients on reduced vs. standard MD [VASP: 10.4 (5.6-22.2) vs. 14.1 (9.4-22.1) platelet reactivity index; P = 0.30; Multiplate: 30.0 (24.0-39.0) vs. 26.5 (22.0-35.0) U; P = 0.26]. Likewise, no differences were found regarding the prevalence of on-ticagrelor high platelet reactivity between patients on ticagrelor 60 mg b.i.d vs. 90 mg b.i.d (VASP: 4% vs. 8%; P = 0.67; Multiplate: 15% vs. 8%; P = 0.54). Administration of reduced MD resulted in proportionally lower plasma concentrations of ticagrelor and its active metabolite on Day 45 after AMI. Conclusion: These results suggest that lowering ticagrelor MD 1 month after AMI confers an adequate antiplatelet effect that is comparable to the standard dose. The tested strategy warrants further research to assess its clinical efficacy and safety. © 2019 Published on behalf of the European Society of Cardiology. All rights reserved.
Συγγραφείς:
Kubica, J.
Adamski, P.
Buszko, K.
Barańska, M.
Sikora, J.
Marszałł, M.P.
Sobczak, P.
Sikora, A.
Kuliczkowski, W.
Fabiszak, T.
Kubica, A.
Jilma, B.
Alexopoulos, D.
Navarese, E.P.
Περιοδικό:
EUROPEAN HEART JOURNAL-CARDIOVASCULAR PHARMACOTHERAPY
Εκδότης:
Oxford University Press
Λέξεις-κλειδιά:
ticagrelor; antithrombocytic agent; P2RY12 protein, human; purinergic P2Y receptor antagonist; purinergic P2Y12 receptor; ticagrelor, acute heart infarction; adult; antiplatelet activity; Article; controlled study; drug dose comparison; drug dose reduction; drug effect; drug screening; dyspnea; female; human; limit of quantitation; loading drug dose; maintenance drug dose; major clinical study; male; middle aged; patient compliance; percutaneous coronary intervention; phase 3 clinical trial; platelet reactivity; prevalence; priority journal; randomized controlled trial; thrombocyte aggregation inhibition; thrombosis; adverse event; aged; blood; clinical trial; metabolism; non ST segment elevation myocardial infarction; percutaneous coronary intervention; Poland; ST segment elevation myocardial infarction; thrombocyte; thrombocyte aggregation; treatment outcome, Aged; Blood Platelets; Female; Humans; Male; Middle Aged; Non-ST Elevated Myocardial Infarction; Percutaneous Coronary Intervention; Platelet Aggregation; Platelet Aggregation Inhibitors; Poland; Purinergic P2Y Receptor Antagonists; Receptors, Purinergic P2Y12; ST Elevation Myocardial Infarction; Ticagrelor; Treatment Outcome
DOI:
10.1093/ehjcvp/pvz004
