Crushed Versus Integral Tablets of Ticagrelor in ST-Segment Elevation Myocardial Infarction Patients: A Randomized Pharmacokinetic/Pharmacodynamic Study

Clinical Pharmacokinetics
Dimitrios AlexopoulosIoanna Xanthopoulou

Abstract

The objective of this study was to assess the pharmacokinetic and pharmacodynamic behavior of ticagrelor administered either as crushed (in the semi-upright sitting position) or as integral (in the supine position) tablets in ST-segment elevation myocardial infarction (STEMI) patients undergoing primary percutaneous coronary intervention (PCI). We randomized 20 patients to ticagrelor 180 mg either as 2 integral tablets administered in the supine position (standard administration) or as 2 tablets crushed and dispersed, administered in the semi-upright sitting position. Blood samples were drawn for pharmacokinetic and pharmacodynamic assessment at randomization (0 h) and at 0.5, 1, 2, and 4 h. At 1 h, ticagrelor plasma exposure and area under the plasma concentration-time curve from time zero to 1 h (AUC1) (co-primary endpoints) were higher in the crushed versus integral tablets group (median 586 vs. 70.1 ng/mL and 234 vs. 24.4 ng·h/mL, respectively), with a ratio of adjusted geometric means (95% confidence interval [CI]) of 12.67 (2.34-68.51) [p = 0.005] and 19.28 (3.51-106.06) [p = 0.002], respectively. Time to maximum plasma concentration was shorter in the crushed versus integral tablets group (median 2 vs. 4 h), with a ratio...Continue Reading

References

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Citations

Mar 26, 2016·Journal of the American College of Cardiology·Fabiana RolliniDominick J Angiolillo
Mar 26, 2016·Journal of the American College of Cardiology·Gennaro SardellaMassimo Mancone
Jun 28, 2016·Expert Review of Cardiovascular Therapy·Christos PappasDimitrios Alexopoulos
Nov 4, 2016·Expert Review of Cardiovascular Therapy·Aung MyatPaul A Gurbel
Sep 30, 2016·Expert Opinion on Pharmacotherapy·Piotr AdamskiJacek Kubica
Jan 31, 2017·EuroIntervention : Journal of EuroPCR in Collaboration with the Working Group on Interventional Cardiology of the European Society of Cardiology·Enrico FabrisGilles Montalescot
Feb 1, 2017·Journal of the American Association of Nurse Practitioners·Tania Gesheff, Cescelle Barbour
Dec 13, 2017·Journal of Cardiovascular Pharmacology and Therapeutics·Dimitrios AlexopoulosJohn Lekakis
Oct 26, 2018·American Journal of Cardiovascular Drugs : Drugs, Devices, and Other Interventions·Frédéric LapostolleUNKNOWN ATLANTIC Investigators
Mar 19, 2019·Journal of Thrombosis and Haemostasis : JTH·Matteo SerenelliGianluca Campo
Oct 16, 2019·The Journal of Clinical Endocrinology and Metabolism·Tomohiko YoshidaTomoaki Tanaka
Feb 22, 2017·EuroIntervention : Journal of EuroPCR in Collaboration with the Working Group on Interventional Cardiology of the European Society of Cardiology·Hanna RatcovichLene Holmvang
Feb 22, 2017·EuroIntervention : Journal of EuroPCR in Collaboration with the Working Group on Interventional Cardiology of the European Society of Cardiology·Fabiana RolliniDominick J Angiolillo
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Oct 4, 2017·The Journal of Nutrition, Health & Aging·M FodilC Trivalle
Aug 8, 2018·Scientific Reports·Piotr AdamskiJacek Kubica
Mar 12, 2021·Expert Review of Cardiovascular Therapy·Felix VollSalvatore Cassese
Apr 22, 2021·Expert Review of Cardiovascular Therapy·Piera Capranzano, Dominick J Angiolillo
Jun 26, 2021·JACC. Cardiovascular Interventions·Rosanne F VogelGeorgios J Vlachojannis
Jun 26, 2021·JACC. Cardiovascular Interventions·Arka Chatterjee, Kristina Skinner
Aug 24, 2021·European Heart Journal·Himawan FernandoDion Stub

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