Ticagrelor vs clopidogrel followed by ticagrelor re-loading in patients with ST-segment elevation myocardial infarction undergoing primary percutaneous coronary intervention: A randomized, pharmacodynamic comparison

Platelets
Dimitrios AlexopoulosIoanna Xanthopoulou

Abstract

Among patients allocated to ticagrelor in the primary percutaneous coronary intervention (PCI) cohort of Platelet Inhibition and Patient Outcomes (PLATO) trial, 40.7% had received pre-randomization 600 mg of clopidogrel. This scenario is frequently employed in real-world practice. In a prospective, three-center, single-blind, parallel design study, 74 P2Y12 inhibitor-naive patients undergoing primary PCI were randomized (Hour 0) to ticagrelor 180 mg loading dose (LD) vs clopidogrel 600 mg LD followed after 2 h by ticagrelor 180 mg re-LD. Platelet reactivity (VerifyNow, in PRU) was assessed at Hour 0, 2, 4, 6, and 24. The primary comparison was non-inferiority of ticagrelor to clopidogrel followed by ticagrelor re-LD regarding platelet reactivity at 24 h using a prespecified margin of <35 PRU for the upper bound of the one-sided 97.5% confidence interval (CI). Ticagrelor was proven non-inferior to clopidogrel followed by ticagrelor re-LD with a difference between arms of 13.5 PRU (28.8 upper 97.5% CI), p = 0.001. At Hour 2, platelet reactivity was lower in ticagrelor only vs clopidogrel followed by ticagrelor re-LD groups with least square estimate mean difference (95% CI) -105.7 (-140.6 to -70.8), p < 0.001, without significant...Continue Reading

References

May 6, 2008·Thrombosis Research·Antonius A C M HeestermansJurriën M ten Berg
Jul 17, 2009·Cardiovascular Therapeutics·Steen Husted, J J J van Giezen
Nov 22, 2012·Circulation. Cardiovascular Interventions·Dimitrios AlexopoulosGeorge Hahalis
Jan 1, 2013·International Journal of Cardiology·James J DiNicolantonio, Victor L Serebruany
Jun 12, 2013·Journal of the American College of Cardiology·Dimitrios AlexopoulosGeorge Hahalis
Feb 6, 2016·Heart·Matthijs A VeldersUNKNOWN PLATO Investigators

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