03375nam 22003377a 4500008004200000022001400042040002000056099001300076245020400089251006500293252004000358253004600398260000900444260001100453266001500464520042100479520010100900520018501001520013201186520123501318546001202553650003402565651003902599657002002638700001702658790013302675856009102808942001702899952010602916999001503022170428s20172017 xxu||||| |||| 00| 0 eng d a2047-9980 aOvid MEDLINE(R) a28356282 aImpact of Diabetes Mellitus on the Pharmacodynamic Effects of Ticagrelor Versus Clopidogrel in Troponin-Negative Acute Coronary Syndrome Patients Undergoing Ad Hoc Percutaneous Coronary Intervention. aJournal of the American Heart Association. 6(4), 2017 Mar 29 aJ Am Heart Assoc. 6(4), 2017 Mar 29 aJournal of the American Heart Association c2017 fFY2017 d2017-05-06 aBACKGROUND: Diabetes mellitus (DM) is associated with enhanced platelet reactivity and impaired response to oral antiplatelet therapy, including clopidogrel. This post hoc analysis investigated the pharmacodynamic effects of ticagrelor versus clopidogrel loading dose (LD) in troponin-negative acute coronary syndrome patients with or without DM undergoing percutaneous coronary intervention in the Ad Hoc PCI study. aCLINICAL TRIAL REGISTRATION: URL: http://www.clinicaltrials.gov. Unique identifier: NCT01603082. aCONCLUSIONS: Compared with clopidogrel, ticagrelor achieved faster, enhanced platelet inhibition and reduced high on-treatment platelet reactivity rates, in DM and non-DM patients. aCopyright à 2017 The Authors and AstraZeneca. Published on behalf of the American Heart Association, Inc., by Wiley Blackwell. aMETHODS AND RESULTS: Patients randomized (1:1) to receive ticagrelor 180 mg LD or clopidogrel 600 mg LD were assessed by diabetic status. Platelet reactivity (P2Y12 reaction units [PRU] on VerifyNow assay) was measured pre-LD, at 0.5, 2, and 8 hours post-LD, and at the end of the percutaneous coronary intervention. The primary endpoint was PRU levels 2 hours post-LD; secondary endpoints included rates of high on-treatment platelet reactivity (PRU>208). Of 100 randomized patients, 51 received ticagrelor (DM, n=20; non-DM, n=31) and 49 clopidogrel (DM, n=16; non-DM, n=33). At 2 hours post-LD, mean (SD) PRU levels in DM patients were 130.1 (111.7) with ticagrelor versus 287.6 (71.9) with clopidogrel (mean [95%CI] difference -157.5 [-225.3, -89.8]; P<0.001); in non-DM patients, they were 75.3 (75.7) versus 243.0 (72.4) (mean difference -167.7 [-207.1, -128.3]; P<0.001). High on-treatment platelet reactivity rates at 2 hours post-LD were also significantly (P<0.001) reduced with ticagrelor versus clopidogrel in DM and non-DM patients. Between-treatment differences for PRU and high on-treatment platelet reactivity were not significant at earlier time points but were at 8 hours post-LD (P<0.001). aEnglish aIN PROCESS -- NOT YET INDEXED aMedStar Heart & Vascular Institute aJournal Article aWaksman, Ron aAngiolillo DJ, Carlson GF, Dangas G, Franchi F, Khan ND, Mehran R, Raveendran G, Rollini F, Sweeny JM, Teng R, Waksman R, Zhao Y uhttps://dx.doi.org/10.1161/JAHA.117.005650zhttps://dx.doi.org/10.1161/JAHA.117.005650 cARTdArticle 001040708Articleaauthcatbauthcatd2017-05-06l0o28356282p28356282r2017-05-06w2017-05-06yART c2159d2159