MedStar Authors catalog › Details for: Effects of Ticagrelor Versus Clopidogrel in Troponin-Negative Patients With Low-Risk ACS Undergoing Ad Hoc PCI.
Effects of Ticagrelor Versus Clopidogrel in Troponin-Negative Patients With Low-Risk ACS Undergoing Ad Hoc PCI. Journal: Journal of the American College of Cardiology.Published: 2016ISSN: 0735-1097.UI/PMID: 26868683.Subject(s): Acute Coronary Syndrome/bl [Blood] | *Acute Coronary Syndrome/th [Therapy] | Adenosine/ad [Administration & Dosage] | *Adenosine/aa [Analogs & Derivatives] | Adenosine/pk [Pharmacokinetics] | Administration, Oral | Aged | Dose-Response Relationship, Drug | Female | Follow-Up Studies | Humans | Male | Middle Aged | *Percutaneous Coronary Intervention/mt [Methods] | Platelet Aggregation/de [Drug Effects] | Platelet Aggregation Inhibitors/ad [Administration & Dosage] | Platelet Aggregation Inhibitors/pk [Pharmacokinetics] | Platelet Function Tests | *Preoperative Care/mt [Methods] | Prospective Studies | Purinergic P2Y Receptor Antagonists/ad [Administration & Dosage] | Purinergic P2Y Receptor Antagonists/pk [Pharmacokinetics] | Ticlopidine/ad [Administration & Dosage] | *Ticlopidine/aa [Analogs & Derivatives] | Ticlopidine/pk [Pharmacokinetics] | Treatment Outcome | *Troponin/bl [Blood]Institution(s): MedStar Heart & Vascular InstituteActivity type: Journal Article.Medline article type(s): Clinical Trial, Phase IV | Journal Article | Multicenter Study | Randomized Controlled TrialOnline resources: Click here to access online Digital Object Identifier: http://dx.doi.org/10.1016/j.jacc.2015.11.044 (Click here) Abbreviated citation: J Am Coll Cardiol. 67(6):603-13, 2016 Feb 16.Local Holdings: Available online from MWHC library: 1995 - present, Available in print through MWHC library:1999-2007.Abstract: BACKGROUND: Many low-risk acute coronary syndrome (ACS) patients are not pre-treated with a P2Y12 receptor inhibitor, and percutaneous coronary interventions (PCIs) are often performed on an ad hoc basis in this population. Pharmacodynamic (PD) studies comparing ticagrelor versus clopidogrel in patients undergoing ad hoc PCI are lacking.Abstract: OBJECTIVES: This study sought to assess PD effects of ticagrelor versus clopidogrel loading dose (LD) in the peri-procedural period among troponin-negative ACS patients undergoing ad hoc PCI.Abstract: METHODS: This was a prospective, open-label, randomized, multicenter, parallel-group, phase IV PD study. One hundred P2Y12 inhibitor-naive patients presenting with biomarker-negative ACS and undergoing ad hoc PCI, on a background of aspirin therapy, were randomized to receive either ticagrelor 180 mg LD or clopidogrel 600 mg LD. Platelet reactivity (P2Y12 reaction units [PRU]; VerifyNow assay) was measured at 5 time points: pre-LD, at 0.5, 2, and 8 h post-LD, and at end of PCI. The primary endpoint was PRU levels 2 h post-LD; secondary endpoints included PRU levels at all other time points and inhibition of platelet aggregation; an exploratory analysis evaluated rates of high on-treatment platelet reactivity (HPR) (PRU >208).Abstract: RESULTS: At 2 h, PRU levels were significantly lower with ticagrelor versus clopidogrel (98.4 +/- 95.4 vs. 257.5 +/- 74.5; p < 0.001; primary endpoint). PRU levels diverged as early as 0.5 h post-LD, with significant differences observed by the end of PCI (mean 0.6 h post-LD) and maintained up to 8 h post-LD. HPR rates were also significantly reduced with ticagrelor compared with clopidogrel at the end of PCI (p = 0.030), and at 2 h (p < 0.001) and 8 h (p < 0.001) after LD.Abstract: CONCLUSIONS: In low-risk ACS patients undergoing ad hoc PCI, ticagrelor LD provides more prompt and potent platelet inhibition, and lower HPR rates, compared with clopidogrel LD. (Ad Hoc Percutaneous Coronary Intervention Study in Acute Coronary Syndrome Patients: NCT01603082).Copyright © 2016 American College of Cardiology Foundation. Published by Elsevier Inc. All rights reserved.