Ticagrelor vs prasugrel one-month maintenance therapy: Impact on platelet reactivity and bleeding events

Dimitrios Alexopoulos; Katerina Stavrou; Ioanna Koniari; Vassilios Gkizas; Angelos Perperis; Kosmas Kontoprias; Chrysoula Vogiatzi; Theodora Bampouri; Ioanna Xanthopoulou

doi:10.1160/TH14-02-0119

Thrombosis and Haemostasis, Inhaltsverzeichnis

Thromb Haemost 2014; 112(03): 551-557
DOI: 10.1160/TH14-02-0119

Platelets and Blood Cells

Schattauer GmbH

Ticagrelor vs prasugrel one-month maintenance therapy: Impact on platelet reactivity and bleeding events

Dimitrios Alexopoulos

¹Department of Cardiology, Patras University Hospital, Rion, Patras, Greece

,

Katerina Stavrou

¹Department of Cardiology, Patras University Hospital, Rion, Patras, Greece

,

Ioanna Koniari

¹Department of Cardiology, Patras University Hospital, Rion, Patras, Greece

,

Vassilios Gkizas

¹Department of Cardiology, Patras University Hospital, Rion, Patras, Greece

,

Angelos Perperis

¹Department of Cardiology, Patras University Hospital, Rion, Patras, Greece

,

Kosmas Kontoprias

¹Department of Cardiology, Patras University Hospital, Rion, Patras, Greece

,

Chrysoula Vogiatzi

¹Department of Cardiology, Patras University Hospital, Rion, Patras, Greece

,

Theodora Bampouri

¹Department of Cardiology, Patras University Hospital, Rion, Patras, Greece

,

Ioanna Xanthopoulou

¹Department of Cardiology, Patras University Hospital, Rion, Patras, Greece

› Institutsangaben

Abstract

Summary

Platelet reactivity (PR) and bleeding events following therapy with ticagrelor vs prasugrel have not been adequately studied. We aimed to compare PR and bleeding events in patients with acute coronary syndrome (ACS) undergoing percutaneous coronary intervention (PCI) while on ticagrelor vs prasugrel for one month. Consecutive patients who were discharged either on ticagrelor 90 mg bid maintenance dose (MD) or prasugrel 10 mg MD were invited for PR assessment (VerifyNow, in PRU) at one month. High PR (HPR) was defined as >208 PRU. Bleeding events [Bleeding Academic Research Consortium (BARC) classification] were monitored. Out of 937 screened patients, 512 were analysed, 278 under ticagrelor MD and 234 under prasugrel MD. PR at 30 days (C-statistic of the propensity score model 0.63, 0.58–0.67 95% CI, p<0.001) was lower when on ticagrelor compared with prasugrel (33.3, 95% CI 29.3–37.3 vs 84.6, 95% CI 73.6–95.6, p<0.001). In the analysed population more BARC type 1 bleeding events were observed with ticagrelor compared to prasugrel (36.7% vs 28.2%, p=0.047). In 221 propensity score matched pairs, BARC type 1 bleeding rate was marginally higher in ticagrelor vs prasugrel treated patients (35.7% vs 27.1%, p=0.05). BARC type ≥2 events did not differ between groups 5 (2.3%) vs 5 (2.3%). HPR rate was higher for prasugrel-treated patients (5.4% vs 0%, p<0.001). In conclusion, in patients with ACS undergoing PCI, ticagrelor MD produces a significantly higher platelet inhibition compared to prasugrel MD. This pharmacodynamic difference might be associated with more nuisance bleeding events with ticagrelor use.

Clinical Trial Registration ClinicalTrials.gov Identifier: NCT01774955.

Keywords

Ticagrelor - prasugrel - platelet aggregation - percutaneous coronary intervention

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Referenzen

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