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Thromb Haemost 2014; 111(02): 273-278
DOI: 10.1160/TH13-05-0384
Platelets and Blood Cells
Schattauer GmbH

Ticagrelor versus prasugrel in diabetic patients with an acute coronary syndrome

A pharmacodynamic randomised study
Marc Laine
1   Département de cardiologie, Hôpital universitaire nord, Assistance-Publique Hôpitaux de Marseille, Marseille, France
,
Corinne Frere
4   INSERM UMRS 1076, Aix-Marseille University, Faculté de pharmacie, Marseille, France
,
Richard Toesca
2   Pôle RUSH, Hôpital Timone, Marseille, France
,
Julie Berbis
3   Unité de recherche EA 3279 et département de santé publique, Marseille, France
,
Pierre Barnay
5   Service de Cardiologie, Hôpital d’Avignon, France
,
Michel Pansieri
5   Service de Cardiologie, Hôpital d’Avignon, France
,
Pierre Michelet
2   Pôle RUSH, Hôpital Timone, Marseille, France
,
Jacques Bessereau
2   Pôle RUSH, Hôpital Timone, Marseille, France
,
Elise Camilleri
6   Service de Cardiologie, Hôpital de Martigues, France
,
Olivia Ronsin
7   Service d’endocrinologie, Hôpital universitaire nord, Assistance Publique -Hôpitaux de Marseille, Marseille, France
,
Olfa Helal
1   Département de cardiologie, Hôpital universitaire nord, Assistance-Publique Hôpitaux de Marseille, Marseille, France
,
Franck Paganelli
1   Département de cardiologie, Hôpital universitaire nord, Assistance-Publique Hôpitaux de Marseille, Marseille, France
,
Françoise Dignat-George
4   INSERM UMRS 1076, Aix-Marseille University, Faculté de pharmacie, Marseille, France
,
Laurent Bonello
1   Département de cardiologie, Hôpital universitaire nord, Assistance-Publique Hôpitaux de Marseille, Marseille, France
4   INSERM UMRS 1076, Aix-Marseille University, Faculté de pharmacie, Marseille, France
› Author Affiliations Financial support: The present work was supported by a grant from the Assistance-Publique Hôpitaux de Marseille.
Further Information

Publication History

Received: 13 May 2013

Accepted after major revision: 23 September 2013

Publication Date:
27 November 2017 (online)

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Summary

Optimal P2Y12 receptor blockade is critical to prevent ischaemic recurrence in patients undergoing percutaneous coronary intervention (PCI). We aimed to compare the level of platelet reactivity (PR) inhibition achieved by prasugrel and ticagrelor loading dose (LD) in diabetic acute coronary syndrome (ACS) patients undergoing PCI. We performed a single-center prospective open-label randomised trial. Patients with diabetes mellitus undergoing PCI for an ACS were randomised to receive prasugrel 60 mg or ticagrelor 180 mg. The primary endpoint of the study was the level of platelet reactivity (PR) assessed between 6 and 18 hours post-LD using the VASP index. We randomised 100 diabetic patients undergoing PCI for an ACS. No difference was observed in baseline characteristics between the two groups. In particular, the rate of patient receiving insulin therapy was identical (25 vs 28.6%; p =0.7). Ticagrelor achieved a significantly lower PR compared to prasugrel loading dose (17.3 ± 14.2 vs 27.7 ± 23.3%; p=0.009). In addition the rate of high on-treatment platelet reactivity, defined by a VASP ≥50%, tend to be lower in the ticagrelor group although the difference did not reach statistical significance (6 vs 16%; p=0.2). The rate of low on treatment PR was identical (60 vs 54%; p=0.8). The present study demonstrates that ticagrelor LD is superior to prasugrel LD to reduce PR in ACS patients with diabetes mellitus. Whether the higher potency of ticagrelor could translate into a clinical benefit should be investigated.

Keywords

VASP index - P2Y12 receptor blockade - acute coronary syndrome - diabetes mellitus - percutaneous coronary intervention
 

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