Ticagrelor versus prasugrel in diabetic patients with an acute coronary syndrome

Marc Laine; Corinne Frere; Richard Toesca; Julie Berbis; Pierre Barnay; Michel Pansieri; Pierre Michelet; Jacques Bessereau; Elise Camilleri; Olivia Ronsin; Olfa Helal; Franck Paganelli; Françoise Dignat-George; Laurent Bonello

doi:10.1160/TH13-05-0384

Thrombosis and Haemostasis, Table of Contents

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

¹Département de cardiologie, Hôpital universitaire nord, Assistance-Publique Hôpitaux de Marseille, Marseille, France

,

Corinne Frere

⁴INSERM UMRS 1076, Aix-Marseille University, Faculté de pharmacie, Marseille, France

,

Richard Toesca

²Pôle RUSH, Hôpital Timone, Marseille, France

,

Julie Berbis

³Unité de recherche EA 3279 et département de santé publique, Marseille, France

,

Pierre Barnay

⁵Service de Cardiologie, Hôpital d’Avignon, France

,

Michel Pansieri

⁵Service de Cardiologie, Hôpital d’Avignon, France

,

Pierre Michelet

²Pôle RUSH, Hôpital Timone, Marseille, France

,

Jacques Bessereau

²Pôle RUSH, Hôpital Timone, Marseille, France

,

Elise Camilleri

⁶Service de Cardiologie, Hôpital de Martigues, France

,

Olivia Ronsin

⁷Service d’endocrinologie, Hôpital universitaire nord, Assistance Publique -Hôpitaux de Marseille, Marseille, France

,

Olfa Helal

¹Département de cardiologie, Hôpital universitaire nord, Assistance-Publique Hôpitaux de Marseille, Marseille, France

,

Franck Paganelli

¹Département de cardiologie, Hôpital universitaire nord, Assistance-Publique Hôpitaux de Marseille, Marseille, France

,

Françoise Dignat-George

⁴INSERM UMRS 1076, Aix-Marseille University, Faculté de pharmacie, Marseille, France

,

Laurent Bonello

¹Département de cardiologie, Hôpital universitaire nord, Assistance-Publique Hôpitaux de Marseille, Marseille, France

⁴INSERM UMRS 1076, Aix-Marseille University, Faculté de pharmacie, Marseille, France

› Author Affiliations

Abstract

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

Full Text

References

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