Consistent platelet inhibition with ticagrelor 60 mg twice-daily following myocardial infarction regardless of diabetes status

Mark R. Thomas; Dominick J. Angiolillo; Marc P. Bonaca; Ramzi A. Ajjan; Heather M. Judge; Fabiana Rollini; Francesco Franchi; Arif J. Ahsan; Deepak L. Bhatt; Julia F. Kuder; Philippe Gabriel Steg; Marc Cohen; Rangasamy Muthusamy; Marc S. Sabatine; Robert F. Storey

doi:10.1160/TH16-09-0703

Thrombosis and Haemostasis, Inhaltsverzeichnis

Thromb Haemost 2017; 117(05): 940-947
DOI: 10.1160/TH16-09-0703

Cellular Haemostasis and Platelets

Schattauer GmbH

Consistent platelet inhibition with ticagrelor 60 mg twice-daily following myocardial infarction regardless of diabetes status

Mark R. Thomas

¹Cardiovascular Research Unit, Department of Infection Immunity and Cardiovascular Disease, University of Sheffield, Sheffield, UK

,

Dominick J. Angiolillo

²Division of Cardiology, University of Florida College of Medicine, Jacksonville, Florida, USA

,

Marc P. Bonaca

³TIMI Study Group, Division of Cardiovascular Medicine, Brigham and Women’s Hospital, Boston, Massachusetts, USA

,

Ramzi A. Ajjan

⁴Leeds Institute of Cardiovascular and Metabolic Medicine, University of Leeds, Leeds, UK

,

Heather M. Judge

¹Cardiovascular Research Unit, Department of Infection Immunity and Cardiovascular Disease, University of Sheffield, Sheffield, UK

,

Fabiana Rollini

²Division of Cardiology, University of Florida College of Medicine, Jacksonville, Florida, USA

,

Francesco Franchi

²Division of Cardiology, University of Florida College of Medicine, Jacksonville, Florida, USA

,

Arif J. Ahsan

⁵Trent Cardiac Centre, Nottingham University Hospitals NHS Trust, Nottingham, UK

,

Deepak L. Bhatt

³TIMI Study Group, Division of Cardiovascular Medicine, Brigham and Women’s Hospital, Boston, Massachusetts, USA

,

Julia F. Kuder

³TIMI Study Group, Division of Cardiovascular Medicine, Brigham and Women’s Hospital, Boston, Massachusetts, USA

,

Philippe Gabriel Steg

⁶INSERM-Unité 1148, Assistance Publique- Hôpitaux de Paris, Département Hospitalo-Universitaire FIRE, Hôpital Bichat, and Université Paris-Diderot, Sorbonne-Paris Cité, Paris, France

,

Marc Cohen

⁷Newark Beth Israel Medical Center, Rutgers-New Jersey Medical School, Newark, New Jersey, USA

,

Rangasamy Muthusamy

⁸Rotherham NHS Foundation Trust, Rotherham, UK

,

Marc S. Sabatine

³TIMI Study Group, Division of Cardiovascular Medicine, Brigham and Women’s Hospital, Boston, Massachusetts, USA

,

Robert F. Storey

¹Cardiovascular Research Unit, Department of Infection Immunity and Cardiovascular Disease, University of Sheffield, Sheffield, UK

› Institutsangaben

Abstract

Summary

Diabetes increases cardiovascular risk and reduces pharmacodynamic response to some oral antiplatelet drugs. This study aimed to determine whether ticagrelor 60 mg twice daily (bid) provided potent and consistent platelet inhibition in patients with vs without diabetes in the PEGASUS-TIMI 54 platelet function substudy. Out of 180 patients studied, 58 patients were randomised to and had received at least four weeks of ticagrelor 60 mg bid, with 20 (34 %) having diabetes, 58 patients received ticagrelor 90 mg bid, with 12 (21 %) having diabetes, and 64 patients received placebo, with 18 (28 %) having diabetes. Blood was sampled pre- and 2 hours post-maintenance dose. In patients treated with ticagrelor 60 mg bid, on-treatment platelet reactivity to ADP, as determined by light transmission aggregometry (LTA), VerifyNow and VASP, was similar in patients with vs without diabetes (LTA post-dose, ADP 20 ?M: 29 ± 14 vs 34 ± 10 %, respectively; p = 0.19). A consistent inhibitory effect of ticagrelor 60 mg bid was observed pre- and post-dose regardless of diabetes status, even in insulin-treated patients. Patients with diabetes did not have an increased incidence of high platelet reactivity in either ticagrelor group. Platelet reactivity was similar in patients with diabetes treated with ticagrelor 60 mg vs 90 mg bid. Pharmacokinetics of ticagrelor were not affected by diabetes status. In conclusion, ticagrelor 60 mg bid is equally effective at reducing platelet reactivity in patients with and without diabetes, yielding a consistently high level of platelet inhibition regardless of diabetes status.

Keywords

Coronary artery disease - acute coronary syndromes - pharmacology - pharmacodynamics

Volltext

Referenzen

References
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