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CC BY-NC-ND 4.0 · Thromb Haemost 2023; 123(04): 464-477
DOI: 10.1055/a-1988-5047
Atherosclerosis and Ischaemic Disease

Association between Platelet Count and Treatment Effect of Ticagrelor or Prasugrel in Patients with Acute Coronary Syndromes

Authors

  • Tobias Koch 

    1   Klinik für Herz- und Kreislauferkrankungen, Deutsches Herzzentrum München, Technische Universität München, Munich, Germany

  • Shqipdona Lahu

    1   Klinik für Herz- und Kreislauferkrankungen, Deutsches Herzzentrum München, Technische Universität München, Munich, Germany

  • J. J. Coughlan

    1   Klinik für Herz- und Kreislauferkrankungen, Deutsches Herzzentrum München, Technische Universität München, Munich, Germany

  • Salvatore Cassese

    1   Klinik für Herz- und Kreislauferkrankungen, Deutsches Herzzentrum München, Technische Universität München, Munich, Germany

  • Felix Voll

    1   Klinik für Herz- und Kreislauferkrankungen, Deutsches Herzzentrum München, Technische Universität München, Munich, Germany

  • Gjin Ndrepepa

    1   Klinik für Herz- und Kreislauferkrankungen, Deutsches Herzzentrum München, Technische Universität München, Munich, Germany

  • Maurizio Menichelli

    2   Ospedale Fabrizio Spaziani, Cardiology, Frosinone, Italy

  • Christian Valina

    3   Department of Cardiology and Angiology II, University Heart Center Freiburg - Bad Krozingen, Standort Bad Krozingen, Germany

  • Rayyan Hemetsberger

    4   Division of Cardiology, Department of Internal Medicine II, Medical University of Vienna, Vienna, Austria

  • Bernhard Witzenbichler

    5   Helios Amper-Klinikum Dachau, Cardiology and Pneumology, Dachau, Germany

  • Isabell Bernlochner

    6   Medizinische Klinik und Poliklinik Innere Medizin I (Kardiologie, Angiologie, Pneumologie), Klinikum rechts der Isar, Technische Universität München, Munich, Germany
    7   German Center for Cardiovascular Research (DZHK), Partner Site Munich Heart Alliance, Munich, Germany

  • Michael Joner

    1   Klinik für Herz- und Kreislauferkrankungen, Deutsches Herzzentrum München, Technische Universität München, Munich, Germany
    7   German Center for Cardiovascular Research (DZHK), Partner Site Munich Heart Alliance, Munich, Germany

  • Erion Xhepa 

    1   Klinik für Herz- und Kreislauferkrankungen, Deutsches Herzzentrum München, Technische Universität München, Munich, Germany

  • Katharina Mayer

    1   Klinik für Herz- und Kreislauferkrankungen, Deutsches Herzzentrum München, Technische Universität München, Munich, Germany

  • Thorsten Kessler

    1   Klinik für Herz- und Kreislauferkrankungen, Deutsches Herzzentrum München, Technische Universität München, Munich, Germany
    7   German Center for Cardiovascular Research (DZHK), Partner Site Munich Heart Alliance, Munich, Germany

  • Karl-Ludwig Laugwitz

    6   Medizinische Klinik und Poliklinik Innere Medizin I (Kardiologie, Angiologie, Pneumologie), Klinikum rechts der Isar, Technische Universität München, Munich, Germany
    7   German Center for Cardiovascular Research (DZHK), Partner Site Munich Heart Alliance, Munich, Germany

  • Gert Richardt

    4   Division of Cardiology, Department of Internal Medicine II, Medical University of Vienna, Vienna, Austria

  • Heribert Schunkert

    1   Klinik für Herz- und Kreislauferkrankungen, Deutsches Herzzentrum München, Technische Universität München, Munich, Germany
    7   German Center for Cardiovascular Research (DZHK), Partner Site Munich Heart Alliance, Munich, Germany

  • Dominick J. Angiolillo 

    8   Division of Cardiology, University of Florida College of Medicine, Jacksonville, Florida, United States

  • Dirk Sibbing

    9   Privatklinik Lauterbacher Mühle am Ostersee, Iffeldorf and Ludwig-Maximilians-Universität München, Munich, Germany

  • Adnan Kastrati 

    1   Klinik für Herz- und Kreislauferkrankungen, Deutsches Herzzentrum München, Technische Universität München, Munich, Germany
    7   German Center for Cardiovascular Research (DZHK), Partner Site Munich Heart Alliance, Munich, Germany

  • Sebastian Kufner

    1   Klinik für Herz- und Kreislauferkrankungen, Deutsches Herzzentrum München, Technische Universität München, Munich, Germany
    7   German Center for Cardiovascular Research (DZHK), Partner Site Munich Heart Alliance, Munich, Germany
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Graphical Abstract

Abstract

Background The relative efficacy and safety of ticagrelor and prasugrel based dual antiplatelet therapy strategies according to the platelet count (PC) in patients with acute coronary syndromes (ACS) have not been defined.

Methods This is a posthoc analysis of the ISAR-REACT 5 trial, in which patients presenting with ACS were randomized to treatment with ticagrelor versus prasugrel. Patients were divided into quartiles according to PC. The primary endpoint was incidence of death, myocardial infarction, or stroke, and the safety endpoint was incidence of BARC (Bleeding Academic Research Consortium) type 3 to 5 bleeding at 12 months.

Results A total of 3,943 patients with known PC (997 patients in quartile 1 (Q1), 1,003 in quartile 2 (Q2) [205 ± 10.3 × 109/L], 961 patients in quartile 3 (Q3) [241 ± 11.7 × 109/L], and 982 patients in quartile 4 (Q4) [317 ± 68.6 × 109/L]). There was no significant interaction between treatment arm (ticagrelor vs. prasugrel) and PC group with respect to primary endpoint (Q1: 8.8 vs. 6.3%, hazard ratio [HR] =1.41, 95% confidence interval [CI]: 0.89–2.23; p = 0.148; Q2: 9.9 vs. 5.8%, HR = 1.68, 95% CI: 1.06–2.66; p = 0.027; Q3: 7.8 vs. 5.5%, HR = 1.43, 95% CI: 0.87–2.37; p = 0.159; Q4: 10.1 vs. 10.1%, HR = 1.05, 95% CI: 0.71–1.57; p = 0.799; p for interaction [p int] = 0.482) and with respect to bleeding endpoint (Q1: 5.8 vs. 4.2%, HR = 1.41, 95% CI: 0.76–2.63; p = 0.279; Q2: 6.4 vs. 3.7%, HR = 1.62, 95% CI: 0.85–2.06; p = 0.140; Q3: 4.4 vs. 3.0%, HR = 1.53, 95% CI: 0.73–3.18; p = 0.258; Q4: 5.6 vs. 8.5%, HR = 0.67, 95% CI: 0.40–1.14; p = 0.138, p int = 0.102).

Conclusions In this analysis, incidences of ischemic and bleeding events at 12 months are comparable across quartiles of platelet count.

Keywords

trials - antiplatelet therapy - myocardial infarction - acute coronary syndrome

Supplementary Material



Publication History

Received: 17 May 2022

Accepted: 27 October 2022

Accepted Manuscript online:
28 November 2022

Article published online:
18 January 2023

© 2023. The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/)

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