Thromb Haemost 2020; 120(08): 1221-1229
DOI: 10.1055/s-0040-1713375
Atherosclerosis and Ischaemic Disease

Platelet Inhibition with Ticagrelor versus Clopidogrel in Diabetic Patients after Percutaneous Coronary Intervention for Chronic Coronary Syndromes

Zhenyu Liu
1  Department of Cardiology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
,
Ran Tian
1  Department of Cardiology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
,
Yang Wang
2  Medical Research and Biometrics Center, Fu-Wai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
,
Qian Chen
3  Department of Laboratory Medicine, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
,
Jingyi Li
1  Department of Cardiology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
,
Lihong Xu
4  Clinical Pharmacology Research Center, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
,
Shuyang Zhang
1  Department of Cardiology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
› Author Affiliations
Funding This study was an investigator-initiated study funded by AstraZeneca (ESR-14–10403).

Abstract

Background Clopidogrel is currently the only P2Y12 inhibitor with class I recommendation in patients after percutaneous coronary intervention (PCI) for chronic coronary syndromes (CCS). Diabetic patients have reduced therapeutic response to clopidogrel.

Purpose This study assessed the antiplatelet effect of ticagrelor versus clopidogrel in diabetic patients after recent PCI for CCS.

Methods Eligible patients were randomly assigned to receive ticagrelor 90 mg twice daily or clopidogrel 75 mg once daily, in addition to aspirin 100 mg once daily for 15 days. P2Y12 reaction unit (PRU) and percent inhibition were measured by VerifyNow P2Y12 assay. High on-treatment platelet reactivity (HOPR) was defined as PRU > 208. Bleeding was assessed by the Platelet Inhibition and Patient Outcomes criteria. Cardiac ischemic events were evaluated as adverse events.

Results The baseline characteristics of the patients (n = 39) were well balanced between the two groups. Both before and 2 to 4 hours after the final study dose on day 15, PRU was lower (41.3 ± 35.8 vs. 192.6 ± 49.5, p < 0.001; 36.6 ± 25.8 vs. 187.6 ± 70.9, p < 0.001), percent inhibition was higher (83.0% [70.5%, 96.0%] vs. 16.0% [0%, 25.0%], p < 0.001; 85.0% [76.0%, 96.5%] vs. 25.0% [0%, 39.0%], p < 0.001), and HOPR occurred less frequently (0% [0/20] vs. 26.3% [5/19], p = 0.020; 0% [0/20] vs. 31.6% [6/19], p = 0.008) in the ticagrelor group (n = 20) compared with the clopidogrel group (n = 19). No major or minor bleeding, or serious adverse events occurred in both groups.

Conclusion Ticagrelor achieved greater peak and trough platelet inhibition than did clopidogrel in diabetic patients after recent PCI for CCS, which suggests the potential use of ticagrelor in this clinical setting.

Note

The authors are solely responsible for the design and conduct of the study, collection, analysis, and interpretation of the data, and writing, editing, and submitting of the manuscript. The study protocol was reviewed and approved by the ethics committee in Peking Union Medical College Hospital (Approval No. HS-873). Written informed consent was obtained from each study participant before initiation of any study procedure.


Trial Registration

The PLATIDE-PCI study was registered on ClinicalTrials.gov (NCT02748330) on April 19, 2016.


Authors' Contributions

Z.L. and S.Z. designed and conducted the study, analyzed and interpreted the data, and drafted the manuscript. Y.W. helped to design the study and to draft the manuscript, in particular the statistics section. R.T., J.L., and L.X. participated in the conduct of the study and the collection of the data, and helped to prepare the manuscript. Q.C. did the statistical analysis of the study and helped to prepare the manuscript. All authors revised the manuscript critically and gave the final approval of the manuscript submitted.


Supplementary Material



Publication History

Received: 18 March 2020

Accepted: 08 May 2020

Publication Date:
15 July 2020 (online)

Georg Thieme Verlag KG
Stuttgart · New York