Thromb Haemost 2014; 112(03): 551-557
DOI: 10.1160/TH14-02-0119
Platelets and Blood Cells
Schattauer GmbH

Ticagrelor vs prasugrel one-month maintenance therapy: Impact on platelet reactivity and bleeding events

Dimitrios Alexopoulos
1   Department of Cardiology, Patras University Hospital, Rion, Patras, Greece
,
Katerina Stavrou
1   Department of Cardiology, Patras University Hospital, Rion, Patras, Greece
,
Ioanna Koniari
1   Department of Cardiology, Patras University Hospital, Rion, Patras, Greece
,
Vassilios Gkizas
1   Department of Cardiology, Patras University Hospital, Rion, Patras, Greece
,
Angelos Perperis
1   Department of Cardiology, Patras University Hospital, Rion, Patras, Greece
,
Kosmas Kontoprias
1   Department of Cardiology, Patras University Hospital, Rion, Patras, Greece
,
Chrysoula Vogiatzi
1   Department of Cardiology, Patras University Hospital, Rion, Patras, Greece
,
Theodora Bampouri
1   Department of Cardiology, Patras University Hospital, Rion, Patras, Greece
,
Ioanna Xanthopoulou
1   Department of Cardiology, Patras University Hospital, Rion, Patras, Greece
› Author Affiliations
Further Information

Publication History

Received: 08 February 2014

Accepted after major revision: 25 March 2014

Publication Date:
02 December 2017 (online)

Summary

Platelet reactivity (PR) and bleeding events following therapy with ticagrelor vs prasugrel have not been adequately studied. We aimed to compare PR and bleeding events in patients with acute coronary syndrome (ACS) undergoing percutaneous coronary intervention (PCI) while on ticagrelor vs prasugrel for one month. Consecutive patients who were discharged either on ticagrelor 90 mg bid maintenance dose (MD) or prasugrel 10 mg MD were invited for PR assessment (VerifyNow, in PRU) at one month. High PR (HPR) was defined as >208 PRU. Bleeding events [Bleeding Academic Research Consortium (BARC) classification] were monitored. Out of 937 screened patients, 512 were analysed, 278 under ticagrelor MD and 234 under prasugrel MD. PR at 30 days (C-statistic of the propensity score model 0.63, 0.58–0.67 95% CI, p<0.001) was lower when on ticagrelor compared with prasugrel (33.3, 95% CI 29.3–37.3 vs 84.6, 95% CI 73.6–95.6, p<0.001). In the analysed population more BARC type 1 bleeding events were observed with ticagrelor compared to prasugrel (36.7% vs 28.2%, p=0.047). In 221 propensity score matched pairs, BARC type 1 bleeding rate was marginally higher in ticagrelor vs prasugrel treated patients (35.7% vs 27.1%, p=0.05). BARC type ≥2 events did not differ between groups 5 (2.3%) vs 5 (2.3%). HPR rate was higher for prasugrel-treated patients (5.4% vs 0%, p<0.001). In conclusion, in patients with ACS undergoing PCI, ticagrelor MD produces a significantly higher platelet inhibition compared to prasugrel MD. This pharmacodynamic difference might be associated with more nuisance bleeding events with ticagrelor use.

Clinical Trial Registration ClinicalTrials.gov Identifier: NCT01774955.

 
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