A head-to-head pharmacodynamic comparison of prasugrel vs. ticagrelor after switching from clopidogrel in patients with coronary artery disease: results of a prospective randomized study

Rollini, Fabiana; Franchi, Francesco; Cho, Jung Rae; DeGroat, Christopher; Bhatti, M. Tariq; Muñiz–Lozano, Ana; Singh, Karuna; Ferrante, Elisabetta; Wilson, Ryan E.; Dunn, Elizabeth Cullen; Zenni, Martin M.; Guzmán, Luis A.; Bass, Theodore A.; Angiolillo, Dominick J.

doi:10.1093/eurheartj/ehv744

Cited by 54 publications

(34 citation statements)

References 28 publications

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“…Pharmacodynamic Comparisons Among Groups Comparison in platelet reactivity across time points among ticagrelor 180 mg loading dose (LD) group (Tic 180 mg), ticagrelor 90 mg bid maintenance dose (MD) without LD group (Tic 90 mg), and prasugrel 10 mg QD MD group (Pras 10 mg). Similar to other PD investigations, dyspnea occurred in approximately one-third of patients who switched to ticagrelor(11,12); however, this was mostly mild and transient and led to discontinuation of study drug only in 1 patient. The p values represent the comparisons among the 3 groups at each time point.…”

contrasting

confidence: 94%

Pharmacodynamic Effects of Switching From Prasugrel to Ticagrelor

Franchi

Faz

Rollini

et al. 2016

JACC: Cardiovascular Interventions

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contrasting

confidence: 94%

Pharmacodynamic Effects of Switching From Prasugrel to Ticagrelor

Franchi

Faz

Rollini

et al. 2016

JACC: Cardiovascular Interventions

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“…Besides, Rollini and colleagues also found similar platelet aggregation values in patients with previous PCI (n = 110), who were switched from clopidogrel MD to either prasugrel or ticagrelor using light transmission aggregometry, the VerifyNow P2Y12 system, and the VASP assay [29]. Of note, in this study population HTPR rates on clopidogrel MD varied from only 13.6% to 66% depending on the assay used for platelet function testing [29], whereas in our study population, exclusively patients with HTPR on clopidogrel LD within the first hours after PCI were included.…”

Section: Discussionmentioning

confidence: 80%

Ticagrelor versus prasugrel in patients with high on-clopidogrel treatment platelet reactivity after PCI: The ISAR-ADAPT-PF study

et al. 2016

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Patients with high on-treatment platelet reactivity (HTPR) on clopidogrel are at high risk for adverse cardiovascular events after percutaneous coronary intervention (PCI). The aim of the ISAR-ADAPT-PF study was to assess the antiplatelet efficacy of ticagrelor versus prasugrel in patients with HTPR on clopidogrel. In a prospective and randomized clinical study, 70 patients with HTPR on clopidogrel loading dose (LD) within 24 h post PCI were assigned to receive either ticagrelor [180 mg LD followed by 90 mg maintenance dose (MD) twice daily] or prasugrel (60 mg LD followed by 10 mg MD once daily). The adenosine diphosphate-induced platelet aggregation assessed on the Multiplate analyzer on day 2 after randomization (primary end point) was as follows: the mean difference between the two treatment groups was 6 aggregation units (AU) × min with an upper 95% confidence interval (CI) of 41 AU × min, which was greater than the predefined noninferiority margin of 18 AU × min (P for noninferiority = 0.29). However, no significant differences in absolute platelet reactivity levels between ticagrelor- versus prasugrel-treated patients at that time point were observed (138 ± 100 AU × min vs. 132 ± 64 AU × min, P for superiority = 0.77). In conclusion, neither drug was statistically more effective for inhibition of platelet aggregation in patients with HTPR on clopidogrel post PCI, although the study could not formally demonstrate the assumed noninferiority of ticagrelor versus prasugrel.

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“…Thus, to what extent our findings can be extrapolated to ticagrelor remains unclear. Nevertheless, prasugrel and ticagrelor have very similar P2Y 12 inhibitory effects 38 and a randomised study comparing the two drugs in patients with acute coronary syndrome showed similar efficacy and safety outcomes. 10 This suggests that our findings could indeed apply to patients with acute coronary syndrome treated with ticagrelor.…”

Section: Hr (95% CImentioning

confidence: 97%

Guided de-escalation of antiplatelet treatment in patients with acute coronary syndrome undergoing percutaneous coronary intervention (TROPICAL-ACS): a randomised, open-label, multicentre trial

Sibbing¹,

Aradi²,

Jacobshagen³

et al. 2017

The Lancet

485

382

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SummaryBackground Current guidelines recommend potent platelet inhibition with prasugrel or ticagrelor for 12 months after an acute coronary syndrome managed with percutaneous coronary intervention (PCI). However, the greatest antiischaemic benefit of potent antiplatelet drugs over the less potent clopidogrel occurs early, while most excess bleeding events arise during chronic treatment. Hence, a stage-adapted treatment with potent platelet inhibition in the acute phase and de-escalation to clopidogrel in the maintenance phase could be an alternative approach. We aimed to investigate the safety and efficacy of early de-escalation of antiplatelet treatment from prasugrel to clopidogrel guided by platelet function testing (PFT).

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A head-to-head pharmacodynamic comparison of prasugrel vs. ticagrelor after switching from clopidogrel in patients with coronary artery disease: results of a prospective randomized study

Abstract: NCT01852175.

Cited by 54 publications

References 28 publications

Pharmacodynamic Effects of Switching From Prasugrel to Ticagrelor

Pharmacodynamic Effects of Switching From Prasugrel to Ticagrelor

Ticagrelor versus prasugrel in patients with high on-clopidogrel treatment platelet reactivity after PCI: The ISAR-ADAPT-PF study

Guided de-escalation of antiplatelet treatment in patients with acute coronary syndrome undergoing percutaneous coronary intervention (TROPICAL-ACS): a randomised, open-label, multicentre trial

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