Comparison of Prasugrel and Ticagrelor Loading Doses in ST-Segment Elevation Myocardial Infarction Patients

Abstract

In patients with STEMI, prasugrel showed to be noninferior as compared with ticagrelor in terms of residual platelet reactivity 2 h after the LD. The 2 drugs provide an effective platelet inhibition 2 h after the LD in only a half of patients, and at least 4 h are required to achieve an effective platelet inhibition in the majority of patients. Morphine use is associated with a delayed activity of these agents. (Rapid Activity of Platelet Inhibitor Drugs Study, NCT01510171).

Cangrelor inhibits the binding of the active metabolites of clopidogrel and prasugrel to P2Y12receptorsin vitro

“…Cangrelor is a rapidly acting, direct-binding, reversible, intravenous P2Y 12 antagonist, which makes it attractive for use during percutaneous coronary intervention (PCI) in patients who may not have been sufficiently pretreated with an oral P2Y 12 antagonist, such as may occur in the management of acute ST-segment elevation myocardial infarction (STEMI) [1,2]. In the recent CHAMPION PHOENIX study, a bolus plus 2 hour infusion of cangrelor resulted in a decrease in ischaemic events during PCI with no increase in severe bleeding [3].…”

Cangrelor for the management and prevention of arterial thrombosis

“…Opiates also delay gastric emptying and therefore can delay the absorption and onset of action of oral P2Y 12 inhibitors, which rely on intestinal absorption [27][28][29][30]. Vomiting of stomach contents may lead to uncertainty about absorption of oral therapy and patients can also be unable to swallow e.g.…”

Chewed ticagrelor tablets provide faster platelet inhibition compared to integral tablets

“…Beside the higher baseline PR in STEMI patients, a limited or delayed intestinal absorption of orally administered drugs is another major contributor to this observation. (6)(7)(8) Previous pharmacokinetic studies have demonstrated that chewable aspirin and crushed clopidogrel administration increased the rate of drug absorption compared to integral tablets, when administered orally. (9,10) Recently, crushed ticagrelor tablets, administered orally or via a naso-gastric tube, has been shown to be feasible and resulted in increased plasma concentration of ticagrelor and its active metabolite at an earlier time point compared to integral tablets.…”