Diabetes mellitus and platelet reactivity in patients under prasugrel or ticagrelor treatment: an observational study

Alexopoulos, Dimitrios; Vogiatzi, Chrysoula; Stavrou, Katerina; Vlassopoulou, Niki; Perperis, Angelos; Pentara, Ioanna; Xanthopoulou, Ioanna

doi:10.1186/s12933-015-0232-1

Cited by 22 publications

(22 citation statements)

References 43 publications

(51 reference statements)

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“…Contrasting with the clinical data of TRITON-TIMI 38, instead, Laine and colleagues [34] reported in 100 diabetic post-ACS patients that ticagrelor achieved a significantly lower platelet reactivity as compared to prasugrel loading dose. In addition, similar results have been achieved by Alexopulos et al in a cohort of 777 patients [35], thus raising potential concerns on the problem of suboptimal platelet inhibition also among prasugrel-treated patients, and especially in settings at higher thrombotic risk.…”

Section: Discussionsupporting

confidence: 72%

Prevalence and predictors of high-on treatment platelet reactivity during prasugrel treatment in patients with acute coronary syndrome undergoing stent implantation

Verdoia¹,

Pergolini²,

Nardin³

et al. 2019

Journal of Cardiology

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Background: ADP-antagonists such as prasugrel have reduced but yet not overcome the phenomenon of high-on treatment platelet reactivity (HRPR), that has been shown to increase the rate of major cardiovascular events after an acute coronary syndrome (ACS) or percutaneous coronary intervention (PCI). However, the exact prevalence and the principal determinants of suboptimal platelet inhibition in patients treated with dual antiplatelet therapy (DAPT) with prasugrel have not been completely clarified and were therefore the aim of the present study. Methods: We included patients (<75 years and >60 kg) treated with DAPT (aspirin + prasugrel) after PCI, mainly for an ACS. Platelet function test evaluation was performed at 1-3 months from discharge. HRPR was assessed by multiplate impedance aggregometry and defined for results above upper limit of normal after ADP stimulation. Results: We included 190 post-ACS patients. HRPR with prasugrel was observed in 19 patients (10%). The prevalence of HRPR was stable in different high-risk subgroups of patients (female gender, hypercholesterolemic, and chronic kidney disease) whereas it was increased in diabetic patients (p = 0.045), with a significant interaction between diabetic status and HRPR (p = 0.04). However, at multivariate analysis, an impaired metabolic status, with higher levels of glycosylated hemoglobin and low-density lipoprotein (LDL) cholesterol, but not diabetic status, emerged as independent predictors of HRPR with prasugrel [OR (95% CI) = 2.1 (1.32-3.33), p = 0.002 and OR (95% CI) = 1.03 (1.01-1.05), p = 0.003, respectively], with a stronger linear relationship between ADP-mediated platelet aggregation and glycosylated hemoglobin levels (r = 0.24, p = 0.002), than for LDL-cholesterol (r = 0.13, p = 0.09). Conclusions: In post-ACS patients treated with PCI and receiving DAPT with prasugrel, HRPR is observed in about 10% of patients. Impaired metabolic status, and especially elevated glycosylated hemoglobin, emerged as independent predictors of the suboptimal effectiveness of prasugrel.

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Section: Discussionsupporting

confidence: 72%

Prevalence and predictors of high-on treatment platelet reactivity during prasugrel treatment in patients with acute coronary syndrome undergoing stent implantation

Verdoia¹,

Pergolini²,

Nardin³

et al. 2019

Journal of Cardiology

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“…23 Similarly no significant difference was observed in the study by Alexopoulos D anomg Type 2 DM and controls. 24 …”

Section: Discussionmentioning

confidence: 99%

Haematological profile of diabetes and non-diabetes patients in rural tertiary centre

2017

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Background: Anemia is a common haematological finding in diabetic patients. Many research studies have reported that anemia mostly occurs in patients with diabetes who also have renal insufficiency. A few other studies have also reported an incidence of anemia in diabetics prior to evidence of renal impairment. Anemia occurs earlier and at a greater degree in patients presenting with diabetic nephropathy than those presenting with other causes of renal failure. The objective of this study is to determine the haematological profile among type 2 Diabetes mellitus in comparison with non-diabetic controls.Methods: Hospital based case control study was conducted in a rural tertiary care centre for a period of 1 year (May 2016 to April 2017) among type 2 diabetic patients and equal proportion of controls without diabetes. 70 diabetics and non-diabetics as controlled were enrolled for the study. Pretested and structured questionnaire was used to collect the data from subjects. For laboratory investigation 5 ml of blood was drawn from the patient and analysed in the automated cell counter for haematological parameters. Data was analysed using SPSS 22 version, Chi-square test and independent t test was the test of significance for qualitative and quantitative data respectively. P value of <0.05 was considered to be statistically significant.Results: Mean age of diabetics was 55.7±3.6 years and non-diabetics was 56.2±3.5 years. Majority of subjects in both the groups were females. In diabetics mean haemoglobin, RBCs, PCV, and MCV was significantly lower than in non-diabetics. Whereas mean MCHC, WBCs and lymphocytes was significantly higher in diabetics compared to non-diabetics. No difference was observed for MCH, neutrophils and platelets between two groups. This shows that diabetics are prone for anemia, leucocytosis and lymphocytosis.Conclusions: Haematological profile in diabetes patients in deranged and diabetics are more prone for anemia, leucocytosis and lymphocytosis. Hence routine and regular screening for haematological profile is recommended in diabetic patients to initiate early prevention strategies and to reduce the morbidity related to it.

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“…In the PLATO trial, ticagrelor provided a consistent benefit over clopidogrel, regardless of whether patients did or did not have DM [ 77 ]. Ticagrelor has also demonstrated the ability to achieve better platelet inhibition compared with prasugrel in patients with DM with an ACS undergoing PCI [ 78 ].…”

Section: The Parthenon Programmentioning

confidence: 99%

The PARTHENON Clinical Development Program: the Role of Ticagrelor in Patients with Atherothrombotic Disease

Dobesh

Patel

2017

Cardiovasc Drugs Ther

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Although the rate of cardiovascular disease (CVD)-related mortality has declined over the last decade, it is still the leading cause of mortality in the USA, accounting for over 1.4 million deaths annually. In addition, total direct (primarily hospital admissions) and indirect costs of CVD in the US is over $316 billion annually and is expected to grow to over $918 billion by 2030. Much of the etiology of CVD is due to atherosclerosis and its thrombotic complications, and central to this is the role of platelets. Atherosclerosis is a systemic disease, with meaningful morbidity and mortality when present in the coronary, cerebral, or major peripheral arteries. The recommended antiplatelet therapy differs based on the vascular bed impacted, with the optimal antiplatelet therapy yet to be defined. The PARTHENON program is a series of completed and ongoing phase III clinical trials investigating the efficacy and safety of ticagrelor in atherosclerotic CVD in comparison with established antiplatelet therapy or placebo. The overall aim of the program is to determine if more potent antiplatelet therapy, with different pharmacology, may reduce cardiovascular events in patients with atherosclerotic disease.

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Diabetes mellitus and platelet reactivity in patients under prasugrel or ticagrelor treatment: an observational study

Cited by 22 publications

References 43 publications

Prevalence and predictors of high-on treatment platelet reactivity during prasugrel treatment in patients with acute coronary syndrome undergoing stent implantation

Prevalence and predictors of high-on treatment platelet reactivity during prasugrel treatment in patients with acute coronary syndrome undergoing stent implantation

Haematological profile of diabetes and non-diabetes patients in rural tertiary centre

The PARTHENON Clinical Development Program: the Role of Ticagrelor in Patients with Atherothrombotic Disease

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