Effect of Clopidogrel vs Ticagrelor on Platelet Aggregation and Inflammation Markers After Percutaneous Coronary Intervention for ST-Elevation Myocardial Infarction

Jiang, Zaixin; Zhang, Ruoxi; Sun, Meng; Liu, Qi; Wang, Shuqing; Wang, Wei; Zhao, Qi; Zhang, Hui; Wang, Yu; Hou, Jingbo; Yu, Bo

doi:10.1016/j.cjca.2018.08.024

Cited by 25 publications

(22 citation statements)

References 33 publications

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“…In the real-world observation study of ACS treatment in Taiwan, DAPT with ticagrelor was associated with a lower risk of cardiovascular outcomes and did not increase the major bleeding compared with DAPT with clopidogrel [25]. A study from Asia demonstrated that ticagrelor provides more potent platelet inhibition and suppresses more inflammatory reaction than clopidogrel [26]. These results are consistent with those of a study from Europe [27].…”

Section: Discussionsupporting

confidence: 84%

P2Y12 Inhibitor Monotherapy with Clopidogrel versus Ticagrelor in Patients with Acute Coronary Syndrome Undergoing Percutaneous Coronary Intervention

Chen

Feng

et al. 2020

JCM

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Background: P2Y12 inhibitor monotherapy is an alternative antiplatelet strategy in patients undergoing percutaneous coronary intervention (PCI). However, the ideal P2Y12 inhibitor for monotherapy is unclear. Methods and Results: We performed a multicenter, retrospective, observational study to compare the efficacy and safety of monotherapy with clopidogrel versus ticagrelor in patients with acute coronary syndrome (ACS) undergoing PCI. From 1 January 2014 to 31 December 2018, 610 patients with ACS who received P2Y12 monotherapy with either clopidogrel (n = 369) or ticagrelor (n = 241) after aspirin was discontinued prematurely were included. Inverse probability of treatment weighting was used to balance covariates between the groups. The primary endpoint was the composite of all-cause mortality, recurrent ACS or unplanned revascularization, and stroke within 12 months after discharge. Overall, 84 patients reached the primary endpoint, with 57 (15.5%) in the clopidogrel group and 27 (11.2%) in the ticagrelor group. Multivariate adjustment in Cox proportional-hazards models revealed a lower risk of the primary endpoint with ticagrelor than with clopidogrel (adjusted hazard ratio (aHR): 0.67, 95% confidence interval (CI): 0.49–0.93). Ticagrelor significantly reduced the risk of recurrent ACS or unplanned revascularization (aHR: 0.46, 95% CI: 0.28–0.75). No significant difference in all-cause mortality and major bleeding events was observed between the 2 groups. Conclusions: Among patients with ACS undergoing PCI who cannot complete course of dual antiplatelet therapy, a significantly lower risk of cardiovascular events was associated with ticagrelor monotherapy than with clopidogrel monotherapy. The major bleeding risk was similar in both the groups.

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Section: Discussionsupporting

confidence: 84%

P2Y12 Inhibitor Monotherapy with Clopidogrel versus Ticagrelor in Patients with Acute Coronary Syndrome Undergoing Percutaneous Coronary Intervention

Chen

Feng

et al. 2020

JCM

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“…32,33 The use of ticagrelor has been found in many studies to be superior to other antiplatelet therapies, including aspirin, clopidogrel and prasugrel with respect to platelet inhibition and reducing inflammation, endothelial function or fibrosis. 20,21,27,34 This indicates that ticagrelor is a potent treatment to reduce the cardiovascular risk and inhibit the development of DN in diabetic patients.…”

Section: Discussionmentioning

confidence: 99%

“…18 In addition to the greater platelet inhibitory effects of ticagrelor, it has been shown to lower the incidence of cardiovascular mortality, myocardial infarction, and stroke. 19 Next to its anti-thrombotic effects, ticagrelor has been found to have pronounced anti-inflammatory 20,21 and anti-fibrotic effects, 21 compared with clopidogrel.…”

mentioning

confidence: 99%

Platelet inhibition by ticagrelor is protective against diabetic nephropathy in mice

et al. 2020

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Diabetic nephropathy (DN) is a major complication of diabetes and is associated with high risk for cardiovascular mortality, which is partially related to elevated platelet activity. Platelets are also active players in inflammation and fibrosis. In this study, we examine the effect of ticagrelor‐induced platelet inhibition on the development of DN. DN was induced by unilateral nephrectomy followed by streptozotocin injections for 5 days. Mice received ticagrelor (300 mg/kg) or vehicle every other day, for 16 weeks. Experimental groups: non‐diabetic control, diabetic control, non‐diabetic ticagrelor, and diabetic ticagrelor. Ticagrelor treatment in diabetic mice lowered urinary albumin excretion, it prevented diabetes‐induced mesangial matrix expansion, podocyte effacement, and glomerular endothelial cell injury, which includes loss of endothelial fenestrations, ICAM‐1 expression, and PECAM expression. In addition, ticagrelor treatment prevented collagen IV deposition and macrophage infiltration in the tubulointerstitium and these diabetic mice showed lower systemic and tubular inflammation and tubular apoptosis. This tubular protection is likely to be a result of protection to the glomerular endothelium by ticagrelor, which reduces albuminuria and albumin toxicity to the tubules and reduced tubular and interstitial inflammation and fibrosis. In conclusion, ticagrelor‐induced platelet inhibition protects against renal injury in diabetic mice, likely by protecting the glomerular endothelial cells.

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“…In most trials, there is a decreased inflammatory burden as expressed by the levels of different inflammatory biomarkers, which is dependent on the combination of antiplatelet agents, the potency of each drug and the different dosages that have been tried. Interestingly, recent trials with ticagrelor have shown promising results, which ought to be confirmed in larger scale randomized control trials (RCTs) [91,92] (Table 1).…”

Section: Antiplatelet Medicationmentioning

confidence: 97%

A link between inflammation and thrombosis in atherosclerotic cardiovascular diseases: Clinical and therapeutic implications

et al. 2020

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Effect of Clopidogrel vs Ticagrelor on Platelet Aggregation and Inflammation Markers After Percutaneous Coronary Intervention for ST-Elevation Myocardial Infarction

Cited by 25 publications

References 33 publications

P2Y12 Inhibitor Monotherapy with Clopidogrel versus Ticagrelor in Patients with Acute Coronary Syndrome Undergoing Percutaneous Coronary Intervention

P2Y12 Inhibitor Monotherapy with Clopidogrel versus Ticagrelor in Patients with Acute Coronary Syndrome Undergoing Percutaneous Coronary Intervention

Platelet inhibition by ticagrelor is protective against diabetic nephropathy in mice

A link between inflammation and thrombosis in atherosclerotic cardiovascular diseases: Clinical and therapeutic implications

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