Lack of Evidence for Deterioration in Endothelial Function Following Ticagrelor Treatment Cessation

Abstract

We identified 30 eligible patients with endothelial function assessment pre- and post-ticagrelor cessation (86.7% men, 13.3% with diabetes and 33.3% current smokers; mean age: 63.6±11.5 years). The study's primary endpoint of RHI at Day 5 did not differ significantly compared with RHI at Day 0, 1.69 (1.45-2.23) vs 1.81 (1.59-2.13). ED rate did not differ significantly between Day 5 and Day 0, 40 vs 33.3%, p=0.8, respectively. No differences in RHI or ED rate were observed between Day 2 and Day 0, 1.64 (1.54-2.04) vs 1.8 1(1.59-2.13), p=0.3 and 53.3 vs 33.3%, p=0.2, respectively. In stable CAD patients there is no evidence of deterioration in endothelial function after discontinuing ticagrelor.

Remote ischemic conditioning protects against endothelial ischemia-reperfusion injury via a glucagon-like peptide-1 receptor-mediated mechanism in humans

“…Furthermore, discontinuation of chronic ticagrelor treatment did not result in decline in endothelial function per se. While this supports the findings of one previous trial 201 , our study examined the subjects with a longer interval after cessation of ticagrelor and longer intervals between examinations, ruling out any possible lingering effect of the medication (additionally confirmed by measurements of platelet inhibition) or conditioning state from previous examinations. Study IV adds substantial knowledge to the growing understanding of the pleiotropic effects of ticagrelor and its possible implications.…”

Ticagrelor Does Not Improve Endothelial Dysfunction in Stable Survivors of Acute Coronary Syndrome

“…Whereas some studies showed beneficial effects, [10][11][12][13][14][15] others demonstrated that it had a lack of effect on endothelial function. [16][17][18] Several probable factors, such as comorbidities, and methods to evaluate endothelial function, will be associated with these inconsistent results. Previous studies examined patients with different comorbidities.…”

“…4,9 While a series of clinical trials investigated the effect of ticagrelor on endothelial function in patients with coronary artery disease (CAD), the results were contradictory. [10][11][12][13][14][15][16][17][18] Probable explanations of these inconsistent findings include different clinical presentations, comorbidities, methods to evaluate endothelial function, timing from the index event, and the various statuses of concomitant medications. In the 2 studies showing a beneficial effect, patients with ACS, not stable angina, in the acute period were enrolled, and the prescription rate of concomitant medications was lower or unknown.…”

“…12,15 Conversely, the trials showing a lack of effect enrolled stable patients with prior ACS and demonstrated a higher use of concomitant medications. [16][17][18] However, this result was measured by peripheral arterial tonometry, which evaluates the microvascular response, whereas brachial artery flow-mediated dilation (baFMD) measures the macrovascular response. Brachial artery flow-mediated dilation is the most established and commonly used method to evaluate endothelial function.…”

l-Arginine and B vitamins improve endothelial function in subjects with mild to moderate blood pressure elevation

“…However, FMD is known to be highly user dependent since it requires specially trained personnel [ 57 ]. In this study, we employed the non-invasive, easy-to-use and user-independent pulse amplitude tonometry (EndoPAT) which has already extensively been used in several studies assessing endothelial function [ 57 – 61 ]. In addition, this method adequately depicts the overall health of the endothelium [ 38 , 39 ] which corresponds with the indication of the nutritional product and which emphasizes that the endpoint is not only validated, but also clinically important.…”