Meta-Analysis of Direct and Indirect Comparison of Ticagrelor and Prasugrel Effects on Platelet Reactivity

Lhermusier, Thibault; Lipinski, Michael J.; Tantry, Udaya S.; Escárcega, Ricardo O.; Baker, Nevin C.; Bliden, Kevin P.; Magalhães, Marco A.; Ota, Hiroyoshi; Tian, Wenjie; Pendyala, Lakshmana; Minha, Sa’ar; Chen, Fang; Torguson, Rebecca; Gurbel, Paul A.; Waksman, Ron

doi:10.1016/j.amjcard.2014.12.029

Cited by 33 publications

(25 citation statements)

References 28 publications

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“…Based on these disparities, two recent meta-analyses about the impact of ticagrelor and prasugrel on platelet reactivity were performed and both found ticagrelor being more effective than prasugrel in terms of platelet inhibition [32,33]. Of note, these studies did not include trials that assessed platelet aggregation with the Multiplate analyzer or LTA and the proportion of trials that used the VASP assay that comes along with a potential overestimation of the pharmacodynamic ticagrelor effectiveness was high [16,31].…”

Section: Discussionmentioning

confidence: 99%

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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Section: Discussionmentioning

confidence: 99%

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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“…Furthermore, ticagrelor did not significantly reduce the incidence of stroke compared to clopidogrel [OR = 1.14, 95%CI (0.93, 1.40), P = 0.20]. According to the research of Thibault Lhermusier, ticagrelor showed stronger inhibition of platelet reactivity in ACS patients compared to prasugrel [MD: -42.5, 95% CI: -62.9, -21.9] and was more effective than regular doses [MD: -159.7, 95% CI: -182.6, -136.6] or high doses [MD: -125.5, 95% CI: -154.9, -96.4] of clopidogrel [12]. The results of this study further supported the evidence presented above.…”

Section: Discussionmentioning

confidence: 99%

“…Several clinical studies have indicated that ticagrelor is superior to clopidogrel in reducing platelet reactivity, myocardial infarction, cardiovascular death, stroke and adverse events [12]. It may also reduce the incidence of clinical bleeding events compared with prasugrel [13, 14].…”

Section: Introductionmentioning

confidence: 99%

The clinical efficacy and safety evaluation of ticagrelor for acute coronary syndrome in general ACS patients and diabetic patients: A systematic review and meta-analysis

Tan

Xin²,

Huang

et al. 2017

PLoS ONE

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ObjectiveIn this study, a systematic evaluation was conducted to estimate the efficacy and safety of ticagrelor for treating acute coronary syndrome (ACS) in general ACS patients and a diabetes mellitus (DM) group.MethodsA search of PubMed, Cochrane Central Register of Controlled Trials, Web of Science, CNKI databases was conducted to analyze relevant randomized controlled trails (RCTs) of ticagrelor treating ACS during 2007 to 2015. Article screening, quality accessing and data extracting was independently undertaken by two reviewers. A meta-analysis was performed to clarify the efficacy and safety of ticagrelor in general ACS patients, and a meta-regression analysis was taken to demonstrate the efficacy and safety of ticagrelor in DM patients compared with general ACS patients.ResultTwenty-two studies with 35004 participants were included. The meta-analysis result implicated that ticagrelor could: 1) reduce the incidence of the composite endpoint [OR = 0.83, 95%CI (0.77, 0.90), P<0.00001] and the incidence of myocardial infarction [OR = 0.81, 95%CI (0.74, 0.89), P = 0.0001]; 2) not statistically reduce the incidence of cardiovascular death, the incidence of stroke and the incidence of bleeding events; 3) increase the incidence of dyspnea [OR = 1.90, 95%CI (1.73, 2.08), P<0.00001] compared with clopidogrel. Meanwhile, compared with prasugrel, ticagrelor could 1) reduce the platelet reactivity of patients at maintenance dose [MD = -44.59, 95%CI (-59.16, -30.02), P<0.00001]; 2) not statistically reduce the incidence of cardiovascular death, the platelet reactivity of patients 6 hours or 8 hours after administration, or the incidence of bleeding events; 3) induce the incidence of dyspnea [OR = 13.99, 95%CI (2.58, 75.92), P = 0.002]. Furthermore, the result of meta-regression analysis implicated that there was a positive correlation between DM patients and the platelet reactivity of patients 6 hours and 8 hours after administration, but there was no obvious correlation between DM patients and general ACS patients in other endpoints.ConclusionTicagrelor could reduce the incidence of composite endpoint of cardiovascular death, myocardial infarction and stroke as well as platelet reactivity in DM patients with ACS, while not increasing the risk of bleeding. Because there are differences in platelet reactivity between DM patients and general ACS patients, we suggest that caution is needed when using ticagrelor in clinical applications.

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“…The prehospital administration of ticagrelor in patients with acute STEMI planned for reperfusion appears to be safe [24], and ticagrelor treatment was demonstrated to be effective and even superior to prasugrel [25] in high-risk diabetic patients with ACS. Moreover, the superiority of ticagrelor over prasugrel has been confirmed in a recent meta-analysis of 5395 patients from 29 studies published by Lhermusier et al [26]. These data support the use of ticagrelor in HTPR patients with ACS.…”

Section: Ticagrelor As An Approach For Overcoming High Clopidogrel Onmentioning

confidence: 63%

Ticagrelor

Samoš

Fedor

Kovář

et al. 2016

Blood Coagulation &Amp; Fibrinolysis

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Stent thrombosis is a morbid complication following percutaneous coronary intervention (PCI). Dual antiplatelet therapy significantly reduces stent thrombosis risk. However, the antiplatelet response to clopidogrel - the most frequently used ADP receptor antagonist in post-PCI patients - varies among individuals. High on-treatment platelet reactivity was repeatedly associated with the risk of stent thrombosis. Ticagrelor is a novel ADP receptor blocker that has shown greater, more rapid and more consistent platelet inhibition than clopidogrel. This agent offers a unique mechanism of action, no relevant pharmacological interactions, consistent platelet inhibition, and a good safety profile. This article reviews the prospective use of ticagrelor in the treatment of stent thrombosis in acute coronary syndrome patients undergoing PCI of culprit coronary lesion.

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Meta-Analysis of Direct and Indirect Comparison of Ticagrelor and Prasugrel Effects on Platelet Reactivity

Cited by 33 publications

References 28 publications

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

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

The clinical efficacy and safety evaluation of ticagrelor for acute coronary syndrome in general ACS patients and diabetic patients: A systematic review and meta-analysis

Ticagrelor

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