Diurnal Variability of Platelet Aggregation in Patients with Myocardial Infarction Treated with Prasugrel and Ticagrelor

Background: Contemporary antiplatelet treatment in acute myocardial infarction (AMI) is based on one of two P2Y12 receptor inhibitors, prasugrel or ticagrelor. The aim of this study was to compare diurnal variability of platelet reactivity between patients receiving prasugrel and ticagrelor during t...

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Autores principales: Adamski, Piotr, Barańska, Malwina, Ostrowska, Małgorzata, Kuliczkowski, Wiktor, Buszko, Katarzyna, Kościelska-Kasprzak, Katarzyna, Karolko, Bożena, Mysiak, Andrzej, Kubica, Jacek
Formato: Online Artículo Texto
Lenguaje:English
Publicado: MDPI 2022
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8876868/
https://www.ncbi.nlm.nih.gov/pubmed/35207396
http://dx.doi.org/10.3390/jcm11041124
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author Adamski, Piotr
Barańska, Malwina
Ostrowska, Małgorzata
Kuliczkowski, Wiktor
Buszko, Katarzyna
Kościelska-Kasprzak, Katarzyna
Karolko, Bożena
Mysiak, Andrzej
Kubica, Jacek
author_facet Adamski, Piotr
Barańska, Malwina
Ostrowska, Małgorzata
Kuliczkowski, Wiktor
Buszko, Katarzyna
Kościelska-Kasprzak, Katarzyna
Karolko, Bożena
Mysiak, Andrzej
Kubica, Jacek
author_sort Adamski, Piotr
collection PubMed
description Background: Contemporary antiplatelet treatment in acute myocardial infarction (AMI) is based on one of two P2Y12 receptor inhibitors, prasugrel or ticagrelor. The aim of this study was to compare diurnal variability of platelet reactivity between patients receiving prasugrel and ticagrelor during the initial phase of maintenance treatment after AMI. Methods: It was a prospective, two-center, pharmacodynamic, observational study. Blood for platelet testing was sampled at four time points on day four after AMI (8:00, 12:00, 16:00, 20:00). Diurnal variability of platelet reactivity was expressed as a coefficient of variation (CV) of the above-mentioned measurements. Results: 73 invasively-treated patients were enrolled (ticagrelor: n = 47, prasugrel: n = 26). CV was greater in patients treated with ticagrelor compared with prasugrel according to a VASP assay (47.8 [31.6–64.6]% vs. 21.3 [12.9–25.5]%, p < 0.001), while no statistical differences were detected when the CVs of platelet aggregation according to Multiplate were compared between ticagrelor- and prasugrel-treated patients. Ticagrelor-treated patients showed more pronounced platelet inhibition than prasugrel at 16:00 and 20:00 (VASP(16:00): 20.6 ± 15.0 vs. 24.9 ± 12.8 PRI, p = 0.049; VASP(20:00): 18.6 ± 17.7 vs. 26.0 ± 11.7 PRI, p = 0.002). Conclusions: Ticagrelor shows greater diurnal variability in platelet aggregation than prasugrel during the initial maintenance phase of AMI treatment, and this is due to the continuous increase of platelet inhibition after the morning maintenance dose. Both drugs provide an adequate antiplatelet effect early after AMI. Evaluation of the clinical significance of these findings warrants further investigation.
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spelling pubmed-88768682022-02-26 Diurnal Variability of Platelet Aggregation in Patients with Myocardial Infarction Treated with Prasugrel and Ticagrelor Adamski, Piotr Barańska, Malwina Ostrowska, Małgorzata Kuliczkowski, Wiktor Buszko, Katarzyna Kościelska-Kasprzak, Katarzyna Karolko, Bożena Mysiak, Andrzej Kubica, Jacek J Clin Med Article Background: Contemporary antiplatelet treatment in acute myocardial infarction (AMI) is based on one of two P2Y12 receptor inhibitors, prasugrel or ticagrelor. The aim of this study was to compare diurnal variability of platelet reactivity between patients receiving prasugrel and ticagrelor during the initial phase of maintenance treatment after AMI. Methods: It was a prospective, two-center, pharmacodynamic, observational study. Blood for platelet testing was sampled at four time points on day four after AMI (8:00, 12:00, 16:00, 20:00). Diurnal variability of platelet reactivity was expressed as a coefficient of variation (CV) of the above-mentioned measurements. Results: 73 invasively-treated patients were enrolled (ticagrelor: n = 47, prasugrel: n = 26). CV was greater in patients treated with ticagrelor compared with prasugrel according to a VASP assay (47.8 [31.6–64.6]% vs. 21.3 [12.9–25.5]%, p < 0.001), while no statistical differences were detected when the CVs of platelet aggregation according to Multiplate were compared between ticagrelor- and prasugrel-treated patients. Ticagrelor-treated patients showed more pronounced platelet inhibition than prasugrel at 16:00 and 20:00 (VASP(16:00): 20.6 ± 15.0 vs. 24.9 ± 12.8 PRI, p = 0.049; VASP(20:00): 18.6 ± 17.7 vs. 26.0 ± 11.7 PRI, p = 0.002). Conclusions: Ticagrelor shows greater diurnal variability in platelet aggregation than prasugrel during the initial maintenance phase of AMI treatment, and this is due to the continuous increase of platelet inhibition after the morning maintenance dose. Both drugs provide an adequate antiplatelet effect early after AMI. Evaluation of the clinical significance of these findings warrants further investigation. MDPI 2022-02-21 /pmc/articles/PMC8876868/ /pubmed/35207396 http://dx.doi.org/10.3390/jcm11041124 Text en © 2022 by the authors. https://creativecommons.org/licenses/by/4.0/Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license (https://creativecommons.org/licenses/by/4.0/).
spellingShingle Article
Adamski, Piotr
Barańska, Malwina
Ostrowska, Małgorzata
Kuliczkowski, Wiktor
Buszko, Katarzyna
Kościelska-Kasprzak, Katarzyna
Karolko, Bożena
Mysiak, Andrzej
Kubica, Jacek
Diurnal Variability of Platelet Aggregation in Patients with Myocardial Infarction Treated with Prasugrel and Ticagrelor
title Diurnal Variability of Platelet Aggregation in Patients with Myocardial Infarction Treated with Prasugrel and Ticagrelor
title_full Diurnal Variability of Platelet Aggregation in Patients with Myocardial Infarction Treated with Prasugrel and Ticagrelor
title_fullStr Diurnal Variability of Platelet Aggregation in Patients with Myocardial Infarction Treated with Prasugrel and Ticagrelor
title_full_unstemmed Diurnal Variability of Platelet Aggregation in Patients with Myocardial Infarction Treated with Prasugrel and Ticagrelor
title_short Diurnal Variability of Platelet Aggregation in Patients with Myocardial Infarction Treated with Prasugrel and Ticagrelor
title_sort diurnal variability of platelet aggregation in patients with myocardial infarction treated with prasugrel and ticagrelor
topic Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8876868/
https://www.ncbi.nlm.nih.gov/pubmed/35207396
http://dx.doi.org/10.3390/jcm11041124
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