News | May 14, 2015

Antiplatelet Drug Ticagrelor More Effective Than Clopidogrel for Ad Hoc PCI Patients

New study finds ticagrelor works more quickly when given at the time of PCI

May 14, 2015 — A new study reports that antiplatelet drug ticagrelor (Brilinta) works faster and is more effective in blocking platelet activity in low-risk patients with acute coronary syndrome (ACS) than clopidogrel. The study was presented as a late-breaking clinical trial at the Society for Cardiovascular Angiography and Interventions (SCAI) 2015 Scientific Sessions in San Diego.

Ticagrelor was approved by the U.S. Food and Drug Administration (FDA) in 2011 based on results from the PLATO trial, which compared ticagrelor to clopidogrel in patients pre-treated with one of the medications plus aspirin prior to percutaneous coronary intervention (PCI). However, many low-risk ACS patients undergoing “ad hoc” PCI, or PCI following a diagnostic catheterization, are not pre-treated with an antiplatelet drug.

In the trial presented at SCAI, 100 patients were randomized to receive either ticagrelor (180 mg loading dose and 90 mg after 12 hours) or clopidogrel (600 mg loading dose) with aspirin (75-100 mg daily) at the time of PCI. All of the patients tested negative for troponin, a substance in the blood indicating damage to the heart muscle. Researchers measured platelet reactivity prior to receiving the medication; at 0.50, two-and eight-hour intervals; and at the end of PCI. The primary endpoint of the study was platelet reactivity at two hours.

The study found platelet activity differed as early as one-half hour after the medication was administered. Significant reduction in platelet activity began as early as the end of PCI, which occurred a mean 0.6 hours after the medication was given, and continued to decrease at eight hours.

“At standard doses, ticagrelor works faster and better inhibits platelet activity than clopidogrel in low-risk ACS patients,” said Roxana Mehran, M.D., FSCAI, director of cardiovascular research and interventional clinical trials at Mount Sinai Medical Center in New York, and the study’s principal investigator. “The study suggests low-risk patients undergoing ad hoc PCI may fare better with ticagrelor.”

Mehran has received research grants from DSI/Eli Lilly, Bristol-Myers Squibb/Sanofi-Aventis, AstraZeneca, and The Medicines Company; and consulting or advisory board fees from AstraZeneca, Bayer, CSL Behring, Janssen Pharmaceuticals, Inc., Merck & Co., Inc., Osprey Medical Inc., Regado Biosciences, Inc., The Medicines Company, Watermark Consulting, Abbott Laboratories, Boston Scientific, Covidien, and Sanofi-Aventis.

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