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Clopidogrel, prasugrel, ticagrelor and platelet inhibition in patients after percutaneous coronary intervention: effects on endothelial function

Session Platelets and thrombosis

Speaker Evangelos Oikonomou

Event : ESC Congress 2016

  • Topic : basic science
  • Sub-topic : Platelets, Haemostasis, Coagulation
  • Session type : Advances in Science

Authors : E Oikonomou (Athens,GR), G Siasos (Athens,GR), E Kokkou (Athens,GR), E Oikonomou (Athens,GR), M Zaromitidou (Athens,GR), S Tsalamandris (Athens,GR), M Anastasiou (Athens,GR), M Vavuranakis (Athens,GR), C Ververeli (Athens,GR), K Maniatis (Athens,GR), T Zografos (Athens,GR), AS Antonopoulos (Athens,GR), K Mourouzis (Athens,GR), A Giannaki (Athens,GR), D Tousoulis (Athens,GR)

E. Oikonomou1 , G. Siasos1 , E. Kokkou1 , E. Oikonomou1 , M. Zaromitidou1 , S. Tsalamandris1 , M. Anastasiou1 , M. Vavuranakis1 , C. Ververeli1 , K. Maniatis1 , T. Zografos1 , A.S. Antonopoulos1 , K. Mourouzis1 , A. Giannaki1 , D. Tousoulis1 , 1Hippokration Hospital, University of Athens, 1st Department of Cardiology - Athens - Greece ,

European Heart Journal ( 2016 ) 37 ( Abstract Supplement ), 1232

Background: The use of prasugrel or ticagrelor as part of dual antiplatelet therapy with acetylsalicylic acid after percutaneous coronary intervention (PCI) improves clinical outcomes relative to clopidogrel. Measurement of endothelial function is a strong predictor of adverse cardiovascular events.

Purpose: To investigate the different impact of clopidogrel, prasugrel and ticagrelor on endothelial function and platelet reactivity in patients after percutaneous coronary intervention.

Methods: We consecutively enrolled 68 patients with stable coronary artery disease (CAD) one month after PCI: 15 patients receiving prasugrel regimen (10mg/d), 34 patients receiving clopidogrel regimen (75mg/d) and 19 patients receiving ticagrelor regimen (180mg/d). Endothelial function was evaluated by flow mediated dilation (FMD) in the brachial artery. High on treatment platelet reactivity was evaluated using VerifyNow Assay. VerifyNow reports its results in P2Y12 reaction units (PRU) and the diagnostic cut-off value is 230 PRU.

Results: There was no difference between CAD patients in the three treatment groups (clopidogrel vs. prasugrel vs. ticagrelor) in age (58±8y vs. 58±10y vs. 53±11y, p=0.24), prevalence of male sex (82% vs. 93% vs. 79%, p=0.50), smoking habits (20% vs. 36% vs. 42%, p=0.23), presence of diabetes mellitus (33% vs. 15% vs. 16%, p=0.27) and in the presence of multi vessel CAD (52% vs. 17% vs. 31%, p=0.61). Interestingly, subjects under clopidogrel treatment had increased PRU compared to subjects under prasugrel and ticagrelor treatment [202 (133–249) vs. 123 (52–155) vs. 24 (6–140), p<0.001)]. Importantly, subjects in clopidogrel group had significantly impaired FMD compared to subjects in prasugrel and ticagrelor groups (4.57±1.97% vs. 9.60±3.77% vs. 7.62±2.48%, p<0.001). Finally, in the total study population there was an inverse association between FMD and PRU (rho=-0.305, p=0.011).

Conclusions: Prasugrel and ticagrelor treatment compared to clopidogrel treatment, showed a greater inhibition of platelet activation in CAD patients after PCI with a parallel improvement in endothelial function. These findings shed some light on the beneficial effects of prasugrel and ticagrelor in cardiovascular disease.

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