Long-term pharmacodynamic effects of Ticagrelor versus Clopidogrel in fibrinolytic-treated STEMI patients undergoing early PCI
The long-term pharmacodynamic effects of Ticagrelor versus Clopidogrel in patients undergoing early percutaneous coronary intervention (PCI) after fibrinolytic therapy is unknown. From May 2014 to August 2016, 212 patients undergoing PCI within 24 h of Tenecteplase (TNK), Aspirin, and Clopidogrel fo...
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| Veröffentlicht in: | Journal of thrombosis and thrombolysis 2018-02, Vol.45 (2), p.225-233 |
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| creator | Yang, Andrew Pon, Quin Lavoie, Andrea Crawford, Jennifer J. Harenberg, Sebastian Zimmermann, Rodney H. Booker, Jeff Kelly, Sheila Lavi, Shahar Cantor, Warren J. Mehta, Shamir R. Bagai, Akshay Goodman, Shaun G. Cheema, Asim N. Dehghani, Payam |
| description | The long-term pharmacodynamic effects of Ticagrelor versus Clopidogrel in patients undergoing early percutaneous coronary intervention (PCI) after fibrinolytic therapy is unknown. From May 2014 to August 2016, 212 patients undergoing PCI within 24 h of Tenecteplase (TNK), Aspirin, and Clopidogrel for ST-elevated myocardial infarction (STEMI) were randomized at four Canadian sites to receive additional Clopidogrel or Ticagrelor initiated prior to PCI. The platelet reactivity units (PRU) were measured with the VerifyNow Assay before study drug administration (baseline), at 4 and 24 h post PCI, and follow-up appointment. A mixed-model analysis with time as the repeated measure and drug as the between-subjects factor was calculated using 2 separate 1 × 4 ANOVAs, with students t-tests used to compare drugs within each time point. Complete clinical follow-up data (median 115.0 days; IQR 80.3–168.8) was available in 50 patients (23.6%) randomized to either Clopidogrel (n = 23) or Ticagrelor (n = 27). Analyses revealed significant decreases in PRU from baseline to 4 h (261.4 vs. 71.7; Mdiff = − 189.7; p |
| doi_str_mv | 10.1007/s11239-017-1581-2 |
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From May 2014 to August 2016, 212 patients undergoing PCI within 24 h of Tenecteplase (TNK), Aspirin, and Clopidogrel for ST-elevated myocardial infarction (STEMI) were randomized at four Canadian sites to receive additional Clopidogrel or Ticagrelor initiated prior to PCI. The platelet reactivity units (PRU) were measured with the VerifyNow Assay before study drug administration (baseline), at 4 and 24 h post PCI, and follow-up appointment. A mixed-model analysis with time as the repeated measure and drug as the between-subjects factor was calculated using 2 separate 1 × 4 ANOVAs, with students t-tests used to compare drugs within each time point. Complete clinical follow-up data (median 115.0 days; IQR 80.3–168.8) was available in 50 patients (23.6%) randomized to either Clopidogrel (n = 23) or Ticagrelor (n = 27). Analyses revealed significant decreases in PRU from baseline to 4 h (261.4 vs. 71.7; Mdiff = − 189.7; p < 0.001) to 24 h (71.7 vs. 27.7; Mdiff = − 44.0; p < 0.001) to end of follow-up (27.7 vs.17.9; Mdiff = − 9.9. p = 0.016) for those randomized to Ticagrelor and significant decreases in PRU only from baseline to 4 h (271.3 vs. 200.8; Mdiff = − 70.5, p = < 0.001) in patients receiving Clopidogrel, and a significantly greater proportion of patients with adequate platelet inhibition (PRU < 208) on long-term follow-up (Clopidogrel, 82.6% vs. Ticagrelor, 100.0%; p = 0.038). Our results demonstrate that in patients undergoing PCI within 24 h of fibrinolysis for STEMI, Ticagrelor provides prolonged platelet inhibition compared with Clopidogrel.</description><identifier>ISSN: 0929-5305</identifier><identifier>EISSN: 1573-742X</identifier><identifier>DOI: 10.1007/s11239-017-1581-2</identifier><identifier>PMID: 29170875</identifier><language>eng</language><publisher>New York: Springer US</publisher><subject>Aspirin ; Cardiology ; Clopidogrel ; Fibrin ; Fibrinolysis ; Hematology ; Medicine ; Medicine & Public Health ; Myocardial infarction ; Pharmacodynamics ; Platelets</subject><ispartof>Journal of thrombosis and thrombolysis, 2018-02, Vol.45 (2), p.225-233</ispartof><rights>Springer Science+Business Media, LLC, part of Springer Nature 2017</rights><rights>Journal of Thrombosis and Thrombolysis is a copyright of Springer, (2017). All Rights Reserved.</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c438t-68698759b07d6cf0aaa7a38a1ee91d4d792023976465db888dd5d17f88ee980c3</citedby><cites>FETCH-LOGICAL-c438t-68698759b07d6cf0aaa7a38a1ee91d4d792023976465db888dd5d17f88ee980c3</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://link.springer.com/content/pdf/10.1007/s11239-017-1581-2$$EPDF$$P50$$Gspringer$$H</linktopdf><linktohtml>$$Uhttps://link.springer.com/10.1007/s11239-017-1581-2$$EHTML$$P50$$Gspringer$$H</linktohtml><link.rule.ids>314,776,780,27901,27902,41464,42533,51294</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/29170875$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Yang, Andrew</creatorcontrib><creatorcontrib>Pon, Quin</creatorcontrib><creatorcontrib>Lavoie, Andrea</creatorcontrib><creatorcontrib>Crawford, Jennifer J.</creatorcontrib><creatorcontrib>Harenberg, Sebastian</creatorcontrib><creatorcontrib>Zimmermann, Rodney H.</creatorcontrib><creatorcontrib>Booker, Jeff</creatorcontrib><creatorcontrib>Kelly, Sheila</creatorcontrib><creatorcontrib>Lavi, Shahar</creatorcontrib><creatorcontrib>Cantor, Warren J.</creatorcontrib><creatorcontrib>Mehta, Shamir R.</creatorcontrib><creatorcontrib>Bagai, Akshay</creatorcontrib><creatorcontrib>Goodman, Shaun G.</creatorcontrib><creatorcontrib>Cheema, Asim N.</creatorcontrib><creatorcontrib>Dehghani, Payam</creatorcontrib><title>Long-term pharmacodynamic effects of Ticagrelor versus Clopidogrel in fibrinolytic-treated STEMI patients undergoing early PCI</title><title>Journal of thrombosis and thrombolysis</title><addtitle>J Thromb Thrombolysis</addtitle><addtitle>J Thromb Thrombolysis</addtitle><description>The long-term pharmacodynamic effects of Ticagrelor versus Clopidogrel in patients undergoing early percutaneous coronary intervention (PCI) after fibrinolytic therapy is unknown. From May 2014 to August 2016, 212 patients undergoing PCI within 24 h of Tenecteplase (TNK), Aspirin, and Clopidogrel for ST-elevated myocardial infarction (STEMI) were randomized at four Canadian sites to receive additional Clopidogrel or Ticagrelor initiated prior to PCI. The platelet reactivity units (PRU) were measured with the VerifyNow Assay before study drug administration (baseline), at 4 and 24 h post PCI, and follow-up appointment. A mixed-model analysis with time as the repeated measure and drug as the between-subjects factor was calculated using 2 separate 1 × 4 ANOVAs, with students t-tests used to compare drugs within each time point. Complete clinical follow-up data (median 115.0 days; IQR 80.3–168.8) was available in 50 patients (23.6%) randomized to either Clopidogrel (n = 23) or Ticagrelor (n = 27). Analyses revealed significant decreases in PRU from baseline to 4 h (261.4 vs. 71.7; Mdiff = − 189.7; p < 0.001) to 24 h (71.7 vs. 27.7; Mdiff = − 44.0; p < 0.001) to end of follow-up (27.7 vs.17.9; Mdiff = − 9.9. p = 0.016) for those randomized to Ticagrelor and significant decreases in PRU only from baseline to 4 h (271.3 vs. 200.8; Mdiff = − 70.5, p = < 0.001) in patients receiving Clopidogrel, and a significantly greater proportion of patients with adequate platelet inhibition (PRU < 208) on long-term follow-up (Clopidogrel, 82.6% vs. Ticagrelor, 100.0%; p = 0.038). Our results demonstrate that in patients undergoing PCI within 24 h of fibrinolysis for STEMI, Ticagrelor provides prolonged platelet inhibition compared with Clopidogrel.</description><subject>Aspirin</subject><subject>Cardiology</subject><subject>Clopidogrel</subject><subject>Fibrin</subject><subject>Fibrinolysis</subject><subject>Hematology</subject><subject>Medicine</subject><subject>Medicine & Public Health</subject><subject>Myocardial infarction</subject><subject>Pharmacodynamics</subject><subject>Platelets</subject><issn>0929-5305</issn><issn>1573-742X</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2018</creationdate><recordtype>article</recordtype><sourceid>BENPR</sourceid><recordid>eNp1kc9rFDEUx4Modm39A3qRgBcv0STzI8mxLK0urCi4BW8hm7wZU2aSaTIj7MW_3SzbSil4Crx83vc93gehS0Y_MkrFp8wYrxShTBDWSEb4C7RijaiIqPnPl2hFFVekqWhzht7kfEcpVYry1-iMKyaoFM0K_dnG0JMZ0oinXyaNxkZ3CGb0FkPXgZ0zjh3eeWv6BENM-DekvGS8HuLkXTwWsQ-48_vkQxwOs7dkTmBmcPjH7vrrBk9m9hBKzhIcpD760GMwaTjg7-vNBXrVmSHD24f3HN3eXO_WX8j22-fN-mpLbF3JmbSyVWVdtafCtbajxhhhKmkYgGKudkJxWi4h2rpt3F5K6VzjmOikLICktjpHH065U4r3C-RZjz5bGAYTIC5ZM9XKuuY1bwv6_hl6F5cUynZHSgiqRNUUip0om2LOCTo9JT-adNCM6qMcfZKjixx9lKN56Xn3kLzsR3D_Oh5tFICfgFy-Qg_pyej_pv4FV0KbBQ</recordid><startdate>20180201</startdate><enddate>20180201</enddate><creator>Yang, Andrew</creator><creator>Pon, Quin</creator><creator>Lavoie, Andrea</creator><creator>Crawford, Jennifer J.</creator><creator>Harenberg, Sebastian</creator><creator>Zimmermann, Rodney H.</creator><creator>Booker, Jeff</creator><creator>Kelly, Sheila</creator><creator>Lavi, Shahar</creator><creator>Cantor, Warren J.</creator><creator>Mehta, Shamir R.</creator><creator>Bagai, Akshay</creator><creator>Goodman, Shaun G.</creator><creator>Cheema, Asim N.</creator><creator>Dehghani, Payam</creator><general>Springer US</general><general>Springer Nature B.V</general><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>3V.</scope><scope>7TK</scope><scope>7X7</scope><scope>7XB</scope><scope>88E</scope><scope>8AO</scope><scope>8FI</scope><scope>8FJ</scope><scope>8FK</scope><scope>ABUWG</scope><scope>AFKRA</scope><scope>BENPR</scope><scope>CCPQU</scope><scope>FYUFA</scope><scope>GHDGH</scope><scope>K9.</scope><scope>M0S</scope><scope>M1P</scope><scope>PQEST</scope><scope>PQQKQ</scope><scope>PQUKI</scope><scope>PRINS</scope><scope>7X8</scope></search><sort><creationdate>20180201</creationdate><title>Long-term pharmacodynamic effects of Ticagrelor versus Clopidogrel in fibrinolytic-treated STEMI patients undergoing early PCI</title><author>Yang, Andrew ; Pon, Quin ; Lavoie, Andrea ; Crawford, Jennifer J. ; Harenberg, Sebastian ; Zimmermann, Rodney H. ; Booker, Jeff ; Kelly, Sheila ; Lavi, Shahar ; Cantor, Warren J. ; Mehta, Shamir R. ; Bagai, Akshay ; Goodman, Shaun G. ; Cheema, Asim N. ; Dehghani, Payam</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c438t-68698759b07d6cf0aaa7a38a1ee91d4d792023976465db888dd5d17f88ee980c3</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2018</creationdate><topic>Aspirin</topic><topic>Cardiology</topic><topic>Clopidogrel</topic><topic>Fibrin</topic><topic>Fibrinolysis</topic><topic>Hematology</topic><topic>Medicine</topic><topic>Medicine & Public Health</topic><topic>Myocardial infarction</topic><topic>Pharmacodynamics</topic><topic>Platelets</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Yang, Andrew</creatorcontrib><creatorcontrib>Pon, Quin</creatorcontrib><creatorcontrib>Lavoie, Andrea</creatorcontrib><creatorcontrib>Crawford, Jennifer J.</creatorcontrib><creatorcontrib>Harenberg, Sebastian</creatorcontrib><creatorcontrib>Zimmermann, Rodney H.</creatorcontrib><creatorcontrib>Booker, Jeff</creatorcontrib><creatorcontrib>Kelly, Sheila</creatorcontrib><creatorcontrib>Lavi, Shahar</creatorcontrib><creatorcontrib>Cantor, Warren J.</creatorcontrib><creatorcontrib>Mehta, Shamir R.</creatorcontrib><creatorcontrib>Bagai, Akshay</creatorcontrib><creatorcontrib>Goodman, Shaun G.</creatorcontrib><creatorcontrib>Cheema, Asim N.</creatorcontrib><creatorcontrib>Dehghani, Payam</creatorcontrib><collection>PubMed</collection><collection>CrossRef</collection><collection>ProQuest Central (Corporate)</collection><collection>Neurosciences Abstracts</collection><collection>Health & Medical Collection</collection><collection>ProQuest Central (purchase pre-March 2016)</collection><collection>Medical Database (Alumni Edition)</collection><collection>ProQuest Pharma Collection</collection><collection>Hospital Premium Collection</collection><collection>Hospital Premium Collection (Alumni Edition)</collection><collection>ProQuest Central (Alumni) (purchase pre-March 2016)</collection><collection>ProQuest Central (Alumni Edition)</collection><collection>ProQuest Central UK/Ireland</collection><collection>ProQuest Central</collection><collection>ProQuest One Community College</collection><collection>Health Research Premium Collection</collection><collection>Health Research Premium Collection (Alumni)</collection><collection>ProQuest Health & Medical Complete (Alumni)</collection><collection>Health & Medical Collection (Alumni Edition)</collection><collection>Medical Database</collection><collection>ProQuest One Academic Eastern Edition (DO NOT USE)</collection><collection>ProQuest One Academic</collection><collection>ProQuest One Academic UKI Edition</collection><collection>ProQuest Central China</collection><collection>MEDLINE - Academic</collection><jtitle>Journal of thrombosis and thrombolysis</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Yang, Andrew</au><au>Pon, Quin</au><au>Lavoie, Andrea</au><au>Crawford, Jennifer J.</au><au>Harenberg, Sebastian</au><au>Zimmermann, Rodney H.</au><au>Booker, Jeff</au><au>Kelly, Sheila</au><au>Lavi, Shahar</au><au>Cantor, Warren J.</au><au>Mehta, Shamir R.</au><au>Bagai, Akshay</au><au>Goodman, Shaun G.</au><au>Cheema, Asim N.</au><au>Dehghani, Payam</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Long-term pharmacodynamic effects of Ticagrelor versus Clopidogrel in fibrinolytic-treated STEMI patients undergoing early PCI</atitle><jtitle>Journal of thrombosis and thrombolysis</jtitle><stitle>J Thromb Thrombolysis</stitle><addtitle>J Thromb Thrombolysis</addtitle><date>2018-02-01</date><risdate>2018</risdate><volume>45</volume><issue>2</issue><spage>225</spage><epage>233</epage><pages>225-233</pages><issn>0929-5305</issn><eissn>1573-742X</eissn><abstract>The long-term pharmacodynamic effects of Ticagrelor versus Clopidogrel in patients undergoing early percutaneous coronary intervention (PCI) after fibrinolytic therapy is unknown. From May 2014 to August 2016, 212 patients undergoing PCI within 24 h of Tenecteplase (TNK), Aspirin, and Clopidogrel for ST-elevated myocardial infarction (STEMI) were randomized at four Canadian sites to receive additional Clopidogrel or Ticagrelor initiated prior to PCI. The platelet reactivity units (PRU) were measured with the VerifyNow Assay before study drug administration (baseline), at 4 and 24 h post PCI, and follow-up appointment. A mixed-model analysis with time as the repeated measure and drug as the between-subjects factor was calculated using 2 separate 1 × 4 ANOVAs, with students t-tests used to compare drugs within each time point. Complete clinical follow-up data (median 115.0 days; IQR 80.3–168.8) was available in 50 patients (23.6%) randomized to either Clopidogrel (n = 23) or Ticagrelor (n = 27). Analyses revealed significant decreases in PRU from baseline to 4 h (261.4 vs. 71.7; Mdiff = − 189.7; p < 0.001) to 24 h (71.7 vs. 27.7; Mdiff = − 44.0; p < 0.001) to end of follow-up (27.7 vs.17.9; Mdiff = − 9.9. p = 0.016) for those randomized to Ticagrelor and significant decreases in PRU only from baseline to 4 h (271.3 vs. 200.8; Mdiff = − 70.5, p = < 0.001) in patients receiving Clopidogrel, and a significantly greater proportion of patients with adequate platelet inhibition (PRU < 208) on long-term follow-up (Clopidogrel, 82.6% vs. Ticagrelor, 100.0%; p = 0.038). Our results demonstrate that in patients undergoing PCI within 24 h of fibrinolysis for STEMI, Ticagrelor provides prolonged platelet inhibition compared with Clopidogrel.</abstract><cop>New York</cop><pub>Springer US</pub><pmid>29170875</pmid><doi>10.1007/s11239-017-1581-2</doi><tpages>9</tpages></addata></record> |
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| subjects | Aspirin Cardiology Clopidogrel Fibrin Fibrinolysis Hematology Medicine Medicine & Public Health Myocardial infarction Pharmacodynamics Platelets |
| title | Long-term pharmacodynamic effects of Ticagrelor versus Clopidogrel in fibrinolytic-treated STEMI patients undergoing early PCI |
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