Author + information
- Payam Dehghani,
- Andrea Lavoie,
- Shahar Lavi,
- Rodney Zimmermann,
- Jeff Booker,
- Warren Cantor,
- Shamir Mehta,
- Sebastian Harenberg,
- Jennifer Crawford,
- Sheila Kelly and
- Asim Cheema
Introduction: Patients undergoing PCI post fibrinolytic therapy are at high risk of both thrombotic and bleeding complications. Anti-platelet effect of ticagrelor compared to clopidogrel fibrinolytic-treated STEMI patients undergoing early PCI is unknown.
Methods: Patients undergoing PCI within 24 hours of tenecteplase (TNK) therapy for STEMI were randomized at four Canadian sites to additional clopidogrel 300mg followed by 75 mg daily or ticagrelor 180 mg followed by 90 mg twice daily dosing initiated prior to PCI. The platelet reactivity units (PRU) by VerifyNow Assay were measured before study drug administration (baseline), at 4 and 24 hours post PCI. The primary endpoint was PRU <208 at 4 hours.
Results: Total of 140 patients (74 in ticagrelor and 66 in clopidogrel group) were enrolled. Mean PRU values at baseline were similar for the two groups (257.8±52.9 vs. 259.5±56.7, p=0.85, respectively). Post PCI, patients on ticagrelor, compared to those on clopidogrel, had significantly lower PRU at 4 hours (80±87 vs. 190±92, respectively, p< 0.001) and at 24 hours (33±31 and 152±78, respectively, p< 0.001). The primary end point of PRU <208 is shown.
Conclusions: Fibrinolysis-treated STEMI patients on optimal adjunctive anti-platelet therapy undergoing early PCI have inadequate platelet inhibition. In this high-risk patient population, ticagrelor provides more prompt and potent platelet inhibition, and lower HPR rates, compared with clopidogrel (Funded by Astra Zeneca; NCT01930591).
Poster Hall, Hall C
Friday, March 17, 2017, 10:00 a.m.-10:45 a.m.
Session Title: Considerations in Antiplatelet Therapy and in ACS
Abstract Category: 15. Interventional Cardiology: ACS/AMI/Hemodynamics and Pharmacology
Presentation Number: 1113-136
- 2017 American College of Cardiology Foundation