Author + information
- Nikolaos Spinthakisa,b,
- Mohamed Faraga,b,
- Manivannan Srinivasana,b,
- David Wellsteda,b and
- Diana Goroga,b
Background: Patients with coronary artery disease (CAD) undergoing percutaneous coronary intervention (PCI) are at risk of thrombosis. Enhanced platelet reactivity and impaired endogenous thrombolysis, despite dual antiplatelet therapy, are risk factors for recurrent thrombotic events. We aimed to compare the relative effects of different P2Y12 antagonists on global thrombotic status including endogenous fibrinolysis.
Methods: Patients with established CAD taking aspirin 75 mg daily and scheduled to undergo PCI, were tested for thrombotic status before and after being established on clopidogrel (n=20), ticagrelor (n=20) or cangrelor (n=15). Thrombotic status was assessed with the automated point-of-care Global Thrombosis Test (GTT, Thromboquest Ltd., UK) that utilizes native, non-anticoagulated blood to assess in vitro occlusive thrombus formation (occlusion time OT, sec) and the time taken to restore flow through endogenous thrombolysis of the occlusive thrombus (lysis time LT, sec). Patients were tested after at least 7 days of continuous oral P2Y12 inhibitor or 5-7 min following the start intravenous cangrelor infusion.
Results: All P2Y12 inhibitors significantly prolonged OT compared to baseline, with the magnitude of effect greatest for cangrelor, followed by ticagrelor, then clopidogrel (mean increase in OT from baseline (delta): clopidogrel 83±120 vs. ticagrelor 102±112 vs. cangrelor 234±213; p=0.01). Cangrelor was the only P2Y12 inhibitor to significantly reduce LT compared to baseline. The difference in LT when comparing samples pre and post P2Y12 inhibition was significantly different between the 3 groups (median change in LT from baseline (delta): clopidogrel 30 [IQR-323, 260] vs. ticagrelol 81 [-58, 259] vs. cangrelor 309 [111, 764], p=0.041).
Conclusions: All P2Y12 inhibitors reduced platelet reactivity as evidenced by increase in OT, with magnitude of effect being cangrelor > ticagrelor > clopidogrel. Of all P2Y12 inhibitors, only cangrelor favorably enhanced endogenous thrombolysis. Further studies are needed to see if preferential cangrelor use in patients with impaired endogenous thrombolysis may translate into improved clinical outcomes.
Poster Hall, Hall C
Sunday, March 19, 2017, 9:45 a.m.-10:30 a.m.
Session Title: Antiplatelet and Antithrombotic Agents in Ischemic Heart Disease
Abstract Category: 3. Acute and Stable Ischemic Heart Disease: Therapy
Presentation Number: 1296-310
- 2017 American College of Cardiology Foundation