Comparison of double (360 mg) ticagrelor loading dose with standard (60 mg) prasugrel loading dose in ST-elevation myocardial infarction patients: The Rapid Activity of Platelet Inhibitor Drugs (RAPID) primary PCI 2 study - 31/05/14
, Benedetta Bellandi, MD a, Renato Valenti, MD a, Angela Migliorini, MD a, Rossella Marcucci, MD b, Nazario Carrabba, MD a, Letizia Giurlani, MD a, Gian Franco Gensini, MD a, b, c, Rosanna Abbate, MD b, David Antoniucci, MD aBackground |
In ST-elevation myocardial infarction (STEMI) patients, residual platelet reactivity soon after a loading dose (LD) of prasugrel or ticagrelor is higher than that reported for healthy volunteers or subjects with stable coronary artery disease; and the majority of primary percutaneous coronary intervention (PPCI) procedures with bivalirudin monotherapy are performed without proper platelet inhibition. However, ticagrelor LD is just the daily dose, whereas prasugrel LD is 6-fold the long-term daily dose. We hypothesized that an increased ticagrelor LD may result in a faster and more effective platelet inhibition as compared with the standard prasugrel LD.
Methods |
Fifty patients with STEMI, pretreated with intravenous aspirin, undergoing PPCI were randomized to receive prasugrel 60-mg LD (n = 25) or ticagrelor 360-mg LD (n = 25). Residual platelet reactivity was assessed by VerifyNow at baseline and 1, 2, 4, and 12 hours after drug LD.
Results |
At the time of LD, 90% of enrolled patients had an aspirin reactivity unit value <550. P2Y12 reaction units 1 hour after the LD (study primary end point) were 236 (129-289) and 248 (115-304) in the prasugrel and ticagrelor group, respectively (P = .899). High residual platelet reactivity (P2Y12 reaction units ≥240) was found in 43% and 56% of patients (P = .386) at 1 hour and in 30% and 32% of patients (P = .907) at 2 hours, respectively. There was no significant difference in bleeding, arrhythmias, or dyspnea episodes in the 2 groups.
Conclusions |
In patients with STEMI undergoing PPCI, double (360 mg) ticagrelor LD failed to achieve a faster and more intense platelet inhibition as compared with the standard prasugrel LD. Intravenously administered aspirin allowed to achieve a very early inhibition of acid arachidonic pathway.
Il testo completo di questo articolo è disponibile in PDF.Mappa
| RCT# NCT01805570. |
|
| Authorship: All authors had access to data and a role in writing the article. |
Vol 167 - N° 6
P. 909-914 - giugno 2014 Ritorno al numero
Articolo precedente
- Arterial access site utilization in cardiogenic shock in the United Kingdom: Is radial access feasible?
- Mamas A. Mamas, Simon G. Anderson, Karim Ratib, Helen Routledge, Ludwig Neyses, Douglas G. Fraser, Iain Buchan, Mark A. de Belder, Peter Ludman, Jim Nolan
- Association between prehospital electrocardiogram use and patient home distance from the percutaneous coronary intervention center on total reperfusion time in ST-segment–elevation myocardial infarction patients: A retrospective analysis from the National Cardiovascular Data Registry
- Bryn E. Mumma, Michael C. Kontos, S. Andrew Peng, Deborah B. Diercks
Benvenuto su EM|consulte, il riferimento dei professionisti della salute.
L'accesso al testo integrale di questo articolo richiede un abbonamento.
Già abbonato a @@106933@@ rivista ?