Author + information
- S1936879815020531-bbfe4b1a6caf8afb1be83f37a64f1642Michael A. Gaglia Jr.,
- S1936879815020531-5b7636d8d04484081f5f4924f987cae2Michael J. Lipinski,
- S1936879815020531-a79033d94483ffa83e69315f45649c25Thibault Lhermusier,
- S1936879815020531-b41fe52590ef8bb393cebb8b291037bfArie Steinvil,
- S1936879815020531-22ca6bb575feb9b0401e73b8ef13bd3aSarkis Kiramijyan,
- S1936879815020531-b6b710f6bfd763713db79a5a2fd2a82eNina Chandra,
- S1936879815020531-716872d786d814660b960e91668b613fJohanna Kim,
- S1936879815020531-43188b297454714a1e633ce32956ff39Rebecca Torguson and
- S1936879815020531-772b1cb1fca98a9f26e1e7f8bddc725bRon Waksman
Ticagrelor significantly decreases platelet reactivity and improves clinical outcomes compared with clopidogrel, but little is known regarding the effects of ticagrelor upon platelet reactivity in African-Americans (AA) with an acute coronary syndrome (ACS). We therefore performed pharmacodynamic studies of platelet reactivity following treatment with ticagrelor in AA patients presenting with ACS and compared them to historical controls of AA with stable coronary artery disease (CAD).
We prospectively enrolled AA with ACS, defined as ≥2 of the following: chest pain, significant ST changes, or troponin elevation. Blood samples were collected 1, 4, and 8 hours following a loading dose of ticagrelor 180 mg and at 30 days on a maintenance dose of 90 mg twice daily. Platelet reactivity was measured with VerifyNow and reported as P2Y12 reactivity units (PRU). Mean PRU values were then compared to AA with stable CAD that underwent platelet reactivity testing at 30 minutes, 2 hours, and 8 hours after a loading dose and 7 days on a maintenance dose.
We enrolled 24 AA with ACS, compared to 32 AA with stable CAD. The two groups were similar in regards to age, gender, and comorbidities. Among patients with ACS, 21 presented with NSTEMI, 1 with STEMI, 2 with unstable angina, and 58% received clopidogrel before ticagrelor. PRU levels were generally similar between the ACS and stable CAD groups, with values at 30 minutes and 1 hour significantly higher than all other time points (Figure). In regards to time points in common between the two groups, PRU levels were also similar: 26 ± 30 in ACS vs. 27 ± 66 in stable patients at 8 hours (p=0.93); and 37 ± 40 in ACS vs. 23 ± 62 in stable patients during maintenance therapy (p=0.31).
AA patients with ACS and receiving ticagrelor have levels of platelet reactivity similar to AA patients with stable CAD.