Effect of ticagrelor versus clopidogrel on platelet reactivity measured by thrombelastography in patients with minor stroke or TIA.

Abstract

In this study, we tested the effect of ticagrelor versus clopidogrel on platelet reactivity in patients with minor stroke or transient ischemic attack (TIA). A pre-specified subgroup analysis of a randomized controlled trial was conducted. Platelet reactivity was assessed by thrombelastography (TEG) platelet mapping. Patients were divided into carriers and non-carriers according to the carrier status of CYP2C19 loss-of-function (LOF) alleles. The primary outcome was the proportion of patients with high on-treatment platelet reactivity (HOPR) (defined as maximum amplitude induced by adenosine diphosphate > 47mm) at 90±7 days. Clinical outcomes within 90±7 days were followed up. Among 339 patients, 170 were randomized to ticagrelor/aspirin and 169 to clopidogrel/aspirin. Compared with clopidogrel/aspirin, the proportion of HOPR at 90±7 days in ticagrelor/aspirin was significantly lower (12.2% versus 30.0%, P < 0.001). Ticagrelor/aspirin had a lower proportion of HOPR among carriers (11.0% versus 35.6%, P < 0.001), but not among non-carriers (13.5% versus 22.4%, P = 0.17). Ticagrelor was superior to clopidogrel in inhibiting platelet reactivity measured by TEG platelet mapping among patients with acute minor stroke or TIA, particularly in carriers of the CYP2C19 LOF alleles. Large randomised controlled trials are needed to confirm our findings.

• Authors: Yingying Yang, Weiqi Chen, Yuesong Pan, Hongyi Yan, Xia Meng, Liping Liu, Yongjun Wang, Yilong Wang
• Journal: Aging (Aging (Albany NY)) Vol. 12 Issue 20 Pg. 20085-20094 (10 16 2020) ISSN: 1945-4589 [Electronic] United States
• PMID: 33065552 (Publication Type: Comparative Study, Journal Article, Multicenter Study, Randomized Controlled Trial, Research Support, Non-U.S. Gov't)

Chemical References

• Platelet Aggregation Inhibitors
• Clopidogrel
• CYP2C19 protein, human
• Cytochrome P-450 CYP2C19
• Ticagrelor
• Aspirin

Topics

• Aged
• Aspirin (therapeutic use)
• Beijing
• Blood Platelets (drug effects, metabolism)
• Clopidogrel (adverse effects, therapeutic use)
• Cytochrome P-450 CYP2C19 (genetics)
• Dual Anti-Platelet Therapy
• Female
• Humans
• Ischemic Attack, Transient (blood, diagnosis, drug therapy)
• Male
• Middle Aged
• Pharmacogenomic Variants
• Platelet Activation (drug effects)
• Platelet Aggregation Inhibitors (adverse effects, therapeutic use)
• Predictive Value of Tests
• Prospective Studies
• Stroke (blood, diagnosis, drug therapy)
• Thrombelastography
• Ticagrelor (adverse effects, therapeutic use)
• Time Factors
• Treatment Outcome