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      Clopidogrel versus ticagrelor in the treatment of Chinese patients undergoing percutaneous coronary intervention: effects on platelet function assessed by platelet function tests and mean platelet volume

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          Abstract

          Background

          Knowledge on the pharmacodynamic effects of antiplatelet drugs including clopidogrel and ticagrelor on Asian patients is scarce. We aim to evaluate the effects of the two drugs on platelet reactivity in the treatment of Chinese patients who underwent percutaneous coronary intervention (PCI), using two platelet function tests (PFT). Meanwhile, the relationship between mean platelet volume (MPV), a routine index of platelet size, and high on-treatment platelet reactivity (HPR) is also investigated.

          Methods

          Patients receiving dual antiplatelet therapy (DAPT) were scheduled for the assessment of platelet reactivity at 2–3 days after PCI. Two PFTs, light transmission aggregometry (LTA) and vasodilator-stimulated phosphoprotein (VASP)-FCM assay, were applied in the evaluation of platelet reactivity. The MPV was measured simultaneously with EDTA plasma using a Sysmex XN 2000 automated hematology analyzer.

          Results

          The final study population included the aspirin + clopidogrel group ( n = 46) and the aspirin + ticagrelor group ( n = 66). In the aspirin + ticagrelor group, the maximal light transmittance (LT) changes in response to 5 μM ADP assessed by LTA was obviously lower than that in the aspirin + clopidogrel group ( P <  0.001). The platelet reactivity index (PRI) level in the VASP test was also markedly lower in the group given aspirin and ticagrelor (P <  0.001). There was a significant difference in HPR between the two groups. MPV showed a potent ability to predict the presence of HPR at VASP assay (AUC = 0.788, 95% CI: 0.701–0.875, P <  0.001) in receiver-operating characteristic curve analysis.

          Conclusions

          Compared with clopidogrel, ticagrelor has dramatically greater antiplatelet effect, with a superiority in suppressing platelet function and a lower HPR rate. In addition, there existed a significant independent association between MPV and high prevalence of HPR in the VASP assay.

          Supplementary Information

          The online version contains supplementary material available at 10.1186/s12959-021-00350-2.

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          Most cited references57

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          Ticagrelor versus clopidogrel in patients with acute coronary syndromes.

          Lars Wallentin, Richard C. Becker, Andrzej Budaj … (2009)
          Ticagrelor is an oral, reversible, direct-acting inhibitor of the adenosine diphosphate receptor P2Y12 that has a more rapid onset and more pronounced platelet inhibition than clopidogrel. In this multicenter, double-blind, randomized trial, we compared ticagrelor (180-mg loading dose, 90 mg twice daily thereafter) and clopidogrel (300-to-600-mg loading dose, 75 mg daily thereafter) for the prevention of cardiovascular events in 18,624 patients admitted to the hospital with an acute coronary syndrome, with or without ST-segment elevation. At 12 months, the primary end point--a composite of death from vascular causes, myocardial infarction, or stroke--had occurred in 9.8% of patients receiving ticagrelor as compared with 11.7% of those receiving clopidogrel (hazard ratio, 0.84; 95% confidence interval [CI], 0.77 to 0.92; P<0.001). Predefined hierarchical testing of secondary end points showed significant differences in the rates of other composite end points, as well as myocardial infarction alone (5.8% in the ticagrelor group vs. 6.9% in the clopidogrel group, P=0.005) and death from vascular causes (4.0% vs. 5.1%, P=0.001) but not stroke alone (1.5% vs. 1.3%, P=0.22). The rate of death from any cause was also reduced with ticagrelor (4.5%, vs. 5.9% with clopidogrel; P<0.001). No significant difference in the rates of major bleeding was found between the ticagrelor and clopidogrel groups (11.6% and 11.2%, respectively; P=0.43), but ticagrelor was associated with a higher rate of major bleeding not related to coronary-artery bypass grafting (4.5% vs. 3.8%, P=0.03), including more instances of fatal intracranial bleeding and fewer of fatal bleeding of other types. In patients who have an acute coronary syndrome with or without ST-segment elevation, treatment with ticagrelor as compared with clopidogrel significantly reduced the rate of death from vascular causes, myocardial infarction, or stroke without an increase in the rate of overall major bleeding but with an increase in the rate of non-procedure-related bleeding. (ClinicalTrials.gov number, NCT00391872.) 2009 Massachusetts Medical Society
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            • Record: found
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            2017 ESC focused update on dual antiplatelet therapy in coronary artery disease developed in collaboration with EACTS

            Marco Valgimigli, Héctor Bueno, Robert A Byrne … (2018)
            Article 0 comments Cited 549 times – based on 0 reviews     Review now
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              2016 ACC/AHA Guideline Focused Update on Duration of Dual Antiplatelet Therapy in Patients With Coronary Artery Disease: A Report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines: An Update of the 2011 ACCF/AHA/SCAI Guideline for Percutaneous Coronary Intervention, 2011 ACCF/AHA Guideline for Coronary Artery Bypass Graft Surgery, 2012 ACC/AHA/ACP/AATS/PCNA/SCAI/STS Guideline for the Diagnosis and Management of Patients With Stable Ischemic Heart Disease, 2013 ACCF/AHA Guideline for the Management of ST-Elevation Myocardial Infarction, 2014 AHA/ACC Guideline for the Management of Patients With Non–ST-Elevation Acute Coronary Syndromes, and 2014 ACC/AHA Guideline on Perioperative Cardiovascular Evaluation and Management of Patients Undergoing Noncardiac Surgery

              Glenn N Levine, Eric R. Bates, John A Bittl … (2016)
              Circulation, 134(10)
              Article 0 comments Cited 297 times – based on 0 reviews     Review now
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                Author and article information

                Contributors
                Xi Chen: chenxifw@pumc.edu.cn
                Zhou Zhou: zhouzhou@fuwaihospital.org
                Journal
                Journal ID (nlm-ta): Thromb J
                Journal ID (iso-abbrev): Thromb J
                Title: Thrombosis Journal
                Publisher: BioMed Central (London )
                ISSN (Electronic): 1477-9560
                Publication date (Electronic): 7 December 2021
                Publication date PMC-release: 7 December 2021
                Publication date Collection: 2021
                Volume: 19
                Electronic Location Identifier: 97
                Affiliations
                [1 ]GRID grid.506261.6, ISNI 0000 0001 0706 7839, Diagnostic Laboratory Service, State Key Laboratory of Cardiovascular Disease, , Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences, Peking Union Medical College, ; No.167, Beilishi Road, Xicheng District, Beijing, 100037 China
                [2 ]Department of Laboratory Medicine, Yunnan Fuwai Cardiovascular Hospital, Kunming, 650000 China
                Article
                Publisher ID: 350
                DOI: 10.1186/s12959-021-00350-2
                PMC ID: 8650403
                SO-VID: d21be09b-9804-4806-bd22-6aaf23371774
                Copyright © © The Author(s) 2021
                License:

                Open AccessThis article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/. The Creative Commons Public Domain Dedication waiver ( http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated in a credit line to the data.

                History
                Date received : 24 July 2020
                Date accepted : 18 November 2021
                Categories
                Subject: Research
                Custom metadata
                issue-copyright-statement © The Author(s) 2021

                ScienceOpen disciplines: Cardiovascular Medicine
                Keywords: dual antiplatelet therapy,platelet function tests,high on-treatment platelet reactivity,mean platelet volume
                Data availability:
                ScienceOpen disciplines: Cardiovascular Medicine
                Keywords: dual antiplatelet therapy, platelet function tests, high on-treatment platelet reactivity, mean platelet volume

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