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Ticagrelor versus high dose clopidogrel in ST-segment elevation myocardial infarction patients with high platelet reactivity post fibrinolysis

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Abstract

Limited data are available on high platelet reactivity (HPR) rate early post fibrinolysis, while no effective way to overcome it has been proposed. In this context, we aimed to compare ticagrelor versus high dose clopidogrel in patients with ST-segment elevation myocardial infarction (STEMI) who exhibit HPR post fibrinolysis. In a prospective, randomized, parallel design, 3-center study, 56 STEMI patients, out of 83 (67.5 %) screened, who presented with HPR (PRU ≥ 208 by VerifyNow) 3–48 h post fibrinolysis and prior to coronary angiography were allocated to ticagrelor 180 mg loading dose (LD)/90 mg bid maintenance dose (MD) or clopidogrel 600 mg LD/150 mg MD. Platelet reactivity was assessed at randomization (Hour 0), at Hour 2, Hour 24 and pre-discharge. The primary endpoint of platelet reactivity (in PRU) at Hour 2 was significantly lower for ticagrelor compared to clopidogrel with a least square mean difference (95 % confidence interval) of −141.7 (−173.4 to −109.9), p < 0.001. HPR rates at Hour 2 and 24 were significantly lower for ticagrelor versus clopidogrel (14.3 vs. 82.1 %, p < 0.001 and 0 vs. 25.0 %, p = 0.01 respectively), though not significantly different pre-discharge. In-hospital Bleeding Academic Research Consortium type ≥2 bleeding occurred in 1 and 2 clopidogrel and ticagrelor-treated patients, respectively. In STEMI patients, post fibrinolysis HPR is common. Ticagrelor treats HPR more effectively compared to high dose clopidogrel therapy. Although antiplatelet regimens tested in this study were well tolerated, this finding should be considered only exploratory.

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Conflict of interest

Dr. Alexopoulos has received payment for lectures from AstraZeneca. All other authors have nothing to disclose.

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Authors and Affiliations

  1. Department of Cardiology, Patras University Hospital, Rion, 26500, Patras, Greece

    Dimitrios Alexopoulos, Angelos Perperis, Ioanna Koniari, Nikolaos Barampoutis, George Hahalis & Ioanna Xanthopoulou

  2. First Cardiology Department, AHEPA University Hospital, Thessaloniki, Greece

    Haralambos Karvounis, Antonios Ziakas & Theofilos Panagiotidis

  3. Department of Cardiology, Konstantopoulio General Hospital, Athens, Greece

    Sotirios Patsilinakos

  4. Department of Internal Medicine, Patras University Hospital, Rion, Patras, Greece

    Karolina Akinosoglou

Authors
  1. Dimitrios Alexopoulos
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  2. Angelos Perperis
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  3. Ioanna Koniari
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  4. Haralambos Karvounis
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  5. Sotirios Patsilinakos
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  6. Antonios Ziakas
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  7. Nikolaos Barampoutis
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  8. Theofilos Panagiotidis
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  9. Karolina Akinosoglou
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  10. George Hahalis
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  11. Ioanna Xanthopoulou
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Correspondence to Dimitrios Alexopoulos.

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Alexopoulos, D., Perperis, A., Koniari, I. et al. Ticagrelor versus high dose clopidogrel in ST-segment elevation myocardial infarction patients with high platelet reactivity post fibrinolysis. J Thromb Thrombolysis 40, 261–267 (2015). https://doi.org/10.1007/s11239-015-1183-9

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  • DOI: https://doi.org/10.1007/s11239-015-1183-9

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