1. Consistent platelet inhibition with ticagrelor 60 mg twice-daily following myocardial infarction regardless of diabetes status
- Author
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Rangasamy Muthusamy, Marc S. Sabatine, Francesco Franchi, Marc Cohen, Marc P. Bonaca, Ramzi A. Ajjan, Julia F Kuder, Robert F. Storey, Philippe Gabriel Steg, Mark R Thomas, Heather M Judge, Dominick J. Angiolillo, Fabiana Rollini, Deepak L. Bhatt, and Arif J. Ahsan
- Subjects
Male ,Ticagrelor ,Adenosine ,Time Factors ,Platelet Aggregation ,medicine.medical_treatment ,Myocardial Infarction ,030204 cardiovascular system & hematology ,Pharmacology ,Gastroenterology ,0302 clinical medicine ,Risk Factors ,Insulin ,Medicine ,030212 general & internal medicine ,Myocardial infarction ,Microfilament Proteins ,Hematology ,Middle Aged ,Receptors, Purinergic P2Y12 ,Treatment Outcome ,England ,Florida ,Platelet aggregation inhibitor ,Female ,medicine.drug ,Blood Platelets ,medicine.medical_specialty ,Platelet Function Tests ,Placebo ,Drug Administration Schedule ,03 medical and health sciences ,Internal medicine ,Diabetes mellitus ,Diabetes Mellitus ,Humans ,Hypoglycemic Agents ,Platelet activation ,Aged ,Glycated Hemoglobin ,business.industry ,Phosphoproteins ,Platelet Activation ,medicine.disease ,Pharmacodynamics ,Purinergic P2Y Receptor Antagonists ,business ,Cell Adhesion Molecules ,Biomarkers ,Platelet Aggregation Inhibitors - Abstract
SummaryDiabetes increases cardiovascular risk and reduces pharmacodynamic response to some oral antiplatelet drugs. This study aimed to determine whether ticagrelor 60 mg twice daily (bid) provided potent and consistent platelet inhibition in patients with vs without diabetes in the PEGASUS-TIMI 54 platelet function substudy. Out of 180 patients studied, 58 patients were randomised to and had received at least four weeks of ticagrelor 60 mg bid, with 20 (34 %) having diabetes, 58 patients received ticagrelor 90 mg bid, with 12 (21 %) having diabetes, and 64 patients received placebo, with 18 (28 %) having diabetes. Blood was sampled pre- and 2 hours post-maintenance dose. In patients treated with ticagrelor 60 mg bid, on-treatment platelet reactivity to ADP, as determined by light transmission aggregometry (LTA), VerifyNow and VASP, was similar in patients with vs without diabetes (LTA post-dose, ADP 20 ?M: 29 ± 14 vs 34 ± 10 %, respectively; p = 0.19). A consistent inhibitory effect of ticagrelor 60 mg bid was observed pre- and post-dose regardless of diabetes status, even in insulin-treated patients. Patients with diabetes did not have an increased incidence of high platelet reactivity in either ticagrelor group. Platelet reactivity was similar in patients with diabetes treated with ticagrelor 60 mg vs 90 mg bid. Pharmacokinetics of ticagrelor were not affected by diabetes status. In conclusion, ticagrelor 60 mg bid is equally effective at reducing platelet reactivity in patients with and without diabetes, yielding a consistently high level of platelet inhibition regardless of diabetes status.
- Published
- 2017