Coronary Artery DiseaseMeta-Analysis of Direct and Indirect Comparison of Ticagrelor and Prasugrel Effects on Platelet Reactivity
Section snippets
Methods
The primary objective of this meta-analysis was to compare the pharmacodynamic effect of ticagrelor and prasugrel. We included all studies providing PR data assessed in patients on prasugrel or ticagrelor maintenance dose. We selected studies including patients with coronary artery disease with or without PCI and excluded the ones performed in healthy volunteers. We limited our analysis to publications providing PR data according to the 3 most widely used platelet function tests: the VerifyNow
Results
From a total of 268 initial hits, 7 publications (Supplementary Data A) for direct comparison and 22 for indirect comparison (Supplementary Data B; 18 studies for clopidogrel-prasugrel comparison and 3 studies for clopidogrel-ticagrelor comparison) were found. The flow diagram of the study analysis and the design of the included studies are shown in Figure 1 and listed in Table 1, respectively. The clinical characteristics of patients enrolled in the studies included in the meta-analysis are
Discussion
Our network meta-analysis providing indirect and direct comparison of pharmacodynamic effects of prasugrel, ticagrelor, and clopidogrel in patients with coronary artery disease leads to the following findings: (a) both prasugrel 10 mg daily and ticagrelor 90 mg twice daily had significantly lower on-treatment platelet function values during maintenance therapy compared with clopidogrel 75 mg daily according to VerifyNow P2Y12 assay, VASP assay, and LTA; (b) both prasugrel 10 mg daily and
Disclosures
The authors have no conflicts of interest to disclose.
References (28)
- et al.
Effects of pretreatment with clopidogrel and aspirin followed by long-term therapy in patients undergoing percutaneous coronary intervention: the PCI-CURE study
Lancet
(2001) - et al.
Platelet reactivity and clinical outcomes after coronary artery implantation of drug-eluting stents (ADAPT-DES): a prospective multicentre registry study
Lancet
(2013) - et al.
Relationship between post-treatment platelet reactivity and ischemic and bleeding events at 1-year follow-up in patients receiving prasugrel
J Thromb Haemost
(2012) - et al.
Prospective evaluation of on-clopidogrel platelet reactivity over time in patients treated with percutaneous coronary intervention relationship with gene polymorphisms and clinical outcome
J Am Coll Cardiol
(2011) - et al.
Ticagrelor versus prasugrel in acute coronary syndrome patients with high on-clopidogrel platelet reactivity following percutaneous coronary intervention: a pharmacodynamic study
J Am Coll Cardiol
(2012) - et al.
Pharmacodynamic evaluation of switching from ticagrelor to prasugrel in subjects with stable coronary artery disease: results of the SWAP-2 study
J Am Coll Cardiol
(2014) - et al.
Comparison of on-treatment platelet reactivity after one-month use of clopidogrel, prasugrel or ticagrelor in Koreans with acute coronary syndromes (TCT Asia Pacifica Oral Presentation)
J Am Coll Cardiol
(2014) - et al.
Clopidogrel 150 mg/day to overcome low responsiveness in patients undergoing elective percutaneous coronary intervention: results from the VASP-02 (Vasodilator-Stimulated Phosphoprotein-02) randomized study
JACC Cardiovasc Interv
(2008) - et al.
A comparison of prasugrel and clopidogrel loading doses on platelet function: magnitude of platelet inhibition is related to active metabolite formation
Am Heart J
(2007) - et al.
Ticagrelor increases adenosine plasma concentration in patients with an acute coronary syndrome
J Am Coll Cardiol
(2014)
Effect of adenosine A2 receptor stimulation on platelet activation-aggregation: differences between canine and human models
Thromb Res
Consensus and update on the definition of on-treatment platelet reactivity to ADP associated with ischemia and bleeding
J Am Coll Cardiol
Effects of clopidogrel in addition to aspirin in patients with acute coronary syndromes without ST-segment elevation
N Engl J Med
Prasugrel versus clopidogrel in patients with acute coronary syndromes
N Engl J Med
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