P2Y12 receptor inhibition with prasugrel and ticagrelor in STEMI patients after fibrinolytic therapy: Analysis from the SAMPA randomized trial

Leonardo de F.C. Guimarães, Philippe Genereux, Diego Silveira, Antonio Eduardo Pesaro, Felipe Falcão, Bruno Robalinho C. Barbosa, Cristiano Freitas de Souza, Francisco A.H. Fonseca, Cláudia Maria Rodrigues Alves, Antônio Carlos de Camargo Carvalho, Gregg W. Stone, Adriano Caixeta

Research output: Contribution to journalArticle

7 Citations (Scopus)

Abstract

Background A pharmacodynamic comparison between ticagrelor and prasugrel after fibrinolytic therapy has not yet been performed. Methods In the single-center SAMPA trial, 50 consecutive STEMI patients previously treated with clopidogrel and undergoing a pharmacoinvasive strategy were randomized to either a ticagrelor (n = 25) 180 mg loading dose followed by 90 mg bid, or a prasugrel (n = 25) 60 mg loading dose followed by 10 mg/day, initiated after fibrinolytic therapy but before angiography. Platelet reactivity was assessed with the VerifyNow P2Y12 assay at 0, 2, 6, and 24 h after randomization. Results Mean times from fibrinolysis to prasugrel or ticagrelor administration were 11.1 ± 6.9 and 13.3 ± 6.3 h, respectively (p = 0.24). The values of PRU decreased significantly from baseline to 2 h (all p < 0.001) and from 2 h to 6 h (all p < 0.001) in both groups. There was no difference in PRU values between 6 h and 24 h. The mean PRU values at 0, 2, 6, and 24 h were 234.9, 127.8, 45.4, and 48.0 in the prasugrel group and 233.1, 135.1, 67.7, and 56.9 in the ticagrelor group, respectively. PRU values did not significantly differ between groups at any time period of the study. Conclusions In patients with STEMI treated with fibrinolytic therapy, platelet inhibition after clopidogrel is suboptimal and can be further increased with more potent agents. Ticagrelor and prasugrel demonstrated a similar extent of P2Y12 receptor inhibition within 24 h, although maximal platelet inhibition after these potent agents was not achieved for 6 h.

Original languageEnglish (US)
Pages (from-to)204-208
Number of pages5
JournalInternational Journal of Cardiology
Volume230
DOIs
StatePublished - Mar 1 2017
Externally publishedYes

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Thrombolytic Therapy
clopidogrel
Blood Platelets
Fibrinolysis
Random Allocation
Angiography
ST Elevation Myocardial Infarction
Prasugrel Hydrochloride
Ticagrelor

All Science Journal Classification (ASJC) codes

  • Cardiology and Cardiovascular Medicine

Cite this

Guimarães, Leonardo de F.C. ; Genereux, Philippe ; Silveira, Diego ; Pesaro, Antonio Eduardo ; Falcão, Felipe ; Barbosa, Bruno Robalinho C. ; de Souza, Cristiano Freitas ; Fonseca, Francisco A.H. ; Alves, Cláudia Maria Rodrigues ; Carvalho, Antônio Carlos de Camargo ; Stone, Gregg W. ; Caixeta, Adriano. / P2Y12 receptor inhibition with prasugrel and ticagrelor in STEMI patients after fibrinolytic therapy : Analysis from the SAMPA randomized trial. In: International Journal of Cardiology. 2017 ; Vol. 230. pp. 204-208.
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title = "P2Y12 receptor inhibition with prasugrel and ticagrelor in STEMI patients after fibrinolytic therapy: Analysis from the SAMPA randomized trial",
abstract = "Background A pharmacodynamic comparison between ticagrelor and prasugrel after fibrinolytic therapy has not yet been performed. Methods In the single-center SAMPA trial, 50 consecutive STEMI patients previously treated with clopidogrel and undergoing a pharmacoinvasive strategy were randomized to either a ticagrelor (n = 25) 180 mg loading dose followed by 90 mg bid, or a prasugrel (n = 25) 60 mg loading dose followed by 10 mg/day, initiated after fibrinolytic therapy but before angiography. Platelet reactivity was assessed with the VerifyNow P2Y12 assay at 0, 2, 6, and 24 h after randomization. Results Mean times from fibrinolysis to prasugrel or ticagrelor administration were 11.1 ± 6.9 and 13.3 ± 6.3 h, respectively (p = 0.24). The values of PRU decreased significantly from baseline to 2 h (all p < 0.001) and from 2 h to 6 h (all p < 0.001) in both groups. There was no difference in PRU values between 6 h and 24 h. The mean PRU values at 0, 2, 6, and 24 h were 234.9, 127.8, 45.4, and 48.0 in the prasugrel group and 233.1, 135.1, 67.7, and 56.9 in the ticagrelor group, respectively. PRU values did not significantly differ between groups at any time period of the study. Conclusions In patients with STEMI treated with fibrinolytic therapy, platelet inhibition after clopidogrel is suboptimal and can be further increased with more potent agents. Ticagrelor and prasugrel demonstrated a similar extent of P2Y12 receptor inhibition within 24 h, although maximal platelet inhibition after these potent agents was not achieved for 6 h.",
author = "Guimar{\~a}es, {Leonardo de F.C.} and Philippe Genereux and Diego Silveira and Pesaro, {Antonio Eduardo} and Felipe Falc{\~a}o and Barbosa, {Bruno Robalinho C.} and {de Souza}, {Cristiano Freitas} and Fonseca, {Francisco A.H.} and Alves, {Cl{\'a}udia Maria Rodrigues} and Carvalho, {Ant{\^o}nio Carlos de Camargo} and Stone, {Gregg W.} and Adriano Caixeta",
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Guimarães, LDFC, Genereux, P, Silveira, D, Pesaro, AE, Falcão, F, Barbosa, BRC, de Souza, CF, Fonseca, FAH, Alves, CMR, Carvalho, ACDC, Stone, GW & Caixeta, A 2017, 'P2Y12 receptor inhibition with prasugrel and ticagrelor in STEMI patients after fibrinolytic therapy: Analysis from the SAMPA randomized trial', International Journal of Cardiology, vol. 230, pp. 204-208. https://doi.org/10.1016/j.ijcard.2016.12.173

P2Y12 receptor inhibition with prasugrel and ticagrelor in STEMI patients after fibrinolytic therapy : Analysis from the SAMPA randomized trial. / Guimarães, Leonardo de F.C.; Genereux, Philippe; Silveira, Diego; Pesaro, Antonio Eduardo; Falcão, Felipe; Barbosa, Bruno Robalinho C.; de Souza, Cristiano Freitas; Fonseca, Francisco A.H.; Alves, Cláudia Maria Rodrigues; Carvalho, Antônio Carlos de Camargo; Stone, Gregg W.; Caixeta, Adriano.

In: International Journal of Cardiology, Vol. 230, 01.03.2017, p. 204-208.

Research output: Contribution to journalArticle

TY - JOUR

T1 - P2Y12 receptor inhibition with prasugrel and ticagrelor in STEMI patients after fibrinolytic therapy

T2 - Analysis from the SAMPA randomized trial

AU - Guimarães, Leonardo de F.C.

AU - Genereux, Philippe

AU - Silveira, Diego

AU - Pesaro, Antonio Eduardo

AU - Falcão, Felipe

AU - Barbosa, Bruno Robalinho C.

AU - de Souza, Cristiano Freitas

AU - Fonseca, Francisco A.H.

AU - Alves, Cláudia Maria Rodrigues

AU - Carvalho, Antônio Carlos de Camargo

AU - Stone, Gregg W.

AU - Caixeta, Adriano

PY - 2017/3/1

Y1 - 2017/3/1

N2 - Background A pharmacodynamic comparison between ticagrelor and prasugrel after fibrinolytic therapy has not yet been performed. Methods In the single-center SAMPA trial, 50 consecutive STEMI patients previously treated with clopidogrel and undergoing a pharmacoinvasive strategy were randomized to either a ticagrelor (n = 25) 180 mg loading dose followed by 90 mg bid, or a prasugrel (n = 25) 60 mg loading dose followed by 10 mg/day, initiated after fibrinolytic therapy but before angiography. Platelet reactivity was assessed with the VerifyNow P2Y12 assay at 0, 2, 6, and 24 h after randomization. Results Mean times from fibrinolysis to prasugrel or ticagrelor administration were 11.1 ± 6.9 and 13.3 ± 6.3 h, respectively (p = 0.24). The values of PRU decreased significantly from baseline to 2 h (all p < 0.001) and from 2 h to 6 h (all p < 0.001) in both groups. There was no difference in PRU values between 6 h and 24 h. The mean PRU values at 0, 2, 6, and 24 h were 234.9, 127.8, 45.4, and 48.0 in the prasugrel group and 233.1, 135.1, 67.7, and 56.9 in the ticagrelor group, respectively. PRU values did not significantly differ between groups at any time period of the study. Conclusions In patients with STEMI treated with fibrinolytic therapy, platelet inhibition after clopidogrel is suboptimal and can be further increased with more potent agents. Ticagrelor and prasugrel demonstrated a similar extent of P2Y12 receptor inhibition within 24 h, although maximal platelet inhibition after these potent agents was not achieved for 6 h.

AB - Background A pharmacodynamic comparison between ticagrelor and prasugrel after fibrinolytic therapy has not yet been performed. Methods In the single-center SAMPA trial, 50 consecutive STEMI patients previously treated with clopidogrel and undergoing a pharmacoinvasive strategy were randomized to either a ticagrelor (n = 25) 180 mg loading dose followed by 90 mg bid, or a prasugrel (n = 25) 60 mg loading dose followed by 10 mg/day, initiated after fibrinolytic therapy but before angiography. Platelet reactivity was assessed with the VerifyNow P2Y12 assay at 0, 2, 6, and 24 h after randomization. Results Mean times from fibrinolysis to prasugrel or ticagrelor administration were 11.1 ± 6.9 and 13.3 ± 6.3 h, respectively (p = 0.24). The values of PRU decreased significantly from baseline to 2 h (all p < 0.001) and from 2 h to 6 h (all p < 0.001) in both groups. There was no difference in PRU values between 6 h and 24 h. The mean PRU values at 0, 2, 6, and 24 h were 234.9, 127.8, 45.4, and 48.0 in the prasugrel group and 233.1, 135.1, 67.7, and 56.9 in the ticagrelor group, respectively. PRU values did not significantly differ between groups at any time period of the study. Conclusions In patients with STEMI treated with fibrinolytic therapy, platelet inhibition after clopidogrel is suboptimal and can be further increased with more potent agents. Ticagrelor and prasugrel demonstrated a similar extent of P2Y12 receptor inhibition within 24 h, although maximal platelet inhibition after these potent agents was not achieved for 6 h.

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