10 Marked differences in the pharmacokinetic and pharmacodynamic profiles of ticagrelor in patients undergoing treatment for ST elevation and non ST elevation myocardial infarction (stemi and nstemi)
Nevill, Alan M.
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AbstractIntroduction Ticagrelor, an orally administered, direct acting, reversible P2Y12 receptor inhibitor, provides faster onset and greater levels of platelet inhibition when compared to clopidogrel. Current data indicates a reduced antiplatelet effect in STEMI. We sought to determine the early pharmacokinetic (PK) and pharmacodynamic (PD) effect of ticagrelor loading doses administered to patients undergoing PCI for STEMI and NSTEMI. Methods This is a single centre non-randomised study. P2Y12 naive patients presenting with STEMI or NSTEMI were considered for inclusion. All patients gave informed consent. Enrolled patients were administered a loading dose of aspirin 300 mg and ticagrelor 180 mg prior to PCI. Blood was sampled at 20 min, coronary balloon time, 1 hour and 4 hours after loading. PD results are expressed as P2Y12 reaction units (PRU) and were assessed using VerifyNow. A PRU>208 indicates a sub-optimal antiplatelet response. PK properties were assessed by measuring plasma concentration of ticagrelor parent compound (T-PC) and active metabolite (T-AM) using liquid chromatography in tandem with mass spectrometry. The lower limits of quantification of T-PC and its active metabolite, AR-C124910XX (T-AM) are 1 ng/ml and 2.5 ng/ml respectively. PRU and plasma concentrations over time were tested between the two groups using 2-way ANOVA. p<0.05 was considered significant. Results 30 patients (15 STEMI/15 NSTEMI) were recruited. Baseline characteristics are described in Table 1.
CitationKhan N., Amoah V., Cornes, M. et al 10 Marked differences in the pharmacokinetic and pharmacodynamic profiles of ticagrelor in patients undergoing treatment for ST elevation and non ST elevation myocardial infarction (stemi and nstemi) Heart 2018;104(Suppl 6), pp. A9-A10.
PublisherBMJ Publishing Group
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