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The effect of ticagrelor versus clopidogrel on high on-treatment platelet reactivity: combined analysis of the ONSET/OFFSET and RESPOND studies.

Publication ,  Journal Article
Bliden, KP; Tantry, US; Storey, RF; Jeong, Y-H; Gesheff, M; Wei, C; Gurbel, PA
Published in: Am Heart J
July 2011

OBJECTIVES: The objective of the study was to determine the prevalence of high on-treatment platelet reactivity (HPR) in coronary artery disease patients enrolled in the ONSET/OFFSET and RESPOND studies. BACKGROUND: HPR has been linked to the occurrence of adverse events after stenting in patients treated with clopidogrel (C) and aspirin. Prevalence of HPR after treatment with ticagrelor (T), a reversible oral P2Y(12) receptor antagonist developed to overcome the limitations of C, is unknown. METHODS: Patients were treated with T (n = 106) or C (n = 103) on top of aspirin therapy. HPR was defined by published cutoff points associated with post-percutaneous coronary intervention ischemic risk: >59% 20 μM adenosine diphosphate-induced aggregation (light transmittance aggregometry), >235 P2Y12 reaction unit by VerifyNow P2Y(12) assay (VerifyNow, San Diego, CA), and >50% platelet reactivity index by vasodilator-stimulated phosphoprotein phosphorylation assay (VASP-P). Proportion differences for T versus C were analyzed by χ(2) test for each time point. Correlations (R) were analyzed by the Pearson method. RESULTS: Ticagrelor was associated with a significantly lower prevalence of HPR (0%-8%) compared with C (21%-81%) at 2, 4, 8, and 24 hours and ≥2 weeks postdosing (P < .0001, for all assays). The R values between light transmittance aggregometry and VerifyNow/VASP-P were all ≥0.43, P < .0001. CONCLUSIONS: The above data represent the largest serial pharmacodynamic evaluation of the comparative effects of T versus C. Ticagrelor was rapidly and consistently associated with a very low prevalence of HPR compared with C, as determined by multiple established methods to measure platelet reactivity. These results provide a mechanism for the lower ischemic event rate associated with T therapy reported in the PLATO trial.

Duke Scholars

Published In

Am Heart J

DOI

EISSN

1097-6744

Publication Date

July 2011

Volume

162

Issue

1

Start / End Page

160 / 165

Location

United States

Related Subject Headings

  • Treatment Outcome
  • Time Factors
  • Ticlopidine
  • Ticagrelor
  • Retrospective Studies
  • Purinergic P2Y Receptor Antagonists
  • Platelet Aggregation Inhibitors
  • Platelet Activation
  • Middle Aged
  • Male
 

Citation

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ICMJE
MLA
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Bliden, K. P., Tantry, U. S., Storey, R. F., Jeong, Y.-H., Gesheff, M., Wei, C., & Gurbel, P. A. (2011). The effect of ticagrelor versus clopidogrel on high on-treatment platelet reactivity: combined analysis of the ONSET/OFFSET and RESPOND studies. Am Heart J, 162(1), 160–165. https://doi.org/10.1016/j.ahj.2010.11.025
Bliden, Kevin P., Udaya S. Tantry, Robert F. Storey, Young-Hoon Jeong, Martin Gesheff, Cheryl Wei, and Paul A. Gurbel. “The effect of ticagrelor versus clopidogrel on high on-treatment platelet reactivity: combined analysis of the ONSET/OFFSET and RESPOND studies.Am Heart J 162, no. 1 (July 2011): 160–65. https://doi.org/10.1016/j.ahj.2010.11.025.
Bliden KP, Tantry US, Storey RF, Jeong Y-H, Gesheff M, Wei C, et al. The effect of ticagrelor versus clopidogrel on high on-treatment platelet reactivity: combined analysis of the ONSET/OFFSET and RESPOND studies. Am Heart J. 2011 Jul;162(1):160–5.
Bliden, Kevin P., et al. “The effect of ticagrelor versus clopidogrel on high on-treatment platelet reactivity: combined analysis of the ONSET/OFFSET and RESPOND studies.Am Heart J, vol. 162, no. 1, July 2011, pp. 160–65. Pubmed, doi:10.1016/j.ahj.2010.11.025.
Bliden KP, Tantry US, Storey RF, Jeong Y-H, Gesheff M, Wei C, Gurbel PA. The effect of ticagrelor versus clopidogrel on high on-treatment platelet reactivity: combined analysis of the ONSET/OFFSET and RESPOND studies. Am Heart J. 2011 Jul;162(1):160–165.
Journal cover image

Published In

Am Heart J

DOI

EISSN

1097-6744

Publication Date

July 2011

Volume

162

Issue

1

Start / End Page

160 / 165

Location

United States

Related Subject Headings

  • Treatment Outcome
  • Time Factors
  • Ticlopidine
  • Ticagrelor
  • Retrospective Studies
  • Purinergic P2Y Receptor Antagonists
  • Platelet Aggregation Inhibitors
  • Platelet Activation
  • Middle Aged
  • Male