Skip to main content

Response to ticagrelor in clopidogrel nonresponders and responders and effect of switching therapies: the RESPOND study.

Publication ,  Journal Article
Gurbel, PA; Bliden, KP; Butler, K; Antonino, MJ; Wei, C; Teng, R; Rasmussen, L; Storey, RF; Nielsen, T; Eikelboom, JW; Sabe-Affaki, G ...
Published in: Circulation
March 16, 2010

BACKGROUND: The antiplatelet effects of the Platelet Inhibition and Patient Outcomes (PLATO) trial dose of ticagrelor in patients nonresponsive to clopidogrel and after they switch agents are unknown. METHODS AND RESULTS: Patients with stable coronary artery disease on aspirin therapy received a 300-mg clopidogrel load; nonresponders were identified by light transmittance aggregometry. In a 2-way crossover design, nonresponders (n=41) and responders (n=57) randomly received clopidogrel (600 mg/75 mg once daily) or ticagrelor (180 mg/90 mg twice daily) for 14 days during period 1. In period 2, all nonresponders switched treatment; half of the responders continued the same treatment, whereas the others switched treatment. Inhibition of platelet aggregation was higher in nonresponders treated with ticagrelor compared with clopidogrel (P<0.05). Treatment with ticagrelor among nonresponders resulted in a >10%, >30%, and >50% decrease in platelet aggregation from baseline in 100%, 75%, and 13% of patients, respectively. Platelet aggregation fell from 59+/-9% to 35+/-11% in patients switched from clopidogrel to ticagrelor and increased from 36+/-14% to 56+/-9% in patients switched from ticagrelor to clopidogrel (P<0.0001 for both). Platelet reactivity was below the cut points previously associated with ischemic risk measured by light transmittance aggregometry, VerifyNow P2Y(12) assay, and vasodilator-stimulated phosphoprotein phosphorylation in 98% to 100% of patients after ticagrelor therapy versus 44% to 76% of patients after clopidogrel therapy. CONCLUSIONS: Ticagrelor therapy overcomes nonresponsiveness to clopidogrel, and its antiplatelet effect is the same in responders and nonresponders. Nearly all clopidogrel nonresponders and responders treated with ticagrelor will have platelet reactivity below the cut points associated with ischemic risk. Clinical Trial Registration- http://www.clinicaltrials.gov. Unique Identifier: NCT00642811.

Duke Scholars

Altmetric Attention Stats
Dimensions Citation Stats

Published In

Circulation

DOI

EISSN

1524-4539

Publication Date

March 16, 2010

Volume

121

Issue

10

Start / End Page

1188 / 1199

Location

United States

Related Subject Headings

  • Ticlopidine
  • Ticagrelor
  • Receptors, Purinergic P2Y12
  • Purinergic P2 Receptor Antagonists
  • Platelet Aggregation Inhibitors
  • Platelet Aggregation
  • Phosphorylation
  • Phosphoproteins
  • Middle Aged
  • Microfilament Proteins
 

Citation

APA
Chicago
ICMJE
MLA
NLM
Gurbel, P. A., Bliden, K. P., Butler, K., Antonino, M. J., Wei, C., Teng, R., … Tantry, U. S. (2010). Response to ticagrelor in clopidogrel nonresponders and responders and effect of switching therapies: the RESPOND study. Circulation, 121(10), 1188–1199. https://doi.org/10.1161/CIRCULATIONAHA.109.919456
Gurbel, Paul A., Kevin P. Bliden, Kathleen Butler, Mark J. Antonino, Cheryl Wei, Renli Teng, Lars Rasmussen, et al. “Response to ticagrelor in clopidogrel nonresponders and responders and effect of switching therapies: the RESPOND study.Circulation 121, no. 10 (March 16, 2010): 1188–99. https://doi.org/10.1161/CIRCULATIONAHA.109.919456.
Gurbel PA, Bliden KP, Butler K, Antonino MJ, Wei C, Teng R, et al. Response to ticagrelor in clopidogrel nonresponders and responders and effect of switching therapies: the RESPOND study. Circulation. 2010 Mar 16;121(10):1188–99.
Gurbel, Paul A., et al. “Response to ticagrelor in clopidogrel nonresponders and responders and effect of switching therapies: the RESPOND study.Circulation, vol. 121, no. 10, Mar. 2010, pp. 1188–99. Pubmed, doi:10.1161/CIRCULATIONAHA.109.919456.
Gurbel PA, Bliden KP, Butler K, Antonino MJ, Wei C, Teng R, Rasmussen L, Storey RF, Nielsen T, Eikelboom JW, Sabe-Affaki G, Husted S, Kereiakes DJ, Henderson D, Patel DV, Tantry US. Response to ticagrelor in clopidogrel nonresponders and responders and effect of switching therapies: the RESPOND study. Circulation. 2010 Mar 16;121(10):1188–1199.

Published In

Circulation

DOI

EISSN

1524-4539

Publication Date

March 16, 2010

Volume

121

Issue

10

Start / End Page

1188 / 1199

Location

United States

Related Subject Headings

  • Ticlopidine
  • Ticagrelor
  • Receptors, Purinergic P2Y12
  • Purinergic P2 Receptor Antagonists
  • Platelet Aggregation Inhibitors
  • Platelet Aggregation
  • Phosphorylation
  • Phosphoproteins
  • Middle Aged
  • Microfilament Proteins