Magazine article Drug Topics

Time to Effective Platelet Inhibition Extended with Ticagrelor, Prasugrel

Magazine article Drug Topics

Time to Effective Platelet Inhibition Extended with Ticagrelor, Prasugrel

Article excerpt

anticoagulation therapies

In a study comparing ticagrelor and prasugrel in patients with ST-segment elevation myocardial infarction (STEMI) undergoing primary PCI, prasugrel was shown to be non-inferior to ticagrelor in terms of residual platelet reactivity measured 2 hours after the loading dose. The study also demonstrated that 4 hours is needed to achieve effective platelet inhibition in most patients. Only half of treated patients achieved effective platelet inhibition 2 hours after receiving the drugs.

In the pharmacodynamic study 25 STEMI patients undergoing primary PCI with bivalirudin were randomized to receive a 60-mg loading dose of prasugrel, and 25 patients were randomized to receive a 180-mg loading dose of ticagrelor. At 2 hours after the dose, 44% of patients treated with prasugrel and 60% of those treated with ticagrelor had high residual platelet reactivity (HRPR). For those treated with prasugrel and ticagrelor, the time required to achieve a PRU <240 was 3 hours and 5 hours, respectively. The use of morphine significantly affected the activity of prasugrel and ticagrelor, with morphine use shown to be an independent predictor of HRPR 2 hours after the loading doses were administered.

The results suggest a significant time window after primary PCI in which many patients are at high risk of stent thrombosis.

Source: Parodi G, Valenti R, Bellandi B et al. Comparison of prasugrel and ticagrelor loading doses in ST-segment elevation myocardial infarction patients: RAPID (Rapid Activity of Platelet Inhibitor Drugs) primary PCI study. J Am Coll Cardiol. 2013;61(15):16011606.

Tenecteplase plus heparin improves outcomes in PE

Adding tenecteplase to standard treatment with heparin in patients with intermediate-risk pulmonary embolism (PE) significantly reduced mortality or hemodynamic collapse, according to the PE Thrombolysis Study (?????). However, patients are at increased risk of major hemorrhage.

This trial, which was conducted in 1006 patients with a mean age of 70 years, is the largest for this indication. Patients received heparin plus placebo or heparin plus a weightbased bolus of tenecteplase. The primary end point was death from any cause or hemodynamic collapse after seven days.

The primary end point was reduced in patients treated with tenecteplase and heparin, compared with the heparinonly group (2. …

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