Diurnal Variability of Platelet Aggregation in Patients with Myocardial Infarction Treated with Prasugrel and Ticagrelor

Piotr Adamski; Malwina Barańska; Małgorzata Ostrowska; Wiktor Kuliczkowski; Katarzyna Buszko; Katarzyna Kościelska-Kasprzak; Bożena Karolko; Andrzej Mysiak; Jacek Kubica

doi:10.3390/jcm11041124

Diurnal Variability of Platelet Aggregation in Patients with Myocardial Infarction Treated with Prasugrel and Ticagrelor

J Clin Med. 2022 Feb 21;11(4):1124. doi: 10.3390/jcm11041124.

Authors

Piotr Adamski¹, Malwina Barańska¹, Małgorzata Ostrowska¹, Wiktor Kuliczkowski², Katarzyna Buszko³, Katarzyna Kościelska-Kasprzak⁴, Bożena Karolko², Andrzej Mysiak², Jacek Kubica¹

Affiliations

¹ Department of Cardiology and Internal Medicine, Collegium Medicum, Nicolaus Copernicus University, 85-094 Bydgoszcz, Poland.
² Institute for Heart Diseases, Wroclaw Medical University, 50-556 Wroclaw, Poland.
³ Department of Theoretical Foundations of Biomedical Science and Medical Informatics, Collegium Medicum, Nicolaus Copernicus University, 87-067 Bydgoszcz, Poland.
⁴ Department and Clinic of Nephrology and Transplantation Medicine, Wroclaw Medical University, 50-367 Wroclaw, Poland.

Abstract

Background: Contemporary antiplatelet treatment in acute myocardial infarction (AMI) is based on one of two P2Y12 receptor inhibitors, prasugrel or ticagrelor. The aim of this study was to compare diurnal variability of platelet reactivity between patients receiving prasugrel and ticagrelor during the initial phase of maintenance treatment after AMI.

Methods: It was a prospective, two-center, pharmacodynamic, observational study. Blood for platelet testing was sampled at four time points on day four after AMI (8:00, 12:00, 16:00, 20:00). Diurnal variability of platelet reactivity was expressed as a coefficient of variation (CV) of the above-mentioned measurements.

Results: 73 invasively-treated patients were enrolled (ticagrelor: n = 47, prasugrel: n = 26). CV was greater in patients treated with ticagrelor compared with prasugrel according to a VASP assay (47.8 [31.6-64.6]% vs. 21.3 [12.9-25.5]%, p < 0.001), while no statistical differences were detected when the CVs of platelet aggregation according to Multiplate were compared between ticagrelor- and prasugrel-treated patients. Ticagrelor-treated patients showed more pronounced platelet inhibition than prasugrel at 16:00 and 20:00 (VASP_16:00: 20.6 ± 15.0 vs. 24.9 ± 12.8 PRI, p = 0.049; VASP_20:00: 18.6 ± 17.7 vs. 26.0 ± 11.7 PRI, p = 0.002).

Conclusions: Ticagrelor shows greater diurnal variability in platelet aggregation than prasugrel during the initial maintenance phase of AMI treatment, and this is due to the continuous increase of platelet inhibition after the morning maintenance dose. Both drugs provide an adequate antiplatelet effect early after AMI. Evaluation of the clinical significance of these findings warrants further investigation.

Keywords: myocardial infarction; platelet aggregation variability; prasugrel; ticagrelor.