Ticagrelor Compared to Clopidogrel in Low-Risk ACS Patients

May 7, 2015—Roxana Mehran, MD, presented late-breaking clinical trial results showing that the antiplatelet drug ticagrelor (Brilinta, AstraZeneca) works faster and is more effective in blocking platelet activity in low-risk patients with acute coronary syndrome (ACS) than clopidogrel.

Dr. Mehran, the study’s principal investigator, is Director of Cardiovascular Research and Interventional Clinical Trials at Mount Sinai Medical Center in New York, New York.

Dr. Mehran’s paper, “Ticagrelor versus Clopidogrel in Troponin-negative Patients with Acute Coronary Syndrome Undergoing Ad Hoc Percutaneous Coronary Intervention: Results of a Prospective, Randomized, Multicenter Pharmacodynamic Study,” was presented at the Society for Cardiovascular Angiography and Interventions (SCAI) 2015 scientific sessions being held May 6–9 in San Diego, California.

According to SCAI, the US Food and Drug Administration approved ticagrelor in 2011 based on results from the PLATO trial. PLATO compared ticagrelor to clopidogrel in patients pretreated with one of the medications plus aspirin before percutaneous coronary intervention (PCI). SCAI noted, though, that many low-risk ACS patients undergoing ad hoc PCI are not pretreated with an antiplatelet drug.

The current trial presented at SCAI 2015 was composed of 100 patients—all of whom tested negative for troponin. The patients were randomized to receive either ticagrelor (180-mg loading dose and 90-mg after 12 hours) or clopidogrel (600-mg loading dose) with aspirin (75–100 mg daily) at the time of PCI.

The investigators measured platelet reactivity in patients before receiving the medication and at 30 minutes and 2 hours after receiving the medication, then at 8-hour intervals, and at the end of PCI. The primary endpoint of the study was platelet reactivity at 2 hours. 

The study found platelet activity differed as early as 30 minutes after the medication was administered. Significant reduction in platelet activity began as early as the end of PCI, which occurred a mean 0.6 hours after the medication was given, and continued to decrease at 8 hours, reported SCAI.

In SCAI’s press release, Dr. Mehran commented, “At standard doses, ticagrelor works faster and better inhibits platelet activity than clopidogrel in low-risk ACS patients. The study suggests low-risk patients undergoing ad hoc PCI may fare better with ticagrelor.”