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Randomized Controlled Trial
. 2015 Dec 1;36(45):3202-10.
doi: 10.1093/eurheartj/ehv326. Epub 2015 Jul 27.

Impact of immature platelets on platelet response to ticagrelor and prasugrel in patients with acute coronary syndrome

Isabell Bernlochner  1 , Alexander Goedel  2 , Conny Plischke  2 , Stefanie Schüpke  3 , Bernhard Haller  4 , Christoph Schulz  5 , Katharina Mayer  6 , Tanja Morath  6 , Siegmund Braun  6 , Heribert Schunkert  3 , Wolfgang Siess  7 , Adnan Kastrati  3 , Karl-Ludwig Laugwitz  8
Affiliations
Randomized Controlled Trial

Impact of immature platelets on platelet response to ticagrelor and prasugrel in patients with acute coronary syndrome

Isabell Bernlochner et al. Eur Heart J. .

Abstract

Aims: The influence of reticulated platelets (RPs) on platelet inhibition by ticagrelor when compared with prasugrel is unknown. We aimed to determine the influence of RPs on adenosine diphosphate- (ADP-) induced platelet aggregation in patients with acute coronary syndrome who were randomly assigned to receive either ticagrelor or prasugrel for P2Y12 receptor inhibition.

Methods and results: One hundred and twenty-four patients were prospectively enrolled. The immature platelet fraction (IPF) was measured by an automated haematoanalyzer and platelet aggregation was assessed by multiple electrode aggregometry. In a subgroup of patients (n = 28) ADP-induced P-selectin expression was measured in dependence of the time point of study drug intake in RPs that were discriminated from mature platelets by thiazole-orange (TO) staining. The primary endpoint was the correlation of platelet aggregation and IPF in ticagrelor- vs. prasugrel-treated patients. Platelet aggregation significantly correlated with IPF in patients who received prasugrel (r = 0.41, P < 0.001). In contrast, no correlation between IPF and platelet aggregation was observed in ticagrelor-treated patients (r = 0.08, P = 0.51, P for difference of correlation coefficients P = 0.05). Within the TO-positive RP fraction, P-selectin expression was significantly higher in prasugrel when compared with ticagrelor-treated individuals (prasugrel 18.6 ± 16.0% vs. ticagrelor 11.5 ± 6.0%, P = 0.047). A time-dependent P-selectin expression was observed in prasugrel but not in ticagrelor-treated patients (prasugrel early 11.9 ± 9.4% vs. late 26.3 ± 19.0%, P = 0.031, ticagrelor early 9.6 ± 4.9% vs. late 13.5 ± 6.6%, P = 0.127).

Conclusion: Reticulated platelets show a greater impact on platelet reactivity in response to prasugrel when compared with ticagrelor.

Keywords: Acute coronary syndrome; Platelet aggregation; Prasugrel; Reticulated platelets; Ticagrelor.

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