Korean Circ J.  2019 Nov;49(11):1052-1061. 10.4070/kcj.2019.0098.

Temporal Variability of Platelet Reactivity in Patients Treated with Clopidogrel or Ticagrelor

• Yun KH
• Cho JY
• Rhee SJ
• Oh SK

• KMID: 2460531
• DOI: http://doi.org/10.4070/kcj.2019.0098

Abstract

BACKGROUND AND OBJECTIVES
The degree of antiplatelet response to P2Y12 inhibitors has been associated with clinical outcomes. The aim of this study was to test the variability of platelet reactivity over time among patients treated with clopidogrel or ticagrelor.
METHODS
A single-center cohort of acute coronary syndrome patients that underwent percutaneous coronary intervention (PCI) was analyzed. Platelet reactivity was measured at baseline, 48 hours after PCI, 1 month, and 6 months after clopidogrel (n=79) or ticagrelor (n=93) treatment. High on-treatment platelet reactivity (HPR) was defined as ≥47 U, assessed by multiple electrode platelet aggregometry.
RESULTS
Platelet reactivity in the clopidogrel group increased over time, 38.2±21.7 U at 48 hours, 41.4±22.3 U at 1 month, and 44.7±25.5 U at 6 months (p=0.018, 48 hours to 6 months). However, platelet reactivity in the ticagrelor group was not significantly changed, 21.4±12.6 U at 48 hours, 20.0±12.2 U at 1 month, and 22.8±13.8 U at 6 months (p=0.392). A platelet reactivity change over time of more than 20U was found in 67.1% of the patients with clopidogrel group and 34.4% of ticagrelor group (p<0.001). Between 48 hours and 6 months, 43% of patients changed their responder status in the clopidogrel group, and 13% in the ticagrelor group (p<0.001).
CONCLUSIONS
Although ticagrelor treatment resulted in less temporal variability of platelet reactivity than clopidogrel treatment in terms of HPR, platelet reactivity varied over time in a significant proportion of patients.

Keyword

Platelet function tests; Clopidogrel; Ticagrelor

MeSH Terms

Acute Coronary Syndrome
Blood Platelets*
Cohort Studies
Electrodes
Humans
Percutaneous Coronary Intervention
Platelet Function Tests

Figure

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  Figure 1 Study flow chart.P2Y12I = P2Y12 inhibitor; CABG = coronary artery bypass grafting; PCI = percutaneous coronary intervention.

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  Figure 2 Platelet reactivity by period. Platelet reactivity in the clopidogrel group increased over time. However, platelet reactivity was not siginificantly changed in the ticagrelor group.

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  Figure 3 Proportion of patients with (A) high on-treatment platelet reactivity and (B) low on-treatment platelet reactivity.

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  Figure 4 Indvidual HPR status over time. 43.0% of patients in the clopidogrel group changed their HPR status during the study period (A). However, only 12.9% of patients in the ticargrelor group changed their responder status (B).HPR = high on-treatment platelet reactivity.

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