Collegium Medicum, Nicolaus Copernicus University, 13-15 Jagiellońska Street, 85-067 Bydgoszcz, Poland.
Department and Clinic of Cardiology, Wrocław Medical University, 213 Borowska Street, Wroclaw 50-556, Poland.
Eur Heart J Cardiovasc Pharmacother. 2019 Jul 1;5(3):139-148. doi: 10.1093/ehjcvp/pvz004.
Currently available data indicate that reduction of ticagrelor maintenance dose (MD) 1-3 years after acute myocardial infarction (AMI) not only provides sufficient platelet inhibition but also can improve ticagrelor's safety profile. The aim of this study was to compare the antiplatelet effect of reduced and standard ticagrelor MD in stable patients beginning 1 month after AMI.
In a single-centre, randomized, open-label, active-controlled trial, on Day 30 following AMI, 52 patients (26 in each study arm) were assigned in a 1:1 ratio to receive either reduced (60 mg b.i.d) or standard (90 mg b.i.d) ticagrelor MD for the following 2 weeks. On Day 45 after AMI the antiplatelet effect of ticagrelor was evaluated with the VASP assay and Multiplate, and there were no significant differences in platelet inhibition between patients on reduced vs. standard MD [VASP: 10.4 (5.6-22.2) vs. 14.1 (9.4-22.1) platelet reactivity index; P = 0.30; Multiplate: 30.0 (24.0-39.0) vs. 26.5 (22.0-35.0) U; P = 0.26]. Likewise, no differences were found regarding the prevalence of on-ticagrelor high platelet reactivity between patients on ticagrelor 60 mg b.i.d vs. 90 mg b.i.d (VASP: 4% vs. 8%; P = 0.67; Multiplate: 15% vs. 8%; P = 0.54). Administration of reduced MD resulted in proportionally lower plasma concentrations of ticagrelor and its active metabolite on Day 45 after AMI.
These results suggest that lowering ticagrelor MD 1 month after AMI confers an adequate antiplatelet effect that is comparable to the standard dose. The tested strategy warrants further research to assess its clinical efficacy and safety.
CLINICALTRIALS.GOV IDENTIFIER: NCT03251859.
目前的可用数据表明，急性心肌梗死（AMI）后 1-3 年减少替格瑞洛维持剂量（MD）不仅能提供充分的血小板抑制作用，还能改善替格瑞洛的安全性。本研究旨在比较 AMI 后 1 个月稳定患者使用减少和标准剂量替格瑞洛 MD 的抗血小板作用。
在一项单中心、随机、开放标签、阳性对照试验中，在 AMI 后第 30 天，52 例患者（每组 26 例）按 1:1 比例随机分配，分别接受减少（60mg，bid）或标准（90mg，bid）替格瑞洛 MD 治疗，为期 2 周。在 AMI 后第 45 天，使用 VASP 测定和 Multiplate 评估替格瑞洛的抗血小板作用，接受减少与标准 MD 治疗的患者之间血小板抑制无显著差异[VASP：血小板反应指数 10.4（5.6-22.2）比 14.1（9.4-22.1）；P=0.30；Multiplate：30.0（24.0-39.0）比 26.5（22.0-35.0）U；P=0.26]。同样，在替格瑞洛 60mg bid 与 90mg bid 治疗的患者中，也未发现高血小板反应性与替格瑞洛之间存在差异（VASP：4%比 8%；P=0.67；Multiplate：15%比 8%；P=0.54）。AMI 后第 45 天，接受减少 MD 治疗的患者替格瑞洛及其活性代谢物的血浆浓度呈比例降低。
这些结果表明，AMI 后 1 个月降低替格瑞洛 MD 可提供充分的抗血小板作用，与标准剂量相当。该策略值得进一步研究，以评估其临床疗效和安全性。
临床试验.gov 标识符：NCT03251859。
