Adamski Piotr, Barańska Malwina, Ostrowska Małgorzata, Kuliczkowski Wiktor, Buszko Katarzyna, Kościelska-Kasprzak Katarzyna, Karolko Bożena, Mysiak Andrzej, Kubica Jacek
Department of Cardiology and Internal Medicine, Collegium Medicum, Nicolaus Copernicus University, 85-094 Bydgoszcz, Poland.
Institute for Heart Diseases, Wroclaw Medical University, 50-556 Wroclaw, Poland.
J Clin Med. 2022 Feb 21;11(4):1124. doi: 10.3390/jcm11041124.
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.
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.
73 invasively-treated patients were enrolled (ticagrelor: = 47, prasugrel: = 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]%, < 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: 20.6 ± 15.0 vs. 24.9 ± 12.8 PRI, = 0.049; VASP: 18.6 ± 17.7 vs. 26.0 ± 11.7 PRI, = 0.002).
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.
急性心肌梗死（AMI）的当代抗血小板治疗基于两种P2Y12受体抑制剂之一，即普拉格雷或替格瑞洛。本研究的目的是比较AMI后维持治疗初始阶段接受普拉格雷和替格瑞洛治疗的患者血小板反应性的日间变异性。
这是一项前瞻性、两中心、药效学、观察性研究。在AMI后第4天的4个时间点（8:00、12:00、16:00、20:00）采集用于血小板检测的血液。血小板反应性的日间变异性表示为上述测量值的变异系数（CV）。
纳入73例接受侵入性治疗的患者（替格瑞洛组：n = 47，普拉格雷组：n = 26）。根据VASP检测，替格瑞洛治疗的患者CV高于普拉格雷治疗的患者（47.8 [31.6 - 64.6]% 对 21.3 [12.9 - 25.5]%，P < 0.001），而在比较替格瑞洛和普拉格雷治疗患者的Multiplate血小板聚集CV时未检测到统计学差异。替格瑞洛治疗的患者在16:00和20:00时血小板抑制比普拉格雷更明显（VASP：20.6 ± 15.0对24.9 ± 12.8 PRI，P = 0.049；VASP：18.6 ± 17.7对26.0 ± 11.7 PRI，P = 0.002）。
在AMI治疗的初始维持阶段，替格瑞洛的血小板聚集日间变异性比普拉格雷更大，这是由于早晨维持剂量后血小板抑制持续增加。两种药物在AMI后早期均提供了足够的抗血小板作用。对这些发现的临床意义进行评估值得进一步研究。
