Abstract
Dual antiplatelet therapy with a P2Y12 inhibitor is mandatory in acute coronary syndromes (ACS) undergoing angioplasty. New antiplatelet drugs prasugrel and ticagrelor offer more efficient inhibition compared to clopidogrel. Under P2Y12 inhibitor, platelet reactivity (PR) assessment can predict ischemic and bleeding events. The aim of our study was to compare PR of P2Y12 inhibitors in a real-world setting. PR was prospectively assesed in consecutive patients with recurent ACS or undergoing high risk angioplasty. PR was measured 24h after last intake of clopidogrel (C) and prasugrel (P) and 12h for ticagrelor (T) by flow cytometry measured vasodilatator-stimulated phosphoprotein platelet reactivity index (VASP-PRI) and light transmission agregometry with ADP 20µM (LTA-ADP). High Platelet Reactivity (HPR) was defined as VASP-PRI>50% or LTA-ADP>65% (thresholds previously linked to clinical events). Low Platelet Reactivity (LPR) was defined as VASP-PRI<16% or LTA-ADP<40%. 619 patients treated with aspirin and C (n=269), P (n=241) or T (n=109) were included from 01/2011 to 07/2013. Mean age was 62±13y.o. 81% were men and 65% STEMI. HPR was more frequent with C compared to P and T and significantly more frequent with P compared to T (Table). At the opposite, LPR was significantly more frequent in patients treated with T. Clinical and biological characteristics were similar between patients on P and those on T, except for hypertension, BMI and prior history of STEMI. In multivariate analysis, the significant predictor of HPR with VASP was P (OR=0.13-CI [0.08-0.22]) or T (OR=0.01-[0.01-0.09]). The significant predictor of LPR with VASP was T (OR=3.37-[2.09-5.44]). This observational biological prospective study confirms a more potent platelet inhibition of the new P2Y12 compared to clopidogrel, mainly T. The very high rate of LPR found with T does not match with the bleeding risk found in the PLATO trial.
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