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type=\u0022text\/css\u0022 rel=\u0022stylesheet\u0022 href=\u0022\/\/d282kpwvnogo5m.cloudfront.net\/sites\/default\/files\/cdn\/css\/http\/css_Xg7z6oCTVgud_Q0huYz9x9iiD5H_2YPSJ5z2ZViSWdY.css\u0022 media=\u0022all\u0022 \/\u003E\n\u003Clink rel=\u0027stylesheet\u0027 type=\u0027text\/css\u0027 href=\u0027\/sites\/all\/modules\/contrib\/panels\/plugins\/layouts\/onecol\/onecol.css\u0027 \/\u003E\u003C\/head\u003E\u003Cbody\u003E\u003Cdiv class=\u0022panels-ajax-tab-panel panels-ajax-tab-panel-sageoa-tab-art\u0022\u003E\u003Cdiv class=\u0022panel-display panel-1col clearfix\u0022 \u003E\n  \u003Cdiv class=\u0022panel-panel panel-col\u0022\u003E\n    \u003Cdiv\u003E\u003Cdiv class=\u0022panel-pane pane-highwire-markup\u0022 \u003E\n  \n      \n  \n  \u003Cdiv class=\u0022pane-content\u0022\u003E\n    \u003Cdiv class=\u0022highwire-markup\u0022\u003E\u003Cdiv xmlns=\u0022http:\/\/www.w3.org\/1999\/xhtml\u0022 id=\u0022content-block-markup\u0022 xmlns:xhtml=\u0022http:\/\/www.w3.org\/1999\/xhtml\u0022\u003E\u003Cdiv class=\u0022article fulltext-view \u0022\u003E\u003Cspan class=\u0022highwire-journal-article-marker-start\u0022\u003E\u003C\/span\u003E\u003Cdiv class=\u0022section abstract\u0022 id=\u0022abstract-1\u0022\u003E\u003Ch2\u003ESummary\u003C\/h2\u003E\u003Cp id=\u0022p-1\u0022\u003EIn low-risk patients with troponin-negative acute coronary syndromes undergoing ad hoc percutaneous coronary intervention, ticagrelor treatment resulted in greater reductions of platelet reactivity and a greater increase in inhibition of platelet aggregation compared with clopidogrel.\u003C\/p\u003E\u003C\/div\u003E\u003Cul class=\u0022kwd-group\u0022\u003E\u003Cli class=\u0022kwd\u0022\u003EACS\u003C\/li\u003E\u003Cli class=\u0022kwd\u0022\u003Eacute coronary syndromes\u003C\/li\u003E\u003Cli class=\u0022kwd\u0022\u003Eticagrelor\u003C\/li\u003E\u003Cli class=\u0022kwd\u0022\u003Eclopidogrel\u003C\/li\u003E\u003Cli class=\u0022kwd\u0022\u003Eplatelet reactivity\u003C\/li\u003E\u003Cli class=\u0022kwd\u0022\u003Ecardiology \u0026amp; cardiovascular medicine clinical trials\u003C\/li\u003E\u003Cli class=\u0022kwd\u0022\u003Einterventional techniques \u0026amp; devices\u003C\/li\u003E\u003Cli class=\u0022kwd\u0022\u003Ethrombotic disorders\u003C\/li\u003E\u003C\/ul\u003E\u003Cdiv class=\u0022section\u0022 id=\u0022sec-1\u0022\u003E\u003Cp id=\u0022p-2\u0022\u003ETicagrelor treatment resulted in rapid and profound reduction in platelet reactivity compared with clopidogrel in low-risk troponin-negative patients with acute coronary syndromes (ACS) who are undergoing elective or non-urgent ad hoc percutaneous coronary intervention (PCI). Roxana Mehran, MD, Mount Sinai Hospital, New York, New York, USA, presented data from an ad hoc PCI study in ACS patients [\u003Ca class=\u0022external-ref external-ref-type-clintrialgov\u0022 href=\u0022\/lookup\/external-ref?link_type=CLINTRIALGOV\u0026amp;access_num=NCT01603082\u0026amp;atom=%2Fspmdc%2F15%2F10%2F5.atom\u0022\u003ENCT01603082\u003C\/a\u003E].\u003C\/p\u003E\u003Cp id=\u0022p-3\u0022\u003ETicagrelor is a potent P2Y\u003Csub\u003E12\u003C\/sub\u003E-receptor inhibitor that is currently approved by the FDA for the treatment of patients with ACS. However, patients with low-risk ACS who are troponin-negative and undergo elective or non-urgent PCI may not receive a loading dose of a P2Y\u003Csub\u003E12\u003C\/sub\u003E receptor inhibitor prior to catheterization. The purpose of this study was to evaluate the effect of ticagrelor on platelet reactivity in patients with troponin-negative ACS undergoing ad hoc PCI who receive a loading dose in the catheterization laboratory immediately prior to PCI.\u003C\/p\u003E\u003Cp id=\u0022p-4\u0022\u003EIn this prospective, open-label, multicenter, phase 4 trial, 100 patients were randomly assigned to receive ticagrelor or clopidogrel. Patients in the ticagrelor arm (n\u2005=\u200551) received a 180-mg loading dose after diagnostic angiography followed by 90 mg 12 hours later. Patients in the clopidogrel arm (n\u2005=\u200549) received a 600-mg loading dose after diagnostic angiography. All patients received a 160- to 500-mg loading dose of aspirin followed by 75 to 100 mg of aspirin daily. Patients with ACS and \u2265\u20051 negative troponin test 6 to 48 hours after symptom onset were included in the study. Patients who used thienopyridine or ticagrelor within 7 days of randomization, had an indication for chronic anticoagulation, or concomitant therapy with a strong CYP3A inhibitor, substrates, or inducers were excluded.\u003C\/p\u003E\u003Cp id=\u0022p-5\u0022\u003EThe primary end point was platelet reactivity 2 hours after dosing of the study drug, which was measured by P2Y\u003Csub\u003E12\u003C\/sub\u003E reaction unit (PRU) level by the VerifyNow system. Secondary end points included PRU levels at 30 min after dosing, end of PCI, and 8 hours after dosing; percent reduction from baseline in PRU levels; and percent inhibition of platelet aggregation from baseline.\u003C\/p\u003E\u003Cp id=\u0022p-6\u0022\u003EPatients who received ticagrelor demonstrated a significantly lower mean PRU level 2 hours after their loading dose compared with patients who received clopidogrel (treatment difference, \u2212159.1; 95% CI, \u2212194.7 to \u2212123.5; \u003Cem\u003EP\u003C\/em\u003E\u2005\u0026lt;\u2005.001). The significant difference in mean PRU levels occurred at the end of PCI and continued up to 8 hours following the loading dose of ticagrelor (\u003Cem\u003EP\u003C\/em\u003E\u2005\u0026lt;\u2005.001; \u003Ca id=\u0022xref-fig-1-1\u0022 class=\u0022xref-fig\u0022 href=\u0022#F1\u0022\u003EFigure 1\u003C\/a\u003E). In addition, there was a significantly greater decrease in the reduction of PRU from baseline beginning at 2 hours after the loading dose compared with clopidogrel over the 8 hours (\u003Cem\u003EP\u003C\/em\u003E\u2005\u0026lt;\u2005.001). Furthermore, inhibition of platelet aggregation was significantly greater in the ticagrelor arm compared with the clopidogrel arm across all time points.\u003C\/p\u003E\u003Cdiv id=\u0022F1\u0022 class=\u0022fig pos-float  odd\u0022\u003E\u003Cdiv class=\u0022highwire-figure\u0022\u003E\u003Cdiv class=\u0022fig-inline-img-wrapper\u0022\u003E\u003Cdiv class=\u0022fig-inline-img\u0022\u003E\u003Ca href=\u0022http:\/\/d282kpwvnogo5m.cloudfront.net\/content\/spmdc\/15\/10\/5\/F1.large.jpg?width=800\u0026amp;height=600\u0026amp;carousel=1\u0022 title=\u0022Mean PRU Level After Treatment With TicagrelorLD, loading dose; PCI, percutaneous coronary intervention; PRU, platelet reaction units.Reproduced with permission from R Mehran, MD.\u0022 class=\u0022fragment-images colorbox-load\u0022 rel=\u0022gallery-fragment-images-1699429647\u0022 data-figure-caption=\u0022Mean PRU Level After Treatment With TicagrelorLD, loading dose; PCI, percutaneous coronary intervention; PRU, platelet reaction units.Reproduced with permission from R Mehran, MD.\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003E\u003Cimg class=\u0022fragment-image\u0022 alt=\u0022Figure 1.\u0022 src=\u0022http:\/\/d282kpwvnogo5m.cloudfront.net\/content\/spmdc\/15\/10\/5\/F1.medium.gif\u0022\/\u003E\u003C\/a\u003E\u003C\/div\u003E\u003C\/div\u003E\u003Cul class=\u0022highwire-figure-links inline\u0022\u003E\u003Cli class=\u00220 first\u0022\u003E\u003Ca href=\u0022http:\/\/d282kpwvnogo5m.cloudfront.net\/content\/spmdc\/15\/10\/5\/F1.large.jpg?download=true\u0022 class=\u0022highwire-figure-link highwire-figure-link-download\u0022 title=\u0022Download Figure 1.\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003EDownload figure\u003C\/a\u003E\u003C\/li\u003E\u003Cli class=\u00221\u0022\u003E\u003Ca href=\u0022http:\/\/d282kpwvnogo5m.cloudfront.net\/content\/spmdc\/15\/10\/5\/F1.large.jpg\u0022 class=\u0022highwire-figure-link highwire-figure-link-newtab\u0022 target=\u0022_blank\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003EOpen in new tab\u003C\/a\u003E\u003C\/li\u003E\u003Cli class=\u00222 last\u0022\u003E\u003Ca href=\u0022\/highwire\/powerpoint\/16672\u0022 class=\u0022highwire-figure-link highwire-figure-link-ppt\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003EDownload powerpoint\u003C\/a\u003E\u003C\/li\u003E\u003C\/ul\u003E\u003C\/div\u003E\u003Cdiv class=\u0022fig-caption\u0022 xmlns:xhtml=\u0022http:\/\/www.w3.org\/1999\/xhtml\u0022\u003E\u003Cspan class=\u0022fig-label\u0022\u003EFigure 1.\u003C\/span\u003E \u003Cp id=\u0022p-7\u0022 class=\u0022first-child\u0022\u003EMean PRU Level After Treatment With Ticagrelor\u003C\/p\u003E\u003Cp id=\u0022p-8\u0022\u003ELD, loading dose; PCI, percutaneous coronary intervention; PRU, platelet reaction units.\u003C\/p\u003E\u003Cp id=\u0022p-9\u0022\u003EReproduced with permission from R Mehran, MD.\u003C\/p\u003E\u003Cdiv class=\u0022sb-div caption-clear\u0022\u003E\u003C\/div\u003E\u003C\/div\u003E\u003C\/div\u003E\u003Cp id=\u0022p-10\u0022\u003EThe most common adverse events included chest pain, unstable angina, hypotension, dyspnea, and hematoma. Bleeding occurred in 5.9% of patients in the ticagrelor arm and 0 in the clopidogrel arm and all events were considered to be mild.\u003C\/p\u003E\u003Cp id=\u0022p-11\u0022\u003EIn conclusion, Dr Mehran stated that the data from this trial suggest that low-risk patients with troponin-negative ACS undergoing ad hoc PCI experienced greater platelet reactivity with ticagrelor treatment compared with clopidogrel.\u003C\/p\u003E\u003C\/div\u003E\u003Cul class=\u0022copyright-statement\u0022\u003E\u003Cli class=\u0022fn\u0022 id=\u0022copyright-statement-1\u0022\u003E\u00a9 2015 SAGE Publications\u003C\/li\u003E\u003C\/ul\u003E\u003Cspan class=\u0022highwire-journal-article-marker-end\u0022\u003E\u003C\/span\u003E\u003C\/div\u003E\u003Cspan id=\u0022related-urls\u0022\u003E\u003C\/span\u003E\u003C\/div\u003E\u003Ca href=\u0022http:\/\/mdc.sagepub.com\/content\/15\/10\/5.abstract\u0022 class=\u0022hw-link hw-link-article-abstract\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003EView Summary\u003C\/a\u003E\u003C\/div\u003E  \u003C\/div\u003E\n\n  \n  \u003C\/div\u003E\n\u003C\/div\u003E\n  \u003C\/div\u003E\n\u003C\/div\u003E\n\u003C\/div\u003E\u003Cscript type=\u0022text\/javascript\u0022 src=\u0022http:\/\/mdc.sagepub.com\/sites\/all\/modules\/highwire\/highwire\/plugins\/highwire_markup_process\/js\/highwire_figures.js?nzll01\u0022\u003E\u003C\/script\u003E\n\u003Cscript type=\u0022text\/javascript\u0022 src=\u0022http:\/\/mdc.sagepub.com\/sites\/all\/modules\/highwire\/highwire\/plugins\/highwire_markup_process\/js\/highwire_openurl.js?nzll01\u0022\u003E\u003C\/script\u003E\n\u003C\/body\u003E\u003C\/html\u003E"}