Pharmacodynamic comparison of low-dose ticagrelor to low-dose prasugrel in patients with prior myocardial infarction: the ALTIC-2 study

Abstract

Given that patients with prior myocardial infarction and features of high ischemic and low bleeding risk may benefit by extending dual antiplatelet therapy beyond 1 year, we aimed of assessing platelet reactivity provided by ticagrelor 60 mg bid versus prasugrel 5 mg od in 20 such patients participating in a randomized, crossover study. The primary end point of platelet reactivity at the end of the two treatment periods (by VerifyNow, in PRU) was significantly lower for ticagrelor (31.9 PRU [95% CI 12.3–51.4]) compared with prasugrel (132.1 PRU [111.9–152.3]) with a least squares mean difference of –100.2 PRU (72.1–128.3, P < .001). This dedicated pharmacodynamic study showed that in post-myocardial infarction patients with high atherothrombotic risk and receiving P2Y₁₂ receptor antagonist beyond 1 year, low-dose ticagrelor results in a significantly lower platelet reactivity compared to low-dose prasugrel.

Keywords:

• Angioplasty
• myocardial infarction
• pharmacology
• platelets

Disclosure statement

Dr Alexopoulos discloses lecturing honoraria/advisory board fees from AstraZeneca, Bayer, Boehringer Ingelheim, AMGEN, Biotronik, Medtronic. Other authors have nothing to disclose.

Supplementary material

Supplemental data for this article can be accessed here.

Additional information

Funding

The study was funded by the National and Kapodistrian University of Athens, ELKE IIS 14005 and the IMETHA (Institute of Study of Thrombosis and Atherosclerosis). The funder was not involved in the study’s design, performance, data collection and analysis or writing of the manuscript.