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Chewed ticagrelor facilitates better platelet inhibition in STEMI
Patients with STEMI undergoing primary PCI achieved better platelet inhibition by chewing a loading dose of ticagrelor instead of swallowing it, researchers reported.
Researchers randomly assigned 50 patients aged 30 to 87 years to chew or swallow a 180-mg loading dose of the P2Y12 inhibitor ticagrelor (Brilinta, AstraZeneca) before undergoing primary PCI for STEMI at a single center.
As Cardiology Today’s Intervention previously reported, crushing another P2Y12 inhibitor, prasugrel (Effient, Daiichi Sankyo/Eli Lilly), before administration prior to PCI for STEMI conferred faster drug absorption and more prompt and potent antiplatelet effects.
For the ticagrelor study, Elad Asher, MD, MHA, from Leviev Heart Center, Sheba Medical Center, Tel Aviv University, Tel Hashomer, Israel, and colleagues evaluated P2Y12 reaction units at baseline, 30 minutes, 1 hour and 4 hours after loading dose using VerifyNow (Accumentrics).
At baseline, P2Y12 reaction units were similar in both groups (chewing group, 224; standard group, 219; P = .26).
However, P2Y12 reaction units were lower in the chewing group vs. the standard group at 30 minutes (168 vs. 230; P = .003) and 1 hour (106 vs. 181; P = .005), and were lower but similar in both groups at 4 hours (chewing group, 43; standard group, 51; P = .3), Asher and colleagues wrote.
In the chewing group, platelet reactivity was reduced by 24% at 30 minutes (P = .001).
Relative inhibition of platelet aggregation was 51% in the chewing group and 10% in the standard group at 1 hour (P = .005), and 81% in the chewing group and 76% on the standard group at 4 hours (P = .24), according to the researchers.
MACE rates at 30 days were 4% in each group (P > .99). A patient in the chewing group had cardiogenic shock after PCI, whereas a patient in the standard group had recurrent ACS. No patients died.
Adverse effects occurred in 24% of the chewing group and 12% of the standard group (P = .46).
“Results of our trial suggest that chewing ticagrelor offers either a faster absorption via the mucosa and/or a faster absorption in the stomach,” Asher and colleagues wrote. “Chewing ticagrelor could overcome the disadvantages of drug absorption via the gastrointestinal tract, particularly during the first crucial hours of STEMI.” – by Erik Swain
Disclosures: The authors report no relevant financial disclosures.