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Modified ticagrelor loading doses according to the vasodilator-stimulated phosphoprotein phosphorylation index improve the clinical outcome in ST-elevation myocardial infarction patients with high on-treatment platelet reactivity
Affiliations- Department of Anesthesiology, Renji Hospital, School of Medicine, Shanghai Jiaotong University, Shanghai, China
- Department of Cardiology, Shanghai East Hospital, School of Medicine, Tongji University, Shanghai, China
- Department of Cardiology, Shanghai East Hospital (Ji’an Campus), School of Medicine, Jinggangshan Univer sity, Ji’an, China
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Abstract
Background: Current guidelines recommend a standard ticagrelor loading dose (LD) in ST-segment
elevation myocardial infarction (STEMI) patients. However, antiplatelet therapy in STEMI patients at
high risk of thrombotic events is suboptimal. The study was conducted to validate whether vasodilatorstimulated
phosphoprotein (VASP)-guided ticagrelor dosing individual therapy may result in more
effective platelet inhibition and better clinical outcomes.
Methods: This trial included 374 STEMI patients with a low platelet response after ticagrelor LD. The
patients were randomized into a control group and a VASP-guided group, where the ticagrelor pretreatment
was individually adjusted before and after percutaneous coronary intervention (PCI) to obtain
a VASP index < 50%. Up to 2 additional boluses of ticagrelor (every additional dosing was 90 mg) were
prescribed after the first LD, and the VASP index was assessed 2 hours after each administration until
a VASP index < 50% was obtained or up to 3 dosages (360 mg). The primary endpoint was major
adverse cardiovascular events (MACEs) at 30 days. The secondary endpoints were thrombolysis in
myocardial infarction (TIMI) major and minor bleeding.
Results: The characteristics were similar in the two groups. After the ticagrelor doses increased, the
platelet reactivity index (PRI) decreased, and 98.4% of patients reached PRI < 50% in the VASP-guided
group. The adenosine concentration increased, and the rate of MACE was significantly lower in the
VASP-guided group (10 [5.3%] vs. 20 [10.8%], hazard ratio 2.38, 95% confidence interval 1.21–3.28,
p = 0.007). There were no major hemorrhagic complications (0 vs. 0, p = 1.0). The rate of minor
bleeding in the VASP-guided group was higher than that in the control group, but the difference was not
significant (24 [12.8%] vs. 16 [8.6%], p = 0.068).
Conclusions: The incremental ticagrelor dosing strategy decreases the rate of MACE after PCI without
increasing major and minor bleeding.
Abstract
Background: Current guidelines recommend a standard ticagrelor loading dose (LD) in ST-segment
elevation myocardial infarction (STEMI) patients. However, antiplatelet therapy in STEMI patients at
high risk of thrombotic events is suboptimal. The study was conducted to validate whether vasodilatorstimulated
phosphoprotein (VASP)-guided ticagrelor dosing individual therapy may result in more
effective platelet inhibition and better clinical outcomes.
Methods: This trial included 374 STEMI patients with a low platelet response after ticagrelor LD. The
patients were randomized into a control group and a VASP-guided group, where the ticagrelor pretreatment
was individually adjusted before and after percutaneous coronary intervention (PCI) to obtain
a VASP index < 50%. Up to 2 additional boluses of ticagrelor (every additional dosing was 90 mg) were
prescribed after the first LD, and the VASP index was assessed 2 hours after each administration until
a VASP index < 50% was obtained or up to 3 dosages (360 mg). The primary endpoint was major
adverse cardiovascular events (MACEs) at 30 days. The secondary endpoints were thrombolysis in
myocardial infarction (TIMI) major and minor bleeding.
Results: The characteristics were similar in the two groups. After the ticagrelor doses increased, the
platelet reactivity index (PRI) decreased, and 98.4% of patients reached PRI < 50% in the VASP-guided
group. The adenosine concentration increased, and the rate of MACE was significantly lower in the
VASP-guided group (10 [5.3%] vs. 20 [10.8%], hazard ratio 2.38, 95% confidence interval 1.21–3.28,
p = 0.007). There were no major hemorrhagic complications (0 vs. 0, p = 1.0). The rate of minor
bleeding in the VASP-guided group was higher than that in the control group, but the difference was not
significant (24 [12.8%] vs. 16 [8.6%], p = 0.068).
Conclusions: The incremental ticagrelor dosing strategy decreases the rate of MACE after PCI without
increasing major and minor bleeding.
Keywords
ticagrelor, vasodilator-stimulated phosphoprotein, platelet reaction index, ST-segment elevation myocardial infarction, primary percutaneous coronary intervention
About this articleTitle
Modified ticagrelor loading doses according to the vasodilator-stimulated phosphoprotein phosphorylation index improve the clinical outcome in ST-elevation myocardial infarction patients with high on-treatment platelet reactivity
Journal
Issue
Article type
Original Article
Pages
771-780
Published online
2021-09-23
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1721
Article views/downloads
790
DOI
Pubmed
Bibliographic record
Cardiol J 2023;30(5):771-780.
Keywords
ticagrelor
vasodilator-stimulated phosphoprotein
platelet reaction index
ST-segment elevation myocardial infarction
primary percutaneous coronary intervention
Authors
Yaling Liu
Sheng Kang
Xiaolin Li
Zhongwen Liu
Yang Gao
Xiaodong Wang
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