Abstract Details

Title The Effect of New P2Y12 Receptor Antagonist, Ticagrelor, On Platelet Reactivity in Patients With Clopidogrel Resistance Undergoing Neuroendovascular Procedures.

Topic Cerebrovascular Disease and Interventional Neurology

Presentation(s) P1 - Poster Session 1 (5:30 PM-6:30 PM)

Poster/Presentation
Number 3-008

Objective

To study the effect of new P2Y12 receptor antagonist on platelet reactivity.

Background Suboptimal inhibition of platelet activity on clopidogrel may be associated with high rates of stent thrombosis and ischemic events. We investigated whether ticagrelor, a competitive inhibitor of P2Y12 receptor can result in greater inhibition of platelet activity in patients with clopidogrel resistance.

Design/Methods Thromboelastography-platelet mapping assay was used in all patients undergoing neuro-endovascular procedure requiring oral clopidogrel. Kaolin-treated citrated blood was used to measure maximum amplitude of thrombin-induced platelet-fibrin clot-strength (MA_thrombin). The strength of the fibrin clot (MA_fibrin) was measured in the presence of activator F. The addition of platelet agonists, either 1 mmol L−1 arachidonic acid or 2 μmol L−1 ADP to activator F ensures determination of the strength of the platelet-fibrin clot. The difference between M_AADP_{or AA} and MA_thrombin was considered as platelet inhibition (%): 100–[(MA_{ADP or AA}–MA_fibrin)/(MA_thrombin–MA_fibrin)×100]. In patients with suboptimal platelet inhibition (<60%) on clopidogrel,ticagrelor was imitated after oral bolus followed by 90 mg twice daily. TEG-PM assay was repeated.

Results

Ticagrelor was initiated in 12 patients (mean age ± SD = 62.6 ± 14.4 years) undergoing neuroendovascular procedures, who demonstrated suboptimal platelet inhibition on clopidogrel. Optimal platelet inhibition on was seen in 10 of the 12 patients after starting ticagrelor (median = 79.5%, range = 60 – 94.6%). There was a significantly higher magnitude of platelet inhibition with ticagrelor compared with clopidogrel (mean value ± SD: 72.3 ± 20.2% versus 26.1 ± 20.7%, p < 0.001). One patient had transient ischemic attack among the two patients who demonstrated suboptimal platelet inhibition to clopidogrel and ticagrelor after stent placement.

Conclusions Oral ticagrelor administration can result in significantly higher levels of platelet inhibition as measured by TEG-PM assay in patients who have suboptimal response to clopidogrel. The clinical significance of these findings need to be determined.

Authors/Disclosures
Muhammad U. Jahngir, MD PRESENTER	No disclosure on file
Hamza I. Maqsood, MD (Dept of Neurology)	Dr. Qureshi has received personal compensation in the range of $5,000-$9,999 for serving as a Consultant for AstraZeneca.
Yasemin Akinci, MD (JFK Neuroscience Institute, Departmant of Neurology)	Dr. Akinci has nothing to disclose.
	No disclosure on file

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