Open AccessDeterminants of high platelet reactivity in patients with acute coronary syndromes treated with ticagrelor
Author(s) -
Piotr Adamski,
Katarzyna Buszko,
Joanna Sikora,
Piotr Niezgoda,
Tomasz Fabiszak,
Małgorzata Ostrowska,
Malwina Barańska,
Aleksandra Karczmarska-Wódzka,
Eliano Pio Navarese,
Jacek Kubica
Publication year - 2019
Publication title -
scientific reports
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.24
H-Index - 213
ISSN - 2045-2322
DOI - 10.1038/s41598-019-40628-0
Subject(s) - ticagrelor , medicine , acute coronary syndrome , myocardial infarction , percutaneous coronary intervention , cardiology , pharmacodynamics , odds ratio , platelet aggregation inhibitor , logistic regression , platelet , pharmacokinetics
High platelet reactivity (HPR) is a risk factor for stent thrombosis, a potentially lethal complication of percutaneous coronary intervention. HPR is also associated with increased risk of myocardial infarction and death in invasively-treated patients with acute coronary syndrome (ACS). HPR occurs even in ACS patients treated with ticagrelor, a state-of-the-art antiplatelet agent, especially during the first hours of treatment. Patient-level pharmacodynamic data obtained from 102 ACS subjects enrolled in two prospective, pharmacodynamic trials were analysed in order to identify clinical features related with increased odds of on-ticagrelor HPR during the first two hours after ticagrelor loading dose in ACS patients. Presence of ST-segment elevation myocardial infarction (versus non-ST-segment elevation ACS) and morphine co-administration were the strongest predictors of HPR at 1 and 2 hours after ticagrelor loading dose according to linear regression analyses, multiple backward stepwise logistic regression analyses and generalized estimating equation model. By pinpointing simple to recognize clinical features, the results of this study facilitate identification of ACS patients who have the highest odds of HPR during the initial phase of treatment with ticagrelor, and who could potentially benefit from alternative treatment strategies.