Comparative Non-Randomised Observational Study of Prasugrel and Ticagrelor in Patients Undergoing Percutaneous Coronary Intervention

  • Samala Sai Keerthana Pharm.D (Doctor of Pharmacy), Department of Pharmacy Practice, Bhaskar Pharmacy College, Moinabad, Hyderabad, Telangana, India
  • Vaddepally Shravya Pharm.D (Doctor of Pharmacy), Department of Pharmacy Practice, Bhaskar Pharmacy College, Moinabad, Hyderabad, Telangana, India
  • Bandi Divya Pharm.D (Doctor of Pharmacy), Department of Pharmacy Practice, Bhaskar Pharmacy College, Moinabad, Hyderabad, Telangana, India
  • Subash Chandra Bose Senior Consultant, Department of Cardiology, Apollo Hospitals, Jubilee Hills, Hyderabad- 500033, India
  • A. Srinivasa Rao A. Srinivasa Rao M. Pharm, Ph.D., F.I.C, Principal, Bhaskar Pharmacy College, Moinabad, Hyderabad, 500075, India

Abstract

Percutaneous Coronary Intervention (PCI) is the primary guideline-recommended treatment strategy for patients presenting with CAD, STEMI, NSTEMI, Unstable Angina. It is known that, the use of oral P2Y12 receptor antagonists (Prasugrel and Ticagrelor) in PCI patients could lead to improved outcomes compared with clopidogrel. This study has been designed for review and analysis of clinical safety and outcomes of these agents in patients undergoing PCI.  Out of 100 patients (50 in Prasugrel group & 50 in Ticagrelor group) considered for the study, the incidence of stroke, stent thrombosis was comparable between the groups with P =0.044, P =0.041 respectively and was not comparable for MI (P=0.245). Single Death was reported. The results differed significantly for Palpitations/Arrhythmia(P=0.018), SOB(P=0.000), Dizziness(P=0.005), Creatinine levels(P=0.000), Fatigue(P=0.003), Headache(P=0.000) and did not differ significantly for Bleeding and Back pain in both the drug groups with P =1.000, P =0.438 respectively. Also, majority of the patients showed decreased platelet count in both the drug groups. Withdrawal parameters, like withdrawal due to cost(P=0.172) and withdrawal due to fear of side effects(P=1.000) when evaluated for both the drugs showed no significant difference. Outcomes associated with Prasugrel were not superior to outcomes associated with Ticagrelor when 30 days to 6 months follow up was done. The clinical safety, side effects and withdrawal parameters were comparable and the results showed no significant difference between these drug groups.


Keywords: Percutaneous Coronary Intervention, Ticagrelor, Prasugrel, Dual Anti-Platelet therapy, Acute Coronary Syndrome, Coronary Artery Disease.

Keywords: Percutaneous Coronary Intervention, Ticagrelor, Prasugrel, Dual Anti-Platelet therapy, Acute Coronary Syndrome, Coronary Artery Disease

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Author Biographies

Samala Sai Keerthana, Pharm.D (Doctor of Pharmacy), Department of Pharmacy Practice, Bhaskar Pharmacy College, Moinabad, Hyderabad, Telangana, India

Pharm.D (Doctor of Pharmacy), Department of Pharmacy Practice, Bhaskar Pharmacy College, Moinabad, Hyderabad, Telangana, India

Vaddepally Shravya, Pharm.D (Doctor of Pharmacy), Department of Pharmacy Practice, Bhaskar Pharmacy College, Moinabad, Hyderabad, Telangana, India

Pharm.D (Doctor of Pharmacy), Department of Pharmacy Practice, Bhaskar Pharmacy College, Moinabad, Hyderabad, Telangana, India

Bandi Divya, Pharm.D (Doctor of Pharmacy), Department of Pharmacy Practice, Bhaskar Pharmacy College, Moinabad, Hyderabad, Telangana, India

Pharm.D (Doctor of Pharmacy), Department of Pharmacy Practice, Bhaskar Pharmacy College, Moinabad, Hyderabad, Telangana, India

Subash Chandra Bose, Senior Consultant, Department of Cardiology, Apollo Hospitals, Jubilee Hills, Hyderabad- 500033, India

Senior Consultant, Department of Cardiology, Apollo Hospitals, Jubilee Hills, Hyderabad- 500033, India

A. Srinivasa Rao A. Srinivasa Rao, M. Pharm, Ph.D., F.I.C, Principal, Bhaskar Pharmacy College, Moinabad, Hyderabad, 500075, India

M. Pharm, Ph.D., F.I.C, Principal, Bhaskar Pharmacy College, Moinabad, Hyderabad, 500075, India

References

1. Bhatia R, Chaudhari N, Dugal JS, Mehta AC. Prasugrel versus ticagrelor in Indian patients with acute coronary syndrome undergoing percutaneous coronary intervention: A prospective, randomized, comparative study. Indian Heart Journal Interventions. 2018 May 1; 1(2):136.
2. Kumar A, Cannon CP. Acute coronary syndromes: diagnosis and management, part I. InMayo Clinic Proceedings 2009; 84(10):917-938. Elsevier.
3. Watti H, Dahal K, Zabher HG, Katikaneni P, Modi K, Abdulbaki A. Comparison of prasugrel and ticagrelor in patients with acute coronary syndrome undergoing percutaneous coronary intervention: A meta-analysis of randomized and non-randomized studies. International journal of cardiology. 2017 Dec 15; 249:66-72.
4. Sakurai R, Burazor I, Bonneau HN, Kaneda H. Head‐to‐head comparison of prasugrel versus ticagrelor in patients undergoing percutaneous coronary intervention: A meta‐analysis of randomized controlled trials. Journal of interventional cardiology. 2017 Oct; 30(5):457-64.
5. Schmucker J, Fach A, Mata Marin LA, Retzlaff T, Osteresch R, Kollhorst B, Hambrecht R, Pohlabeln H, Wienbergen H. Efficacy and Safety of Ticagrelor in Comparison to Clopidogrel in Elderly Patients With ST‐Segment–Elevation Myocardial Infarctions. Journal of the American Heart Association. 2019 Sep 17; 8(18): e012530.
6. Schüpke S, Neumann FJ, Menichelli M, Mayer K, Bernlochner I, Wöhrle J, Richardt G, Liebetrau C, Witzenbichler B, Antoniucci D, Akin I. Ticagrelor or prasugrel in patients with acute coronary syndromes. New England Journal of Medicine. 2019 Oct 17; 381(16):1524-34.
7. Giri J, Nathan A. Is it Time to Abandon Dual Antiplatelet Therapy After Percutaneous Coronary Intervention in Patients with Atrial Fibrillation on Anticoagulation?
8. Larmore C, Effron MB, Molife C, DeKoven M, Zhu Y, Lu J, Karkare S, Lieu HD, Lee WC, Vetrovec GW. “Real‐world” comparison of prasugrel with ticagrelor in patients with acute coronary syndrome treated with percutaneous coronary intervention in the United States. Catheterization and Cardiovascular Interventions. 2016 Oct; 88(4):535-44.
9. Degrauwe S, Pilgrim T, Aminian A, Noble S, Meier P, Iglesias JF. Dual antiplatelet therapy for secondary prevention of coronary artery disease. Open heart. 2017 Oct 1; 4(2): e000651.
10. Smith Jr SC, Dove JT, Jacobs AK, Kennedy JW, Kereiakes D, Kern MJ, Kuntz RE, Popma JJ, Schaff HV, Williams DO, Gibbons RJ. ACC/AHA guidelines for percutaneous coronary intervention (revision of the 1993 PTCA guidelines)—executive summary: a report of the American College of Cardiology/American Heart Association task force on practice guidelines (Committee to revise the 1993 guidelines for percutaneous transluminal coronary angioplasty) endorsed by the Society for Cardiac Angiography and Interventions. Circulation. 2001 Jun 19; 103(24):3019-41.
11. Bednar F, Kroupa J, Ondrakova M, Osmancik P, Kopa M, Motovska Z. Antiplatelet efficacy of P2Y 12 inhibitors (prasugrel, ticagrelor, clopidogrel) in patients treated with mild therapeutic hypothermia after cardiac arrest due to acute myocardial infarction. Journal of thrombosis and thrombolysis. 2016 May 1; 41(4):549-55.
12. Motovska Z, Hlinomaz O, Miklik R, Hromadka M, Varvarovsky I, Dusek J, Knot J, Jarkovsky J, Kala P, Rokyta R, Tousek F. Prasugrel versus ticagrelor in patients with acute myocardial infarction treated with primary percutaneous coronary intervention: multicentre randomized PRAGUE-18 study. Circulation. 2016 Nov 22; 134(21):1603-12.
13. Saito Y, Kobayashi Y. Update on antithrombotic therapy after percutaneous coronary intervention. Internal Medicine. 2020 Feb 1; 59(3):311-21.
14. Kumar V, Kumar V, Kumari K, Talwar KK, Prasad D, Agarwal S, Yadav MS, Bashir H, Jatain S, Gupta SK. Clinical safety profile of ticagrelor compared to clopidogrel in 1208 patients: Real world evidence. The Egyptian Heart Journal. 2018 Dec 1; 70(4):375-8.
15. Parodi G, Valenti R, Bellandi B, Migliorini A, Marcucci R, Comito V, Carrabba N, Santini A, Gensini GF, Abbate R, Antoniucci D. Comparison of prasugrel and ticagrelor loading doses in ST-segment elevation myocardial infarction patients: RAPID (Rapid Activity of Platelet Inhibitor Drugs) primary PCI study. Journal of the American College of Cardiology. 2013 Apr 16; 61(15):1601-6.
16. Ahn KT, Seong SW, Choi UL, Jin SA, Kim JH, Lee JH, Choi SW, Jeong MH, Chae SC, Kim YJ, Kim CJ. Comparison of 1-year clinical outcomes between prasugrel and ticagrelor versus clopidogrel in type 2 diabetes patients with acute myocardial infarction underwent successful percutaneous coronary intervention. Medicine. 2019 Mar; 98(11).
17. Franchi F, Rollini F, Aggarwal N, Hu J, Kureti M, Durairaj A, Duarte VE, Cho JR, Been L, Zenni MM, Bass TA. Pharmacodynamic comparison of prasugrel versus ticagrelor in patients with type 2 diabetes mellitus and coronary artery disease: the OPTIMUS (Optimizing Antiplatelet Therapy in Diabetes Mellitus)-4 study. Circulation. 2016 Sep 13; 134(11):780-92.
18. Park K, Cho YR, Park JS, Park TH, Kim MH, Kim YD. Design and rationale for comparison between ticagrelor and clopidogrel on microcirculation in patients with acute coronary syndrome undergoing percutaneous coronary intervention (PLEIO) trial. Journal of cardiovascular translational research. 2018 Feb 1; 11(1):42-9.
19. De Labriolle A, Bonello L, Lemesle G, Roy P, Steinberg DH, Xue Z, Suddath WO, Satler LF, Kent KM, Pichard AD, Lindsay J. Decline in platelet count in patients treated by percutaneous coronary intervention: definition, incidence, prognostic importance, and predictive factors. European heart journal. 2010 May 1; 31(9):1079-87.
20. Wallentin L, Becker RC, Budaj A, Cannon CP, Emanuelsson H, Held C, Horrow J, Husted S, James S, Katus H, Mahaffey KW. Ticagrelor versus clopidogrel in patients with acute coronary syndromes. New England Journal of Medicine. 2009 Sep 10; 361(11):1045-57.
21. Zhao YJ, Khoo AL, Lin L, Teng M, Wu TS, Chan MY, Lim BP. Cost-effectiveness analysis of ticagrelor and prasugrel for the treatment of acute coronary syndrome. Value in health regional issues. 2016 May 1; 9:22-7.
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Keerthana SS, Shravya V, Divya B, Bose SC, A. Srinivasa Rao ASR. Comparative Non-Randomised Observational Study of Prasugrel and Ticagrelor in Patients Undergoing Percutaneous Coronary Intervention. JDDT [Internet]. 15Oct.2020 [cited 21Oct.2020];10(5-s):57-3. Available from: http://jddtonline.info/index.php/jddt/article/view/4338