Dimitrios Venetsanos1, Sofia Sederholm Lawesson2, Eva Swahn3, Joakim Alfredsson4. 1. Department of Cardiology, Department of Medical and Health Sciences, Linköping University, Linköping, Sweden. Electronic address: dimitrios.venetsanos@liu.se. 2. Department of Cardiology, Department of Medical and Health Sciences, Linköping University, Linköping, Sweden. Electronic address: sofia.lawesson@liu.se. 3. Department of Cardiology, Department of Medical and Health Sciences, Linköping University, Linköping, Sweden. Electronic address: eva.swahn@liu.se. 4. Department of Cardiology, Department of Medical and Health Sciences, Linköping University, Linköping, Sweden. Electronic address: joakim.alfredsson@liu.se.
Abstract
AIMS: To provide pharmacodynamic data of crushed and chewed ticagrelor tablets, in comparison with standard integral tablets. METHODS: Ninety nine patients with stable angina were randomly assigned, in a 3:1:1 fashion, to one of the following 180mg ticagrelor loading dose (LD) formulations: A) Integral B) Crushed or C) Chewed tablets. Platelet reactivity (PR) was assessed with VerifyNow before, 20 and 60min after LD. High residual platelet reactivity (HRPR) was defined as >208 P2Y12 reaction units (PRU). RESULTS: There was no significant difference in PRU values at baseline. PRU 20min after LD were 237 (182-295), 112 (53-238) and 84 (29-129) and 60min after LD, 56 (15-150), 51 (18-85) and 9 (7-34) in integral, crushed and chewed ticagrelor LD, respectively (p<0.01 for both). Chewed ticagrelor tablets resulted in significantly lower PRU values compared to crushed or integral tablets at 20 and 60min. Crushed ticagrelor LD resulted in significantly lower PRU values compared to integral tablets at 20min whereas no difference was observed at 60min. At 20min, no patients had HRPR with chewed ticagrelor compared to 68% with integral and 30% with crushed ticagrelor LD (p<0.01). CONCLUSION: With crushed or chewed ticagrelor tablets a more rapid platelet inhibition may be achieved, compared to standard integral tablets. We also show that administration of chewed tablets is feasible and provides faster inhibition than either crushed or integral tablets. CLINICAL TRIAL REGISTRATION: European Clinical Trial Database (EudraCT number 2014-002227-96).
AIMS: To provide pharmacodynamic data of crushed and chewed ticagrelor tablets, in comparison with standard integral tablets. METHODS: Ninety nine patients with stable angina were randomly assigned, in a 3:1:1 fashion, to one of the following 180mg ticagrelor loading dose (LD) formulations: A) Integral B) Crushed or C) Chewed tablets. Platelet reactivity (PR) was assessed with VerifyNow before, 20 and 60min after LD. High residual platelet reactivity (HRPR) was defined as >208 P2Y12 reaction units (PRU). RESULTS: There was no significant difference in PRU values at baseline. PRU 20min after LD were 237 (182-295), 112 (53-238) and 84 (29-129) and 60min after LD, 56 (15-150), 51 (18-85) and 9 (7-34) in integral, crushed and chewed ticagrelor LD, respectively (p<0.01 for both). Chewed ticagrelor tablets resulted in significantly lower PRU values compared to crushed or integral tablets at 20 and 60min. Crushed ticagrelor LD resulted in significantly lower PRU values compared to integral tablets at 20min whereas no difference was observed at 60min. At 20min, no patients had HRPR with chewed ticagrelor compared to 68% with integral and 30% with crushed ticagrelor LD (p<0.01). CONCLUSION: With crushed or chewed ticagrelor tablets a more rapid platelet inhibition may be achieved, compared to standard integral tablets. We also show that administration of chewed tablets is feasible and provides faster inhibition than either crushed or integral tablets. CLINICAL TRIAL REGISTRATION: European Clinical Trial Database (EudraCT number 2014-002227-96).
Authors: Anne Henrieke Tavenier; Renicus Suffridus Hermanides; Jan Paul Ottervanger; Peter Gerrit Johannes Ter Horst; Elvin Kedhi; Adriaan W J van 't Hof Journal: Drug Saf Date: 2018-12 Impact factor: 5.606
Authors: Giuseppe Gargiulo; Giovanni Esposito; Plinio Cirillo; Michael Nagler; Pietro Minuz; Gianluca Campo; Felice Gragnano; Negar Manavifar; Raffaele Piccolo; Marisa Avvedimento; Matteo Tebaldi; Andreas Wahl; Lukas Hunziker; Michael Billinger; Dik Heg; Stephan Windecker; Marco Valgimigli Journal: J Cardiovasc Transl Res Date: 2020-02-24 Impact factor: 4.132
Authors: Abi Selvarajah; Anne H Tavenier; Enrico Fabris; Maarten A H van Leeuwen; Renicus S Hermanides Journal: J Clin Med Date: 2022-09-23 Impact factor: 4.964
Authors: Enrico Fabris; Serge Korjian; Barry S Coller; Jurrien M Ten Berg; Christopher B Granger; C Michael Gibson; Arnoud W J van 't Hof Journal: Thromb Haemost Date: 2021-04-30 Impact factor: 6.681
Authors: Renli Teng; Maria Hammarberg; Glenn F Carlson; Sara Bokelund-Singh; Terese Ruderfelt; Eva Blychert Journal: Clin Drug Investig Date: 2017-11 Impact factor: 2.859
Authors: Piotr Adamski; Joanna Sikora; Ewa Laskowska; Katarzyna Buszko; Małgorzata Ostrowska; Julia M Umińska; Adam Sikora; Natalia Skibińska; Przemysław Sobczak; Urszula Adamska; Danuta Rość; Aldona Kubica; Przemysław Paciorek; Michał P Marszałł; Eliano P Navarese; Diana A Gorog; Jacek Kubica Journal: PLoS One Date: 2017-10-12 Impact factor: 3.240
Authors: Luca Bettari; Gaetano Pero; Cristian Maiandi; Antonio Messina; Matteo Saccocci; Marco Cirillo; Giovanni Troise; Elena Conti; Claudio Cuccia; Diego Maffeo Journal: JACC Case Rep Date: 2020-04-10
Authors: Piotr Niezgoda; Malwina A Barańska; Joanna Sikora; Przemysław Sobczak; Katarzyna Buszko; Adam Sikora; Michał P Marszałł; Eliano P Navarese; Bernd Jilma; Jacek Kubica Journal: Cardiol J Date: 2020-03-24 Impact factor: 3.487