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Wang CC, Zhao Q, Guo BY, Hao J, Zhao JJ, Ren JL, Sun YQ, Zhang XR, Yang XL, Liu JM. The Plasma Concentration of Ticagrelor and Aspirin as a Predictor of Bleeding Complications in Chinese Acute Coronary Syndrome Patients With Dual Antiplatelet Therapy: A Prospective Observational Study. J Cardiovasc Pharmacol 2023; 82:148-156. [PMID: 37295072 DOI: 10.1097/fjc.0000000000001442] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/16/2023] [Accepted: 05/27/2023] [Indexed: 06/12/2023]
Abstract
PURPOSE This study evaluated the association among the plasma concentration of ticagrelor, ARC124910XX, aspirin, and salicylic acid with the risk of recent bleeding in patients with the acute coronary syndrome. To this end, we developed an accurate model to predict bleeding. METHODS A total of 84 patients included in this study cohort between May 2021 and November 2021. The risk factors were identified by univariate and multivariate analyses, and statistically significant risk factors identified in the multivariate analysis were included in the nomogram. We used the calibration curve and the receiver operating characteristic curve to verify the accuracy of the prediction model. RESULTS Multivariable logistic analysis showed that ticagrelor concentration (odds ratio [OR]: 2.47, 95% confidence interval [CI], 1.51-4.75, P = 0.002), ST-segment elevation acute myocardial infarction (OR: 32.2, 95% CI, 2.37-780, P = 0.016), and lipid-lowering drugs (OR: 11.52, 95% CI, 1.91-110, P = 0.015) were positively correlated with bleeding. However, angiotensin-converting enzyme inhibitor/angiotensin II receptor blocker (OR: 0.04, 95% CI, 0.004-0.213, P < 0.001) was negatively correlated with bleeding. The receiver operating characteristic curve analysis showed that ticagrelor concentration and these factors together predict the occurrence of bleeding (area under receiver operating characteristic curve = 0.945, 95% CI, 0.896-0.994) and that ticagrelor concentration >694.90 ng/mL is the threshold of bleeding concentration (area under receiver operating characteristic curve = 0.696, 95% CI, 0.558-0.834). CONCLUSION In patients with acute coronary syndrome treated with dual antiplatelet therapy, ticagrelor concentration >694.90 ng/mL was an independent risk factor for bleeding (OR: 2.47, 95% CI, 1.51-4.75, P = 0.002), but ARC124910XX and salicylic acid concentration did not affect bleeding risk ( P > 0.05).
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Affiliation(s)
- Cui-Cui Wang
- Department of Pharmacy, The Second Hospital of Hebei Medical University, Shijiazhuang City, China
| | - Qing Zhao
- Department of Pharmacy, The Second Hospital of Hebei Medical University, Shijiazhuang City, China
| | - Bing-Yan Guo
- Department of Cardiovascular Medicine, The Second Hospital of Hebei Medical University, Shijiazhuang City, China; and
| | - Jie Hao
- Department of Cardiovascular Medicine, The Second Hospital of Hebei Medical University, Shijiazhuang City, China; and
| | - Jia-Jia Zhao
- Department of Cardiovascular Medicine, The Second Hospital of Hebei Medical University, Shijiazhuang City, China; and
| | | | - Ya-Qing Sun
- Department of Pharmacy, The Second Hospital of Hebei Medical University, Shijiazhuang City, China
| | - Xiao-Rui Zhang
- Department of Pharmacy, The Second Hospital of Hebei Medical University, Shijiazhuang City, China
| | - Xiu-Ling Yang
- Department of Pharmacy, The Second Hospital of Hebei Medical University, Shijiazhuang City, China
| | - Jin-Ming Liu
- Department of Cardiovascular Medicine, The Second Hospital of Hebei Medical University, Shijiazhuang City, China; and
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Yang J, Qi G, Hu F, Zhang X, Xing Y, Wang P. Association between ticagrelor plasma concentration and bleeding events in Chinese patients with acute coronary syndrome. Br J Clin Pharmacol 2022; 88:4870-4880. [PMID: 35644848 DOI: 10.1111/bcp.15422] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2022] [Revised: 05/19/2022] [Accepted: 05/24/2022] [Indexed: 11/30/2022] Open
Affiliation(s)
- Jing Yang
- Department of Pharmacy First Affiliated Hospital of Zhengzhou University Zhengzhou P. R. China
- Henan Key Laboratory of Precision Clinical Pharmacy Zhengzhou University Zhengzhou P. R. China
| | - Guangzhao Qi
- Department of Pharmacy First Affiliated Hospital of Zhengzhou University Zhengzhou P. R. China
- Henan Key Laboratory of Precision Clinical Pharmacy Zhengzhou University Zhengzhou P. R. China
| | - Fudong Hu
- Department of Cardiology First Affiliated Hospital of Zhengzhou University Zhengzhou P. R. China
| | - Xiaojian Zhang
- Department of Pharmacy First Affiliated Hospital of Zhengzhou University Zhengzhou P. R. China
- Henan Key Laboratory of Precision Clinical Pharmacy Zhengzhou University Zhengzhou P. R. China
| | - Yu Xing
- Department of Cardiology First Affiliated Hospital of Zhengzhou University Zhengzhou P. R. China
| | - Peile Wang
- Department of Pharmacy First Affiliated Hospital of Zhengzhou University Zhengzhou P. R. China
- Henan Key Laboratory of Precision Clinical Pharmacy Zhengzhou University Zhengzhou P. R. China
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Chapot R. Platelet Function Testing Is Required for Intracranial Stent Placement. Stroke 2021; 52:3826-3828. [PMID: 34538085 DOI: 10.1161/strokeaha.121.036457] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- René Chapot
- Department of Intracranial Endovascular Therapy, Alfried Krupp Hospital, Essen, Germany
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Seecheran N, Boodhai B, Maharaj A, Ramdeen A, Debideen N, Ochalal V, Singh R, Seecheran R, Seecheran V, Persad S, Abdullah H, Peram L, Motilal S, Tello-Montoliu A, Schneider D. The Effect of Low-Dose Ticagrelor on Platelet Function Profiles in Patients With Stable Coronary Artery Disease in Trinidad: The TWIST Pilot Study. Cardiol Ther 2020; 9:493-503. [PMID: 32766961 PMCID: PMC7584691 DOI: 10.1007/s40119-020-00195-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2020] [Indexed: 10/29/2022] Open
Abstract
INTRODUCTION This prospective, pharmacodynamic study aimed to explore the potential applicability of a low-dose ticagrelor regimen in a heterogeneous Trinidadian subpopulation. METHODS Patients with stable coronary artery disease (n = 25) who were actively treated with dual antiplatelet therapy of aspirin 81 mg daily and clopidogrel 75 mg daily were recruited. Platelet function was measured with the VerifyNow P2Y12 assay (Accriva Diagnostics, San Diego, CA, USA) and assessed before initiation of and after 14 days of treatment with a low-dose ticagrelor 45 mg twice daily maintenance dose regimen. Results were compared with a paired t test. RESULTS The mean P2Y12 reaction units (PRU) score on ticagrelor was significantly less compared to that of clopidogrel (50.4, 95% confidence interval (CI) 29-73.9; vs. 149.6, 95% CI 129.4-169.9; p value < 0.001). Of the patients, 4% experienced Medical Research Council class 1 dyspnea, and Bleeding Academic Research Consortium class 1 bleeding on the ticagrelor regimen (one patient each). CONCLUSIONS Significantly attenuated platelet reactivity was seen on the low ticagrelor maintenance dose as compared to clopidogrel. This dedicated pharmacodynamic study could be applicable and informative for Trinidadian stable coronary artery disease patients. Further studies are required to confirm these exploratory findings.(Funded by the University of the West Indies, St. Augustine). TRIAL REGISTRATION ClinicalTrials.gov number NCT04206176.
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Affiliation(s)
- Naveen Seecheran
- The University of the West Indies, St. Augustine, Port of Spain, Trinidad and Tobago.
| | - Brent Boodhai
- North Central Regional Health Authority, Champs Fleurs, Mount Hope, Trinidad and Tobago
| | - Aarti Maharaj
- North Central Regional Health Authority, Champs Fleurs, Mount Hope, Trinidad and Tobago
| | - Arvinash Ramdeen
- North Central Regional Health Authority, Champs Fleurs, Mount Hope, Trinidad and Tobago
| | - Niranjan Debideen
- North Central Regional Health Authority, Champs Fleurs, Mount Hope, Trinidad and Tobago
| | - Vishesh Ochalal
- North Central Regional Health Authority, Champs Fleurs, Mount Hope, Trinidad and Tobago
| | - Randall Singh
- North Central Regional Health Authority, Champs Fleurs, Mount Hope, Trinidad and Tobago
| | - Rajeev Seecheran
- North Central Regional Health Authority, Champs Fleurs, Mount Hope, Trinidad and Tobago
| | - Valmiki Seecheran
- North Central Regional Health Authority, Champs Fleurs, Mount Hope, Trinidad and Tobago
| | - Sangeeta Persad
- North Central Regional Health Authority, Champs Fleurs, Mount Hope, Trinidad and Tobago
| | - Harun Abdullah
- North Central Regional Health Authority, Champs Fleurs, Mount Hope, Trinidad and Tobago
| | - Lakshmipathi Peram
- North Central Regional Health Authority, Champs Fleurs, Mount Hope, Trinidad and Tobago
| | - Shastri Motilal
- North Central Regional Health Authority, Champs Fleurs, Mount Hope, Trinidad and Tobago
| | | | - David Schneider
- Cardiovascular Research Institute of Vermont, Colchester, Vermont, USA
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Chen Q, Zhang Y, Wang Z, Wang S, Zhang H, Wang Y, Lu C, Xuan H, Wang C, Li D, Xu T. Efficacy and safety of low dose ticagrelor in patients with acute coronary syndrome: a systematic review and meta-analysis. Postgrad Med J 2020; 96:693-702. [PMID: 32561595 DOI: 10.1136/postgradmedj-2019-137180] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2019] [Revised: 05/09/2020] [Accepted: 05/15/2020] [Indexed: 01/13/2023]
Abstract
Our aim was to examine clinical trials, provide guidance to practitioners and estimate the efficacy and safety of two agents by comparing low dose ticagrelor with standard dose clopidogrel in patients with acute coronary syndrome. We systematically looked through Pubmed, Embase, the Cochrane Library, Wanfang data and CNKI for trials comparing low dose ticagrelor with standard dose clopidogrel for the treatment of patients with ACS since the database was created. The primary endpoint for efficacy was the rate of major adverse cardiac events (MACEs). The primary endpoint for safety was the rate of major bleeding events. We also evaluated platelet function between low dose ticagrelor and standard dose clopidogrel in ACS patients. From 6744 articles, 16 studies including 1629 patients met the inclusion criteria. In contrast with standard dose clopidogrel, low dose ticagrelor significantly reduced MACEs (OR 0.39, 95% CI 0.26, 0.58) and the difference was statistically significant (p<0.01). No difference was noted for major bleeding events (OR 1.16, 95% CI 0.43, 3.08) between the two agents (p=0.77). In addition, low dose ticagrelor showed lower platelet aggregation rate than clopidogrel (standardised mean difference (SMD) -0.68, 95% CI -0.83 to 0.53) (p<0.01). Platelet reaction units for low dose ticagrelor were much lower than those for standard dose clopidogrel (SMD -2.46, 95% CI -2.85 to -2.07) (p<0.01). In comparison with standard dose clopidogrel, low dose ticagrelor significantly lowered the incidence of MACEs, improved left ventricular ejection fraction, decreased left ventricular end diastolic dimension and did not expand the risk of major bleeding events or minor or minimal bleeding events in ACS patients with a considerable safety and efficacy profile. In addition, low dose ticagrelor was associated with dramatically lower platelet aggregation compared with standard dose clopidogrel.
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Affiliation(s)
- Qing Chen
- Institute of Cardiovascular Disease Research, Xuzhou Medical University, Xuzhou, Jiangsu, China
| | - Yuanyuan Zhang
- Institute of Cardiovascular Disease Research, Xuzhou Medical University, Xuzhou, Jiangsu, China
| | - Zhen Wang
- Institute of Cardiovascular Disease Research, Xuzhou Medical University, Xuzhou, Jiangsu, China
| | - Shuai Wang
- Institute of Cardiovascular Disease Research, Xuzhou Medical University, Xuzhou, Jiangsu, China
| | - Hao Zhang
- Department of Thoracic Cardiovascular Surgery, The Affiliated Hospital of Xuzhou Medical University, XuZhou, JiangSu, China
| | - Yiwen Wang
- Institute of Cardiovascular Disease Research, Xuzhou Medical University, Xuzhou, Jiangsu, China
| | - Chi Lu
- Institute of Cardiovascular Disease Research, Xuzhou Medical University, Xuzhou, Jiangsu, China
| | - Haochen Xuan
- Department of Cardiology, The Affiliated Hospital of Xuzhou Medical University, Xuzhou, Jiangsu, China
| | - Chaofan Wang
- Department of Cardiology, The Affiliated Hospital of Xuzhou Medical University, Xuzhou, Jiangsu, China
| | - Dongye Li
- Institute of Cardiovascular Disease Research, Xuzhou Medical University, Xuzhou, Jiangsu, China
| | - Tongda Xu
- Institute of Cardiovascular Disease Research, Xuzhou Medical University, Xuzhou, Jiangsu, China .,Department of Cardiology, The Affiliated Hospital of Xuzhou Medical University, Xuzhou, Jiangsu, China
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Chae SU, Min KL, Lee CB, Huang Z, Chang MJ, Bae SK. Simultaneous quantification of ticagrelor and its active metabolite, AR-C124910XX, in human plasma by liquid chromatography-tandem mass spectrometry: Applications in steady-state pharmacokinetics in patients. Transl Clin Pharmacol 2020; 27:98-106. [PMID: 32055590 PMCID: PMC6989238 DOI: 10.12793/tcp.2019.27.3.98] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2019] [Revised: 09/08/2019] [Accepted: 09/16/2019] [Indexed: 01/26/2023] Open
Abstract
A sensitive and simple liquid chromatography-tandem mass spectrometry method was developed and validated for the simultaneous quantification of ticagrelor and its active metabolite, AR-C124910XX from 50 µL human plasma using tolbutamide as an internal standard as per regulatory guidelines. Analytes in plasma were extracted by simple protein precipitation using acetonitrile, followed by chromatographic separation with an Acclaim™ RSLC 120 C18 column (2.2 µm, 2.1 × 100 mm) and a gradient acetonitrile-water mobile phase containing 0.1% formic acid within 8 min. Mass spectrometric detection and quantitation were conducted by selected reaction-monitoring on a negative electrospray ionization mode with the following transitions: m/z 521.11 → 361.10, 477.03 → 361.10, and 269.00 → 169.60 for ticagrelor, AR-C124910XX, and tolbutamide, respectively. The lower limit of quantifications was 0.2 ng/mL with linear ranges of 0.2–2,500 ng/mL (r2 ≥ 0.9949) for both analytes. All validation data, including selectivity, cross-talk, precision, accuracy, matrix effect, recovery, dilution integrity, stability, and incurred sample reanalysis, were well within acceptable limits. This assay method was validated using K2-EDTA as the specific anticoagulant. Also, the anticoagulant effect was tested by lithium heparin, sodium heparin, and K3-EDTA. No relevant anticoagulant effect was observed. This validated method was effectively used in the determination of ticagrelor and its active metabolite, AR-C124910XX, in plasma samples from patients with myocardial infarction.
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Affiliation(s)
- Soon Uk Chae
- College of Pharmacy and Integrated Research Institute of Pharmaceutical Sciences, The Catholic University of Korea, Bucheon 14662, Republic of Korea
| | - Kyoung Lok Min
- Department of Pharmacy and Yonsei Institute of Pharmaceutical Sciences, College of Pharmacy, Yonsei University, Incheon 21983, Republic of Korea
| | - Chae Bin Lee
- College of Pharmacy and Integrated Research Institute of Pharmaceutical Sciences, The Catholic University of Korea, Bucheon 14662, Republic of Korea
| | - Zhouchi Huang
- College of Pharmacy and Integrated Research Institute of Pharmaceutical Sciences, The Catholic University of Korea, Bucheon 14662, Republic of Korea
| | - Min Jung Chang
- Department of Pharmacy and Yonsei Institute of Pharmaceutical Sciences, College of Pharmacy, Yonsei University, Incheon 21983, Republic of Korea
| | - Soo Kyung Bae
- College of Pharmacy and Integrated Research Institute of Pharmaceutical Sciences, The Catholic University of Korea, Bucheon 14662, Republic of Korea
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Yao Y, Wang P, Wang XZ, Zhao X, Zhao W, Zhou TN, Zhang L. Optimal strategy of switching from clopidogrel to ticagrelor in Chinese acute coronary syndrome patients with complicated coronary artery disease: the switching from clopidogrel to ticagrelor (SHIFT-CACS) study. Chin Med J (Engl) 2019; 132:2292-2299. [PMID: 31567375 PMCID: PMC6819042 DOI: 10.1097/cm9.0000000000000444] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2019] [Indexed: 12/03/2022] Open
Abstract
BACKGROUND The dose and time point for switching from clopidogrel to ticagrelor remain controversial, especially for Chinese acute coronary syndrome (ACS) patients with complicated coronary artery disease (CAD). Hence, the purpose of this study was to further explore the optimal dose and time point for the switching strategy to balance the increase in platelet inhibition and the decrease in adverse events in Chinese ACS patients with complicated CAD managed by percutaneous coronary intervention (PCI). METHODS From July 2017 to December 2017, the prospective, randomized, open-label study (the SwitcHIng from clopidogrel to ticagrelor study) assigned the eligible Chinese ACS patients with complicated CAD managed by PCI (n = 102) for 90 mg of ticagrelor at 12 h (T-90 mg-12 h), 90 mg of ticagrelor at 24 h (T-90 mg-24h) or 180 mg ticagrelor at 24 h (T-180 mg-24 h) after the last dose of clopidogrel. The primary endpoint was the comparison of maximal platelet aggregation (MPA) values at 2 h after switching strategies among the three groups. In addition, the MPA values at baseline, 8 h and before discharge and the rates of high on-treatment platelet reactivity were evaluated, the incidences of bleeding episodes and dyspnea during hospitalization and at 30-day follow-up in our study were also recorded. The MPA was measured by light transmittance aggregometry in our study. A repeated-measures analysis of variance (ANOVA) model and one-way ANOVA were used to compare data for the primary endpoint. RESULTS The MPA values were significantly decreased in the T-180 mg-24 h group compared with the T-90 mg-12 h group (P = 0.017) and decreased numerically compared with the T-90 mg-24 h group (P = 0.072) at 2 h. In particular, the MPA values were markedly reduced in the T-90 mg-24 h group compared with the T-90 mg-12 h group at 8 h after switching treatment (P = 0.002). There was no significant difference among the three groups in all bleedings and dyspnea events. CONCLUSIONS The optimal treatment strategy recommended in this study for Chinese ACS patients with complicated CAD managed by PCI is 180 or 90 mg of ticagrelor at 24 h after the last dose of clopidogrel. In addition, a negative interaction was detected in this study between the overlap for clopidogrel and ticagrelor at 12 h after the last dose of clopidogrel. TRIAL REGISTRATION ClinicalTrials.gov, NCT03577652; http://clinicaltrials.gov/ct2/show/NCT03577652.
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Affiliation(s)
- Ying Yao
- Department of Cardiology, Institute of Cardiovascular Research, General Hospital of Northern Theater Command, Shenyang, Liaoning 110840, China
- Department of Clinical Pharmacy, Shenyang Pharmaceutical University, Shenyang, Liaoning 110016, China
| | - Ping Wang
- Department of Cardiology, Institute of Cardiovascular Research, General Hospital of Northern Theater Command, Shenyang, Liaoning 110840, China
- Department of Clinical Pharmacy, Shenyang Pharmaceutical University, Shenyang, Liaoning 110016, China
| | - Xiao-Zeng Wang
- Department of Cardiology, Institute of Cardiovascular Research, General Hospital of Northern Theater Command, Shenyang, Liaoning 110840, China
| | - Xin Zhao
- Department of Cardiology, Institute of Cardiovascular Research, General Hospital of Northern Theater Command, Shenyang, Liaoning 110840, China
| | - Wei Zhao
- Department of Cardiology, Institute of Cardiovascular Research, General Hospital of Northern Theater Command, Shenyang, Liaoning 110840, China
| | - Tie-Nan Zhou
- Department of Cardiology, Institute of Cardiovascular Research, General Hospital of Northern Theater Command, Shenyang, Liaoning 110840, China
| | - Lei Zhang
- Department of Cardiology, Institute of Cardiovascular Research, General Hospital of Northern Theater Command, Shenyang, Liaoning 110840, China
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Xu X, Ding X, Yuan B, Li W, Wang Y, Jin Y, Xu H. Validated liquid chromatography-tandem mass spectrometry method for quantification of ticagrelor and its active metabolite in human plasma. Biomed Chromatogr 2019; 33:e4498. [PMID: 30675914 DOI: 10.1002/bmc.4498] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2018] [Revised: 12/13/2018] [Accepted: 01/13/2019] [Indexed: 12/13/2022]
Abstract
A rapid, simple and sensitive LC-MS/MS method was established and validated for simultaneous quantification of ticagrelor and its active metabolite AR-C124910XX in human plasma. After plasma samples were deproteinized with acetonitrile, the post-treatment samples were chromatographed on a Dikma C18 column interfaced with a triple quadrupole tandem mass spectrometer. Electrospray negative ionization mode and multiple reaction monitoring were adopted to assay ticagrelor and AR-C124910XX. Acetonitrile and 5 mΜ ammonium acetate was used as the mobile phase with a gradient elution at a flow rate of 0.5 mL/min. The method was linear in the range of 0.781-800 ng/mL for both ticagrelor and AR-C124910XX with a correlation coefficient ≥0.994. The intra- and inter-day precisions were within 12.61% in terms of relative standard deviation and the accuracy was within ±7.88% in terms of relative error. The LC-MS/MS method was fully validated for its sensitivity, selectivity, stability, matrix effect and recovery. This convenient and specific LC-MS/MS method was successfully applied to the pharmacokinetic study of ticagrelor and AR-C124910XX in healthy volunteers after an oral dose of 90 mg ticagrelor.
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Affiliation(s)
- Xiaomin Xu
- Department of Pharmaceutical Analysis, Pharmacy School, Shenyang Pharmaceutical University, Shenyang, China
| | - Xiaohong Ding
- Drug Research and Development Center, Shandong Drug and Food Vocational College, Weihai, China
| | - Bo Yuan
- Department of Pharmaceutical Analysis, Pharmacy School, Shenyang Pharmaceutical University, Shenyang, China
| | - Weiwei Li
- Department of Pharmaceutical Analysis, Pharmacy School, Shenyang Pharmaceutical University, Shenyang, China
| | - Yimei Wang
- Department of Pharmaceutical Analysis, Pharmacy School, Shenyang Pharmaceutical University, Shenyang, China
| | - Yi Jin
- Department of Pharmaceutical Analysis, Pharmacy School, Shenyang Pharmaceutical University, Shenyang, China
| | - Haiyan Xu
- Department of Pharmaceutical Analysis, Pharmacy School, Shenyang Pharmaceutical University, Shenyang, China
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Galimzhanov AM, Azizov BS. Ticagrelor for Asian patients with acute coronary syndrome in real-world practice: A systematic review and meta-analysis of observational studies. Indian Heart J 2019; 71:15-24. [PMID: 31000178 PMCID: PMC6477146 DOI: 10.1016/j.ihj.2019.01.003] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2018] [Revised: 01/02/2019] [Accepted: 01/20/2019] [Indexed: 12/11/2022] Open
Abstract
OBJECTIVE We aimed to assess the efficacy and safety of ticagrelor compared to clopidogrel in Asian patients with acute coronary syndrome (ACS) in real-world practice. METHODS PubMed, Web of Science and Scopus databases were searched systematically to obtain relevant Asian observational studies. RESULTS The meta-analysis included six studies with 27959 participants. Compared with clopidogrel, ticagrelor was significantly beneficial in prevention of major adverse cardiac events (MACCEs) (OR=0.62; 95% CI: 0.46-0.83, I2=69%, p=0.001) mainly driven by reducing stroke (OR=0.62; 95% CI: 0.49-0.78, I2=0%, p<0.001). No differences were found between ticagrelor and clopidogrel in the risk of cardiovascular mortality (OR=0.66; 95% CI: 0.41-1.06, I2=0%, p=0.09), target vessel revascularization (OR=0.53; 95% CI: 0.21-1.35, I2=82%, p=0.18), major bleeding (OR=1.11; 95% CI: 0.62-2.00, I2=75%, p=0.73), and net adverse clinical and cerebral events (OR=0.76; 95% CI: 0.55-1.04, I2=78%, p=0.09). However, ticagrelor significantly increased the incidence of major/minor (OR=1.73; 95% CI: 1.36-2.21, I2=0%, p<0.001) and minor bleeding (OR=1.73; 95% CI: 1.29-2.32, I2=0%, p<0.001). Sensitivity analyses did not find consistent effect of ticagrelor on prevention of all-cause death and myocardial infarction. CONCLUSION This meta-analysis suggested that ticagrelor might reduce the risk of MACCEs mainly by reducing stroke in Asian patients with ACS without increasing the rates of major bleeding. Ticagrelor did not show a significant effect on other parts of MACCEs. Considerable increase in the risk of major/minor and minor bleeding was observed in ticagrelor compared with clopidogrel users. Further high-quality studies are required to support these findings.
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Affiliation(s)
| | - Baurzhan Slymovich Azizov
- University Hospital of State Medical University of Semey, Department of Endovascular Surgery, Semey, Kazakhstan
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