A Comparison of the Degree of Platelet Inhibition in Sri Lankan Coronary Artery Disease Patients on Clopidogrel and Ticagrelor
Summary
Current guidelines for management of coronary artery disease (CAD) recommend the use of dual antiplatelet therapy (DAPT), aspirin combined with an oral inhibitor of platelet P2Y12 receptor, to reduce coronary thrombosis and mortality in patients with acute coronary syndrome or following percutaneous coronary intervention. However, use of DAPT is known to increase the risk of bleeding as well.
Diverse degrees of resistance to ticagrelor and clopidogrel have been described in different populations. However, there is no data on ticagrelor resistance in Sri Lankan CAD patients. Hence, it is important to determine the degree of platelet inhibition and quantify the active drug metabolite levels of ticagrelor and clopidogrel among CAD patients in Sri Lanka. These drugs are known to have inter-patient variability regarding their platelet inhibitory effect.
This study will give an idea about the degree of platelet inhibition by ticagrelor and clopidogrel drugs among CAD population of Sri Lanka. Thereby, providing a better idea of how best to manage these patients. The statistical calculation of the prevalence of antiplatelet drug resistance may depend on the laboratory method used, the drug, and its dose and disease status. The main aim of the study is to determine the degree of platelet inhibition by using ROTEM and ROTEM platelet (thromboelastometry), which can be used as a point of care laboratory technique. Therefore, this could even be performed in an outpatient or clinic setting. HPLC will be used to determine active metabolite levels of clopidogrel and ticagrelor in plasma of CAD patients to determine compliance.
Objectives
General Objectives
Compare the degree of platelet inhibition in coronary artery disease patients on clopidogrel and ticagrelor and determine the plasma levels of the active metabolites of each of the two drugs.
Specific objectives
1. Determine the degree of platelet inhibition by clopidogrel and ticagrelor using ROTEM platelet. 2. Determine the plasma levels of active metabolites of clopidogrel and ticagrelor using HPLC.
3. Compare and development of a criteria to determine the degree of platelet inhibition between ticagrelor and clopidogrel in patients with coronary artery disease.