Randomized double-blind assessment of the ONSET and OFFSET of the antiplatelet effects of ticagrelor versus clopidogrel in patients with stable coronary artery disease: The ONSET/OFFSET study

Paul A. Gurbel, Kevin P. Bliden, Kathleen Butler, Udaya S. Tantry, Tania Gesheff, Cheryl Wei, Renli Teng, Mark J. Antonino, Shankar B. Patil, Arun Karunakaran, Dean J. Kereiakes, Cordel Parris, Drew Purdy, Vance Wilson, Gary S. Ledley, Robert F. Storey

Research output: Contribution to journalArticle

Abstract

BACKGROUND-: Ticagrelor is the first reversibly binding oral P2Y12 receptor antagonist. This is the first study to compare the onset and offset of platelet inhibition (IPA) with ticagrelor using the PLATO (PLATelet inhibition and patient Outcomes) trial loading dose (180 mg) with a high loading dose (600 mg) of clopidogrel. METHODS AND RESULTS-: In a multicenter, randomized, double-blind study, 123 patients with stable coronary artery disease who were taking aspirin therapy (75 to 100 mg/d) received ticagrelor (180-mg load, 90-mg BID maintenance dose [n=57]), clopidogrel (600-mg load, 75-mg/d maintenance dose [n=54]), or placebo (n=12) for 6 weeks. Greater IPA (20 μmol/L ADP, final extent) occurred with ticagrelor than with clopidogrel at 0.5, 1, 2, 4, 8, and 24 hours after loading and at 6 weeks (P<0.0001 for all); by 2 hours after loading, a greater proportion of patients achieved >50% IPA (98% versus 31%, P<0.0001) and >70% IPA (90% versus 16%, P<0.0001) in the ticagrelor group than in the clopidogrel group, respectively. A faster offset occurred with ticagrelor than with clopidogrel (4-to-72-hour slope [% IPA/h]-1.04 versus-0.48, P<0.0001). At 24 hours after the last dose, mean IPA was 58% for ticagrelor versus 52% for clopidogrel (P=NS). IPA for ticagrelor on day 3 after the last dose was comparable to clopidogrel at day 5; IPA on day 5 for ticagrelor was similar to clopidogrel on day 7 and did not differ from placebo (P=NS). CONCLUSIONS-: Ticagrelor achieved more rapid and greater platelet inhibition than high-loading-dose clopidogrel; this was sustained during the maintenance phase and was faster in offset after drug discontinuation.

Original languageEnglish (US)
Pages (from-to)2577-2585
Number of pages9
JournalCirculation
Volume120
Issue number25
DOIs
StatePublished - Dec 1 2009

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Keywords

  • Antiplatelet agents
  • Clopidogrel
  • Platelets
  • Ticagrelor

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine
  • Physiology (medical)

Cite this

Gurbel, P. A., Bliden, K. P., Butler, K., Tantry, U. S., Gesheff, T., Wei, C., Teng, R., Antonino, M. J., Patil, S. B., Karunakaran, A., Kereiakes, D. J., Parris, C., Purdy, D., Wilson, V., Ledley, G. S., & Storey, R. F. (2009). Randomized double-blind assessment of the ONSET and OFFSET of the antiplatelet effects of ticagrelor versus clopidogrel in patients with stable coronary artery disease: The ONSET/OFFSET study. Circulation, 120(25), 2577-2585. https://doi.org/10.1161/CIRCULATIONAHA.109.912550