Pharmacodynamic effects of early aspirin withdrawal after percutaneous coronary intervention in patients with atrial fibrillation treated with ticagrelor or prasugrel
Dual antithrombotic therapy (DAT) without aspirin reduces bleeding compared with triple antithrombotic therapy (TAT) in patients with atrial fibrillation who have undergone percutaneous coronary intervention, without apparently increasing ischemic events. A prospective pharmacodynamic study was perf...
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| Language: | English |
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Taylor & Francis Group
2025-12-01
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| Series: | Platelets |
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| Online Access: | https://www.tandfonline.com/doi/10.1080/09537104.2025.2507037 |
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| author | Mark A. Sammut Mohammed E. F. Rahman Claire Bridge Jessica Hanson Heather Judge Bethany Lynch Emily Maz Hannah McMellon Janet Middle Georgia Williamson William A. E. Parker Justin Lee Robert F. Storey |
| author_facet | Mark A. Sammut Mohammed E. F. Rahman Claire Bridge Jessica Hanson Heather Judge Bethany Lynch Emily Maz Hannah McMellon Janet Middle Georgia Williamson William A. E. Parker Justin Lee Robert F. Storey |
| author_sort | Mark A. Sammut |
| collection | DOAJ |
| description | Dual antithrombotic therapy (DAT) without aspirin reduces bleeding compared with triple antithrombotic therapy (TAT) in patients with atrial fibrillation who have undergone percutaneous coronary intervention, without apparently increasing ischemic events. A prospective pharmacodynamic study was performed to investigate the impact of aspirin on bleeding time, platelet function and fibrin clot analysis in this population. Patients receiving TAT (n = 16), comprising aspirin, ticagrelor/prasugrel and a direct-acting oral anticoagulant (DOAC), were compared with those receiving DAT without aspirin (n = 18). Bleeding time was reduced with DAT compared with TAT (median 27.8 vs 30.0 minutes, p = .005). Assessed by light transmission aggregometry, median platelet aggregation was significantly increased with DAT compared with TAT in response to arachidonic acid (63 vs 3%, p = .002) and collagen (72 vs 37%, p < .001) but not 5-μmol/L adenosine diphosphate (25 vs 27%, p = .966) or thrombin-receptor-activating peptide (37 vs 24%, p = .086). VerifyNow P2Y12 assay showed > 70% inhibition in all patients. Fibrin clot lysis time and maximum turbidity were similar between groups. Using P2Y12 inhibitors of consistent potency, DAT improves hemostasis through sparing cyclooxygenase-1-mediated platelet activation but has a comparable effect to TAT on other pathways and fibrin clot properties. DAT with ticagrelor/prasugrel and DOAC may provide sufficient antithrombotic effect without excessive anti-hemostatic effect. |
| format | Article |
| id | doaj-art-007c2c6fcde94c1bbac626ea8dd63c92 |
| institution | OA Journals |
| issn | 0953-7104 1369-1635 |
| language | English |
| publishDate | 2025-12-01 |
| publisher | Taylor & Francis Group |
| record_format | Article |
| series | Platelets |
| spelling | doaj-art-007c2c6fcde94c1bbac626ea8dd63c922025-08-20T02:23:12ZengTaylor & Francis GroupPlatelets0953-71041369-16352025-12-0136110.1080/09537104.2025.2507037Pharmacodynamic effects of early aspirin withdrawal after percutaneous coronary intervention in patients with atrial fibrillation treated with ticagrelor or prasugrelMark A. Sammut0Mohammed E. F. Rahman1Claire Bridge2Jessica Hanson3Heather Judge4Bethany Lynch5Emily Maz6Hannah McMellon7Janet Middle8Georgia Williamson9William A. E. Parker10Justin Lee11Robert F. Storey12Division of Clinical Medicine, School of Medicine and Population Health, University of Sheffield, Sheffield, UKDivision of Clinical Medicine, School of Medicine and Population Health, University of Sheffield, Sheffield, UKDivision of Clinical Medicine, School of Medicine and Population Health, University of Sheffield, Sheffield, UKDivision of Clinical Medicine, School of Medicine and Population Health, University of Sheffield, Sheffield, UKDivision of Clinical Medicine, School of Medicine and Population Health, University of Sheffield, Sheffield, UKDivision of Clinical Medicine, School of Medicine and Population Health, University of Sheffield, Sheffield, UKDivision of Clinical Medicine, School of Medicine and Population Health, University of Sheffield, Sheffield, UKDivision of Clinical Medicine, School of Medicine and Population Health, University of Sheffield, Sheffield, UKDivision of Clinical Medicine, School of Medicine and Population Health, University of Sheffield, Sheffield, UKDivision of Clinical Medicine, School of Medicine and Population Health, University of Sheffield, Sheffield, UKDivision of Clinical Medicine, School of Medicine and Population Health, University of Sheffield, Sheffield, UKSouth Yorkshire Cardiothoracic Centre, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UKDivision of Clinical Medicine, School of Medicine and Population Health, University of Sheffield, Sheffield, UKDual antithrombotic therapy (DAT) without aspirin reduces bleeding compared with triple antithrombotic therapy (TAT) in patients with atrial fibrillation who have undergone percutaneous coronary intervention, without apparently increasing ischemic events. A prospective pharmacodynamic study was performed to investigate the impact of aspirin on bleeding time, platelet function and fibrin clot analysis in this population. Patients receiving TAT (n = 16), comprising aspirin, ticagrelor/prasugrel and a direct-acting oral anticoagulant (DOAC), were compared with those receiving DAT without aspirin (n = 18). Bleeding time was reduced with DAT compared with TAT (median 27.8 vs 30.0 minutes, p = .005). Assessed by light transmission aggregometry, median platelet aggregation was significantly increased with DAT compared with TAT in response to arachidonic acid (63 vs 3%, p = .002) and collagen (72 vs 37%, p < .001) but not 5-μmol/L adenosine diphosphate (25 vs 27%, p = .966) or thrombin-receptor-activating peptide (37 vs 24%, p = .086). VerifyNow P2Y12 assay showed > 70% inhibition in all patients. Fibrin clot lysis time and maximum turbidity were similar between groups. Using P2Y12 inhibitors of consistent potency, DAT improves hemostasis through sparing cyclooxygenase-1-mediated platelet activation but has a comparable effect to TAT on other pathways and fibrin clot properties. DAT with ticagrelor/prasugrel and DOAC may provide sufficient antithrombotic effect without excessive anti-hemostatic effect.https://www.tandfonline.com/doi/10.1080/09537104.2025.2507037Acute coronary syndromeaspirinatrial fibrillationdual antithrombotic therapyticagrelortriple antithrombotic therapy |
| spellingShingle | Mark A. Sammut Mohammed E. F. Rahman Claire Bridge Jessica Hanson Heather Judge Bethany Lynch Emily Maz Hannah McMellon Janet Middle Georgia Williamson William A. E. Parker Justin Lee Robert F. Storey Pharmacodynamic effects of early aspirin withdrawal after percutaneous coronary intervention in patients with atrial fibrillation treated with ticagrelor or prasugrel Platelets Acute coronary syndrome aspirin atrial fibrillation dual antithrombotic therapy ticagrelor triple antithrombotic therapy |
| title | Pharmacodynamic effects of early aspirin withdrawal after percutaneous coronary intervention in patients with atrial fibrillation treated with ticagrelor or prasugrel |
| title_full | Pharmacodynamic effects of early aspirin withdrawal after percutaneous coronary intervention in patients with atrial fibrillation treated with ticagrelor or prasugrel |
| title_fullStr | Pharmacodynamic effects of early aspirin withdrawal after percutaneous coronary intervention in patients with atrial fibrillation treated with ticagrelor or prasugrel |
| title_full_unstemmed | Pharmacodynamic effects of early aspirin withdrawal after percutaneous coronary intervention in patients with atrial fibrillation treated with ticagrelor or prasugrel |
| title_short | Pharmacodynamic effects of early aspirin withdrawal after percutaneous coronary intervention in patients with atrial fibrillation treated with ticagrelor or prasugrel |
| title_sort | pharmacodynamic effects of early aspirin withdrawal after percutaneous coronary intervention in patients with atrial fibrillation treated with ticagrelor or prasugrel |
| topic | Acute coronary syndrome aspirin atrial fibrillation dual antithrombotic therapy ticagrelor triple antithrombotic therapy |
| url | https://www.tandfonline.com/doi/10.1080/09537104.2025.2507037 |
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