A Comprehensive Review of the Pleiotropic Effects of Ticagrelor.

Autor: Triska J; The Department of Medicine, Baylor College of Medicine, Houston, TX, USA. jeffrey.triska@bcm.edu., Maitra N; The Department of Medicine, Baylor College of Medicine, Houston, TX, USA., Deshotels MR; The Department of Medicine, Baylor College of Medicine, Houston, TX, USA., Haddadin F; The Section of Cardiology, Baylor College of Medicine, Houston, TX, USA., Angiolillo DJ; Division of Cardiology, University of Florida College of Medicine, Jacksonville, FL, USA., Vilahur G; Cardiovascular Program, Research Institute Hospital de La Santa Creu I Sant Pau, IIB-Sant Pau, Barcelona, Spain.; CiberCV, Institute Carlos III, Madrid, Spain., Jneid H; Department of Medicine, Section of Cardiology, University of Texas Medical Branch, Galveston, TX, USA., Atar D; The Department of Cardiology, Oslo University Hospital Ulleval, Oslo, Norway.; Institute of Clinical Medicine, University of Oslo, Oslo, Norway., Birnbaum Y; The Section of Cardiology, Baylor College of Medicine, Houston, TX, USA.
Jazyk: angličtina
Zdroj: Cardiovascular drugs and therapy [Cardiovasc Drugs Ther] 2024 Aug; Vol. 38 (4), pp. 775-797. Date of Electronic Publication: 2022 Aug 24.
DOI: 10.1007/s10557-022-07373-5
Abstrakt: Aims: This review summarizes the findings of preclinical studies evaluating the pleiotropic effects of ticagrelor. These include attenuation of ischemia-reperfusion injury (IRI), inflammation, adverse cardiac remodeling, and atherosclerosis. In doing so, it aims to provide novel insights into ticagrelor's mechanisms and benefits over other P2Y 12 inhibitors. It also generates viable hypotheses for the results of seminal clinical trials assessing ticagrelor use in acute and chronic coronary syndromes.
Methods and Results: A comprehensive review of the preclinical literature demonstrates that ticagrelor protects against IRI in the setting of both an acute myocardial infarction (MI), and when MI occurs while on chronic treatment. Maintenance therapy with ticagrelor also likely mitigates adverse inflammation, cardiac remodeling, and atherosclerosis, while improving stem cell recruitment. These effects are probably mediated by ticagrelor's ability to increase local interstitial adenosine levels which activate downstream cardio-protective molecules. Attenuation and augmentation of these pleiotropic effects by high-dose aspirin and caffeine, and statins respectively may help explain variable outcomes in PLATO and subsequent randomized controlled trials (RCTs).
Conclusion: Most RCTs and meta-analyses have not evaluated the pleiotropic effects of ticagrelor. We need further studies comparing cardiovascular outcomes in patients treated with ticagrelor versus other P2Y 12 inhibitors that are mindful of the unique pleiotropic advantages afforded by ticagrelor, as well as possible interactions with other therapies (e.g., aspirin, statins, caffeine).
(© 2022. The Author(s), under exclusive licence to Springer Science+Business Media, LLC, part of Springer Nature.)
Databáze: MEDLINE
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