ASSESSMENT OF ANTIPLATELET EFFECTS OF TICAGRELOR IN PATIENTS WITH RENAL FUNCTION IMPAIRMENT UNDERGOING ISOLATED OFF-PUMP CABG FOR STABLE CORONARY ARTERY DISEASE

Department of Cardiac Surgery, University Federico II, Naples, Italy Background. Chronic kidney disease (CKD) is frequent in atherosclerotic patients with coronary artery disease (CAD). As reported by several studies, patients with mild-to-moderate CKD can advantage from the use of ticagrelor (the recent oral direct inhibitor of P2Y12 receptor) due to more uniform and greater platelet inhibition and the less ischemic event occurrence as compared to clopidogrel. The aim of this study was evaluate the antiplatelet effect of ticagrelor and its impact on renal function when used in addition to aspirin as dual antiplatetel therapy in patients with mild-to-moderate CKD (stage 2 or 3) who underwent off-pump coronary artery bypass graft (CABG) for CAD. Methods. From March 2011 to July 2013, 124 consecutive patients with mild-to-moderate CKD (stage 2 or 3), undergoing isolated off- PUMP CABG for stable coronary artery disease, were randomly assigned to aspirin plus clopidogrel or aspirin plus ticagrelor after surgery. Serum creatinine levels, glomerular filtration rate (GFR) and antiplatelet activity, evaluated by VerifyNow, were evaluated serially after surgery. Drugs adverse effects were collected and analysed as well. Results. The greatest change in PRU from baseline occurred within 24h after aspirin-ticagrelor administration, and PRU was significant lower (65PRU vs 239PRU, p<0.001). The major cardiac and cerebral adverse events rates were not different between study groups as well as major blending incidence. Significant increasing in serum creatinine and decreasing in GFR from baseline occurred in aspirin-ticagrelor group (1 month follow-up: p=0.05 and p=0.05, 6 months follow-up: p=0.04 and p=0.03, respectively). Conclusions. Aspirin plus ticagrelor is actually considered as the best choice for dual antiplatelet therapy. Special care, however, should be paid in patient with CKD who need also to be carefully followed during drug administration.