Ticagrelor versus Prasugrel for Brachial Artery Flow-Mediated Dilation in Diabetic Patients with Non-ST Elevation Acute Coronary Syndrome

Background: Both ticagrelor and prasugrel have potent antiplatelet effects. However, only ticagrelor inhibits cellular uptake of adenosine. This study compared adenosine-associated pleiotropic effects of the two P2Y12 receptor antagonists on vascular function and systemic inflammation.
Methods: Using a randomized, crossover design with 10-week follow-up, ticagrelor or prasugrel was administered to type 2 diabetic patients with non-ST-elevation acute coronary syndrome (ACS) requiring stent implantation. A total of 62 patients underwent randomization in a 1:1 ratio to receive ticagrelor or prasugrel for 5 weeks followed by a direct cross over to the alternative treatment for 5 additional weeks. Brachial artery flow-mediated dilation (baFMD) and inflammatory markers were compared.
Results: Improvement in baFMD was greater in the ticagrelor group (0.15±0.19 mm vs. -0.03±0.18 mm, p<0.001). Moreover, ticagrelor compared to prasugrel decreased interleukin-6 (IL-6) (-0.58±0.43 pg/mL vs. -0.05±0.24 pg/mL, p<0.001), tumor necrosis factor-alpha (TNF-α) (-5.62±4.40 pg/mL vs. -0.42±2.64 pg/mL, p<0.001), and increased adiponectin (2.31±2.00 μg/mL vs. 0.08±1.50 μg/mL, p<0.001) during 10-week follow-up. Other inflammatory cytokines like high-sensitivity C-reactive protein and soluble vascular cell adhesion molecule-1 were decreased in both groups.
Conclusions: Compared to prasugrel, ticagrelor significantly decreased inflammatory cytokines such as IL-6 and TNF-α, contributing to improved arterial endothelial function in diabetic non-ST-elevation ACS patients. Thus, data support that pleiotropic effects of ticagrelor beyond its potent antiplatelet effects could contribute to additional clinical benefits.