{"id":"1c0869f9996f","type":"article","url":"https://hartvaat.nl/2017/12/01/kauwen-versus-slikken-van-ticagrelor-en-plaatjesremming-bij-stemi/","title":"Kauwen versus slikken van ticagrelor en plaatjesremming bij STEMI","title_en":"Effect of Chewing vs Swallowing Ticagrelor on Platelet Inhibition in Patients With ST-Segment Elevation Myocardial Infarction: A Randomized Clinical Trial.","category":"algemeen","category_label":"Algemeen","professions":["apotheker","cardioloog"],"tags":[],"journal":"JAMA cardiology","doi":"10.1001/jamacardio.2017.3868","source_url":"https://doi.org/10.1001/jamacardio.2017.3868","authors":["Elad Asher","Shir Tal","Israel Mazin","Arsalan Abu-Much","Avi Sabbag","Moshe Katz","Ehud Regev","Fernando Chernomordik","Victor Guetta","Amit Segev","Dan Elian","Israel Barbash","Paul Fefer","Michael Narodistky","Roy Beigel","Shlomi Matetzky"],"significance":6,"published":"2017-12-01","source_date":"2017-12-01","image":"","kennis":[],"congress":"","summary_en":"This randomized trial showed that chewing ticagrelor achieves faster and more complete platelet inhibition than swallowing intact tablets in STEMI patients, providing a practical pharmacological strategy for overcoming delayed drug absorption in acute MI.","created":"2026-07-03T10:27:02Z","updated":"2026-07-03T13:26:19Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (de url van het record). Samenvattingen zijn redactioneel werk van HartVaat; de oorspronkelijke publicaties blijven van hun uitgevers (doi). Geen medisch advies.","body_markdown":"JAMA Cardiology gerandomiseerde trial die het kauwen versus doorslikken van ticagrelor vergeleek op plaatjesremming bij STEMI. Praktisch relevant voor het versnellen van plaatjesremming in de acute fase.","abstract_original":"IMPORTANCE: Dual anti-platelet therapy represents standard care for treating patients with ST-segment elevation myocardial infarction (STEMI). Ticagrelor is a direct-acting P2Y12 inhibitor and, unlike clopidogrel and prasugrel, does not require metabolic activation. OBJECTIVE: To evaluate whether chewing a loading dose (LD) of ticagrelor, 180 mg, vs traditional oral administration of an equal dose enhances platelet inhibition at 30 minutes and 1 hour after LD administration in patients with STEMI. DESIGN, SETTING, AND PARTICIPANTS: A randomized clinical trial was conducted in adults aged 30 to 87 years from May to October 2016 in a large tertiary care center. Analyses were intention-to-treat. INTERVENTIONS: Fifty patients with STEMI were randomized to either chewing an LD of ticagrelor, 180 mg, or standard oral administration of an equal dose. MAIN OUTCOMES AND MEASURES: P2Y12 reaction units were evaluated using VerifyNow (Accumentrics) at baseline, 30 minutes, 1 hour, and 4 hours after LD. RESULTS: Baseline characteristics were similar in both groups. The mean (SD) of P2Y12 reaction units in the chewing group compared with the standard group at baseline, 30 minutes, 1 hour, and 4 hours after ticagrelor LD were 224 (33) vs 219 (44) (95% CI, -16.77 to 27.73; P = .26), 168 (78) vs 230 (69) (95% CI, -103.77 to -19.75; P = .003), 106 (90) vs 181 (89) (95% CI, -125.15 to -26.29; P = .005), and 43 (41) vs 51 (61) (95% CI, -36.34 to 21.14; P = .30), respectively. Platelet reactivity in the chewing group was significantly reduced by 24% at 30 minutes after LD (95% CI, 19.75 to 103.77; P = .001). The relative inhibition of platelet aggregation in the chewing vs the standard group were 51% vs 10% (95% CI, 13.69 to 67.67; P = .005) at 1 hour and 81% vs 76% (95% CI, -12.32 to 16.79; P = .24) at 4 hours, respectively. Major adverse cardiac and cardiovascular event rate at 30 days was low (4%) and occurred in 1 patient in each group (95% CI, 0.06 to 16.93; P > .99). CONCLUSIONS AND RELEVANCE: Chewing an LD of ticagrelor, 180 mg, in patients with STEMI is feasible and facilitates better early platelet inhibition compared with a standard oral LD. Larger studies are warranted to see if our preliminary findings translate into clinical outcomes. TRIAL REGISTRATION: clinicaltrials.gov Identifier: NCT02725099."}