{"id":"29de402c09c1","type":"article","url":"https://hartvaat.nl/2020/09/01/clopidogrel-versus-prasugrel-versus-ticagrelor-op-endotheelfunctie-en-inflammati/","title":"Clopidogrel versus prasugrel versus ticagrelor op endotheelfunctie en inflammatie bij ACS","title_en":"Effects of clopidogrel vs. prasugrel vs. ticagrelor on endothelial function, inflammatory parameters, and platelet function in patients with acute coronary syndrome undergoing coronary artery stenting: a randomized, blinded, parallel study.","category":"algemeen","category_label":"Algemeen","professions":["apotheker","cardioloog"],"tags":["trombocytenaggregatieremmers"],"journal":"European heart journal","doi":"10.1093/eurheartj/ehz917","source_url":"https://doi.org/10.1093/eurheartj/ehz917","authors":["Boris Schnorbus","Andreas Daiber","Kerstin Jurk","Silke Warnke","Jochem Koenig","Karl J Lackner","Thomas Münzel","Tommaso Gori"],"significance":6,"published":"2020-09-01","source_date":"2020-09-01","image":"","kennis":["https://hartvaat.nl/kennis/coronairlijden/trombocytenaggregatieremmers-bij-acs/","https://hartvaat.nl/kennis/farmacologie/p2y12-remmers-vergelijking/"],"congress":"","summary_en":"This randomized head-to-head study compared the pleiotropic effects of clopidogrel, prasugrel, and ticagrelor on endothelial function, inflammation, and platelet aggregation in ACS patients, characterizing their differential pharmacological profiles.","created":"2026-07-03T10:28:44Z","updated":"2026-07-03T13:27:54Z","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":"Head-to-head vergelijking van drie P2Y12-remmers op endotheelfunctie, inflammatoire parameters en plaatjesfunctie bij ACS.","abstract_original":"AIMS: In a randomized, parallel, blinded study, we investigate the impact of clopidogrel, prasugrel, or ticagrelor on peripheral endothelial function in patients undergoing stenting for an acute coronary syndrome. METHODS AND RESULTS: The primary endpoint of the study was the change in endothelium-dependent flow-mediated dilation (FMD) following stenting. A total of 90 patients (age 62 ± 9 years, 81 males, 22 diabetics, 49 non-ST elevation myocardial infarctions) were enrolled. There were no significant differences among groups in any clinical parameter. Acutely before stenting, all three drugs improved FMD without differences between groups (P = 0.73). Stenting blunted FMD in the clopidogrel and ticagrelor group (both P < 0.01), but not in the prasugrel group. During follow-up, prasugrel was superior to clopidogrel [mean difference 2.13, 95% confidence interval (CI) 0.68-3.58; P = 0.0047] and ticagrelor (mean difference 1.57, 95% CI 0.31-2.83; P = 0.0155), but this difference was limited to patients who received the study therapy 2 h before stenting. Ticagrelor was not significantly superior to clopidogrel (mean difference 0.55, 95% CI -0.73 to 1.82; P = 0.39). No significant differences were seen among groups for low-flow-mediated dilation. Plasma interleukin (IL)-6 (P = 0.02 and P = 0.01, respectively) and platelet aggregation reactivity in response to adenosine diphosphate (P = 0.002 and P = 0.035) were lower in the prasugrel compared to clopidogrel and ticagrelor group. CONCLUSION: As compared to ticagrelor and clopidogrel, therapy with prasugrel in patients undergoing stenting for an acute coronary syndrome is associated with improved endothelial function, stronger platelet inhibition, and reduced IL-6 levels, all of which may have prognostic implications. This effect was lost in patients who received the study medication immediately after stenting. EUDRACT-NO: 2011-005305-73."}