{"id":"6672a9401c1d","type":"article","url":"https://hartvaat.nl/2021/10/14/lignocaine-versus-opioiden-op-antiplaatjeseffect-van-ticagrelor-local-trial/","title":"Lignocaïne versus opioïden op antiplaatjeseffect van ticagrelor: LOCAL trial","title_en":"Effects of lignocaine vs. opioids on antiplatelet activity of ticagrelor: the LOCAL trial.","category":"algemeen","category_label":"Algemeen","professions":["apotheker","cardioloog"],"tags":[],"journal":"European heart journal","doi":"10.1093/eurheartj/ehab557","source_url":"https://doi.org/10.1093/eurheartj/ehab557","authors":["Himawan Fernando","Thy Duong","Kevin Huynh","Jonathan Noonan","James Shaw","Stephen J Duffy","Ziad Nehme","Karen Smith","Paul S Myles","Peter J Meikle","Karlheinz Peter","Dion Stub"],"significance":6,"published":"2021-10-14","source_date":"2021-10-14","image":"","kennis":[],"congress":"","summary_en":"The LOCAL trial showed that intravenous lignocaine avoids the antiplatelet-delaying effect of opioids on ticagrelor in ACS patients, providing an alternative analgesic strategy that preserves rapid P2Y12 inhibition.","created":"2026-07-03T10:29:27Z","updated":"2026-07-03T13:28:34Z","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":"LOCAL trial die lignocaïne vergeleek met opioïden op het anti-plaatjeseffect van ticagrelor. Alternatief voor opioïden.","abstract_original":"AIMS: We assessed the impact of intravenous fentanyl and lignocaine on the pharmacokinetics and pharmacodynamics of ticagrelor in patients with unstable angina and non-ST-elevation myocardial infarction and their procedural analgesic efficacy and safety. METHODS AND RESULTS: Seventy patients undergoing coronary angiography with ticagrelor loading were included in the pharmacokinetic and pharmacodynamic analyses of this randomized trial. Plasma ticagrelor levels 2 h post-loading dose were significantly lower in the fentanyl arm than in the lignocaine treatment arm (598 vs. 1008 ng/mL, P = 0.014). The area under the plasma-time curves for ticagrelor (1228 vs. 2753 ng h/mL, P < 0.001) and its active metabolite (201 vs. 447 ng h/mL, P = 0.001) were both significantly lower in the fentanyl arm. Expression of activated platelet glycoprotein IIb/IIIa receptor (2829 vs. 1426 mean fluorescence intensity, P = 0.006) and P-selectin (439 vs. 211 mean fluorescence intensity, P = 0.001) was significantly higher at 60 min in the fentanyl arm. A higher proportion of patients had high on-treatment platelet reactivity in the fentanyl arm at 60 min using the Multiplate Analyzer (41% vs. 9%, P = 0.002) and 120 min using the VerifyNow (30% vs. 3%, P = 0.003) and VASP (37% vs. 6%, P = 0.002) assays. Both drugs were well tolerated with a high level of patient satisfaction. CONCLUSIONS: Unlike fentanyl, lignocaine does not impair the bioavailability or delay the antiplatelet effect of ticagrelor. Both drugs were well tolerated and effective with a high level of patient satisfaction for procedural analgesia. Routine procedural analgesia during percutaneous coronary intervention should be reconsidered and if performed, lignocaine is a beneficial alternative to fentanyl."}