The effectiveness of platelet supplementation for the reversal of ticagrelor-induced inhibition of platelet aggregation An in-vitro study

摘要

BACKGROUNDManagement of ticagrelor-induced bleeding is challenging, as no antidote is currently available. Platelet transfusion, usually proposed to reverse antiplatelet drugs, has been suggested to be ineffective but few data are available.OBJECTIVETo assess the efficacy of platelet supplementation to restore platelet aggregation inhibited by ticagrelor.DESIGNIn vitro study.SETTINGBlood samples were obtained from the French Blood Bank Institute.PARTICIPANTSHealthy blood donors.INTERVENTIONSWhole blood from healthy donors was spiked with ticagrelor or aspirin (used as a positive control).MAIN OUTCOME MEASURESPlatelet aggregation was investigated with impedance aggregometry on whole blood [expressed in ohms (V)] and light transmission aggregometry (expressed in %) on platelet-rich plasma using ADP or arachidonic acid as agonists for ticagrelor or aspirin, respectively. Platelet supplementation was defined as the addition of washed platelet suspension increasing at least 60% of whole blood platelet count.RESULTSTicagrelor (3.25mM) inhibited ADP-induced platelet aggregation compared with control either in whole blood (2 vs. 13V, P 0.05) in ticagrelor-treated samples. We also report a case of a ticagrelor-treated patient in whom platelet transfusion failed to restore ADP-induced platelet aggregation.CONCLUSIONPlatelet supplementation restored platelet aggregation in aspirin-spiked but not in ticagrelor-spiked samples. These results do not support the use of platelet transfusion to reverse the effects of ticagrelor.