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Ticagrelor Steady-State Trough Concentration in Chinese Patients Undergoing Percutaneous Coronary Intervention

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Abstract

Background and Objective

Platelets play a pivotal role in thrombotic events associated with acute coronary syndrome (ACS), making oral antiplatelet therapy a cornerstone in antithrombotic strategies. The dosing regimen for the oral antiplatelet drug ticagrelor warrants evaluation to ensure its appropriateness in clinical practice. Therefore, this study aimed to investigate the real-world clinical application of ticagrelor by determining the optimal therapeutic concentration of ticagrelor in Chinese patients undergoing percutaneous coronary intervention (PCI).

Methods

We enrolled a cohort of 912 patients who underwent PCI with drug-eluting stent implantation for the treatment of ACS. We measured steady-state plasma drug concentrations using high-performance liquid chromatography–tandem mass spectrometry. The therapeutic drug concentration range at steady state was established on the basis of clinical pharmacodynamic indices, with verification of reliability through concentration-effect analysis and receiver operating characteristic curve assessment.

Results

Analysis of plasma samples from the 912 patients revealed significant variations in the steady-state trough concentration of ticagrelor associated with factors such as gender, age, hypertension, and hyperlipidemia. On the basis of this analysis, the optimal therapeutic range for steady-state trough concentration was determined to be 240.65–335.83 ng/mL. Furthermore, the upper limit values for steady-state concentration were established at 439.97 ng/mL for male patients and 347.06 ng/mL for female patients.

Conclusions

This study provides robust and reliable insights into the optimal therapeutic steady-state trough concentrations of ticagrelor in Chinese patients with post-percutaneous coronary intervention. These findings have significant implications for guiding the rational use of antiplatelet drugs and facilitating precise drug administration in Chinese patients undergoing percutaneous coronary intervention.

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Acknowledgments

The authors extend their gratitude to the study participants. They also acknowledge the contributions of all members of the Anhui Provincial Key Laboratory for Enhancing and Evaluating the Quality of Chinese Medicine, whose suggestions and discussions were instrumental in preparing this manuscript. Additionally, they thank Editage (www.editage.cn) for their assistance with English language editing.

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Authors and Affiliations

  1. School of Biotechnology and Pharmaceutical Engineering, West Anhui University, Moon Island, West of Yunlu Bridge, Lu’an, 237012, People’s Republic of China

    ShaoJun Zheng & NaiDong Chen

  2. Department of Pharmacy, Nanjing First Hospital, Nanjing Medical University, Nanjing, 210029, People’s Republic of China

    Qiong Jie & YuBing Zhu

  3. Anhui Engineering Laboratory for Conservation and Sustainable Utilization of Traditional Chinese Medicine Resource, Lu’an, 237012, Anhui, People’s Republic of China

    ShaoJun Zheng & NaiDong Chen

  4. School of Basic Medicine and Clinical Pharmacy, China Pharmaceutical University, Nanjing, 211198, People’s Republic of China

    ShaoJun Zheng, XiJing Chen & YuBing Zhu

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  1. ShaoJun Zheng
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Corresponding author

Correspondence to ShaoJun Zheng.

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Funding

Anhui Scientific Research and Innovation Team of Quality Evaluation and Improvement of Traditional Chinese Medicine (2022AH010090).

Conflict of Interest

The author(s) declare no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Ethics Approval

Ethics Committee of Nanjing First Hospital approved the study protocol (approval number KY2019530-05). The study was conducted in accordance with the International Conference on Harmonisation Guideline for Good Clinical Practice and the Declaration of Helsinki.

Consent to participate

All subjects provided written informed consent before participation

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Not applicable.

Availability of Data and Material

The datasets used and/or analyzed during the current study are available from the corresponding author upon reasonable request.

Code Availability

Not applicable.

Authors Contributions

SZ was responsible for conception and design, data collection, interpretation of the data, drafting of the article, final approval of the manuscript, and statistical analysis; QJ and NC for interpretation of the data and data collection; and YZ and XC for conception and design, final approval of the manuscript, and supervision. Each author contributed important intellectual content during manuscript drafting or revision and accepts accountability for the overall work by ensuring that questions pertaining to the accuracy or integrity of any portion of the work are appropriately investigated and resolved.

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Zheng, S., Jie, Q., Chen, N. et al. Ticagrelor Steady-State Trough Concentration in Chinese Patients Undergoing Percutaneous Coronary Intervention. Eur J Drug Metab Pharmacokinet 49, 33–42 (2024). https://doi.org/10.1007/s13318-023-00867-z

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