Background: Ticagrelor may exert pleiotropic actions, beyond platelet inhibition, which
are possibly adenosine-mediated. It has been suggested that in patients with coronary artery disease
(CAD) ticagrelor may influence endothelial function.
Objective: We aimed to assess the possibility of endothelial function deterioration following ticagrelor
Methods: This was a prospective, observational study, in stable CAD patients with prior percutaneous
coronary intervention (PCI) for acute coronary syndrome manifested 1 year earlier, under ticagrelor
maintenance dose (90 mg bid) and due to discontinue ticagrelor. Endothelial function was assessed by Peripheral
Arterial Tonometry (EndoPat 2000 system, Itamar Medical, Caesarea, Israel) immediately after receiving the last tablet of
ticagrelor (Day 0) and at Day 2 and Day 5 post-ticagrelor cessation. Reactive hyperaemia index (RHI) was calculated by
automated software and endothelial dysfunction (ED) was defined as a RHI <1.67.
Results: We identified 30 eligible patients with endothelial function assessment pre- and post-ticagrelor cessation (86.7%
men, 13.3% with diabetes and 33.3% current smokers; mean age: 63.6±11.5 years). The study’s primary endpoint of RHI
at Day 5 did not differ significantly compared with RHI at Day 0, 1.69 (1.45-2.23) vs 1.81 (1.59-2.13). ED rate did not
differ significantly between Day 5 and Day 0, 40 vs 33.3%, p=0.8, respectively. No differences in RHI or ED rate were
observed between Day 2 and Day 0, 1.64 (1.54-2.04) vs 1.8 1(1.59-2.13), p=0.3 and 53.3 vs 33.3%, p=0.2, respectively.
In stable CAD patients there is no evidence of deterioration in endothelial function after discontinuing