Dr. Himawan Fernando interests include general and interventional cardiology. He is presently pursuing a PhD at The Alfred Hospital, Baker Heart and Diabetes Institute, and Monash University, where he is researching alternate pain treatment for heart attack patients. In this Video Dr. Fernando discusses the Effects of lignocaine vs. opioids on antiplatelet activity of ticagrelor.
Link to Abstract-
The effects of intravenous fentanyl and lignocaine on the pharmacokinetics and pharmacodynamics of ticagrelor in patients with unstable angina and non-ST-elevation myocardial infarction, as well as their procedural analgesic efficacy and safety, were studied in patients with unstable angina and non-ST-elevation myocardial infarction.
Methods and outcomes
The pharmacokinetic and pharmacodynamic analysis of this randomized trial included seventy individuals who had coronary angiography with ticagrelor loading. Plasma ticagrelor levels were considerably lower in the fentanyl arm than in the lignocaine treatment arm 2 hours after the loading dosage (598 vs. 1008 ng/mL, P = 0.014). In the fentanyl group, 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. At 60 minutes, the fentanyl arm had significantly greater levels 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). At 60 minutes using the Multiplate Analyzer (41 percent vs. 9 percent, P = 0.002) and 120 minutes using the VerifyNow (30 percent vs. 3 percent, P = 0.003) and VASP (37 percent vs. 6 percent, P = 0.002) assays, the fentanyl arm had a higher proportion of patients with high on-treatment platelet reactivity. Both medicines were well tolerated, with patients reporting high levels of pleasure.
Unlike fentanyl, lignocaine does not reduce the bioavailability of ticagrelor or delay the antiplatelet action. For procedural analgesia, both medications were well tolerated and effective, with a high degree of patient satisfaction. Routine procedural analgesia during percutaneous coronary intervention should be evaluated, and lignocaine is a better option to fentanyl if it is used.