Effects of lignocaine vs. opioids on antiplatelet activity of ticagrelor: the LOCAL trial
Authors' conclusion
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.
Study context
- Population
- Patients with unstable angina or NSTEMI undergoing coronary angiography with ticagrelor loadingPK/PD analyses
- Participants
- 70 patients
- Comparison
- Fentanyl vs Lignocaine
Primary result
As reported in the abstract
Pharmacokinetics and pharmacodynamics of ticagrelor
| Group | Plasma ticagrelor 2 h post-loading | AUC ticagrelor | AUC active metabolite | Activated GP IIb/IIIa expression at 60 min (MFI) | P-selectin expression at 60 min (MFI) | High on-treatment platelet reactivity, Multiplate, 60 min | High on-treatment platelet reactivity, VerifyNow, 120 min | High on-treatment platelet reactivity, VASP, 120 min |
|---|---|---|---|---|---|---|---|---|
| Fentanyl | 598 ng/mL | 1228 ng h/mL | 201 ng h/mL | 2829 | 439 | 41% | 30% | 37% |
| Lignocaine | 1008 ng/mL | 2753 ng h/mL | 447 ng h/mL | 1426 | 211 | 9% | 3% | 6% |
Plasma ticagrelor 2 h post-loading
Fentanyl598 ng/mL
Lignocaine1008 ng/mL
AUC ticagrelor
Fentanyl1228 ng h/mL
Lignocaine2753 ng h/mL
AUC active metabolite
Fentanyl201 ng h/mL
Lignocaine447 ng h/mL
Activated GP IIb/IIIa expression at 60 min (MFI)
Fentanyl2829
Lignocaine1426
P-selectin expression at 60 min (MFI)
Fentanyl439
Lignocaine211
High on-treatment platelet reactivity, Multiplate, 60 min
Fentanyl41%
Lignocaine9%
High on-treatment platelet reactivity, VerifyNow, 120 min
Fentanyl30%
Lignocaine3%
High on-treatment platelet reactivity, VASP, 120 min
Fentanyl37%
Lignocaine6%
- Fentanyl vs Lignocaine: P = 0.014 — plasma ticagrelor 2 h
- Fentanyl vs Lignocaine: P < 0.001 — AUC ticagrelor
- Fentanyl vs Lignocaine: P = 0.001 — AUC active metabolite
- Fentanyl vs Lignocaine: P = 0.006 — GP IIb/IIIa
- Fentanyl vs Lignocaine: P = 0.001 — P-selectin
- Fentanyl vs Lignocaine: P = 0.002 — HPR Multiplate
- Fentanyl vs Lignocaine: P = 0.003 — HPR VerifyNow
- Fentanyl vs Lignocaine: P = 0.002 — HPR VASP
Safety
Tolerability
- Both drugs well tolerated with high patient satisfaction
Original publication
Effects of lignocaine vs. opioids on antiplatelet activity of ticagrelor: the LOCAL trial. Eur Heart J. Published 23 August 2021. doi:10.
Summarised from the published abstract; every number is checked against it