To the Editor Recently, Lancellotti et al1 suggested that ticagrelor protected the participants of the Platelet Inhibition and Patient Outcomes study from infectious adverse events2 via an unforeseen antimicrobial activity. Ticagrelor was found bactericidal in vitro against gram-positive pathogens, including Staphylococcus aureus, but not gram-negative bacteria. Moreover, ticagrelor interfered with S aureus biofilm formation in vitro and in a mouse model of patch infection. However, in vitro bactericidal concentrations of ticagrelor were 10-fold to 40-fold greater than reachable in vivo serum levels. The authors speculated that platelets could have delivered the drug at the infected site. While this could be measured, it is in contradiction with the ticagrelor antiplatelet activity, which should curb platelet deposition at inflamed sites.
Heying R, Vanassche T, Moreillon P. Are Antiplatelet Agents Beneficial in Prevention of Infective Endocarditis? JAMA Cardiol. 2019;4(11):1177. doi:10.1001/jamacardio.2019.3130
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