TY - JOUR
T1 - Switching patients from clopidogrel to prasugrel in acute coronary syndrome
T2 - Impact of the clopidogrel loading dose on platelet reactivity
AU - Lhermusier, Thibault
AU - Lipinski, Michael J.
AU - Drenning, David
AU - Marso, Steven
AU - Chen, Fang
AU - Torguson, Rebecca
AU - Waksman, Ron
PY - 2014/8
Y1 - 2014/8
N2 - Objectives The present study aimed to assess the pharmacodynamic response of a prasugrel 60-mg loading dose (LD) alone compared with prasugrel 60mg added to clopidogrel 600mg. Background Patients with acute coronary syndrome (ACS) undergoing percutaneous coronary intervention (PCI) commonly receive a clopidogrel LD prior to angiography. Switching these patients to prasugrel may be desirable because higher platelet inhibition is expected. Methods In this open-label, multicenter, nonrandomized trial, 75 patients were categorized into 2 treatment strategies: Those who received a clopidogrel 600-mg LD and received a reloading dose of prasugrel 60mg (clopidogrel/prasugrel group) and those who did not receive a clopidogrel LD and received a prasugrel 60-mg LD (prasugrel group). Platelet reactivity was assessed using VerifyNow P2Y12 reaction units (PRU) and Platelet Reactivity Index vasodilator-stimulated phosphoprotein phosphorylation (PRI-VASP) at 3 different times: at the sheath insertion prior to prasugrel LD, 4hours after prasugrel LD, and at discharge. Results Four hours after prasugrel LD, platelet reactivity did not differ between the clopidogrel/prasugrel group and the prasugrel group according to the VerifyNow assay (median PRU 23 [5-71] vs. 54 [5-91], respectively; P=0.18) and the VASP assay (median PRI 8.67 [4.51-16.85] versus 8.03 [4.82-21.72], respectively; P=1.0). No significant differences in PRU and PRI were observed at discharge. Few bleeding events were reported without any significant differences between the 2 groups. Conclusions Platelet reactivity with prasugrel 60mg added to a clopidogrel 600-mg LD was not significantly different compared with prasugrel 60mg alone in ACS patients undergoing PCI. (J Interven Cardiol 2014;27:365-372)
AB - Objectives The present study aimed to assess the pharmacodynamic response of a prasugrel 60-mg loading dose (LD) alone compared with prasugrel 60mg added to clopidogrel 600mg. Background Patients with acute coronary syndrome (ACS) undergoing percutaneous coronary intervention (PCI) commonly receive a clopidogrel LD prior to angiography. Switching these patients to prasugrel may be desirable because higher platelet inhibition is expected. Methods In this open-label, multicenter, nonrandomized trial, 75 patients were categorized into 2 treatment strategies: Those who received a clopidogrel 600-mg LD and received a reloading dose of prasugrel 60mg (clopidogrel/prasugrel group) and those who did not receive a clopidogrel LD and received a prasugrel 60-mg LD (prasugrel group). Platelet reactivity was assessed using VerifyNow P2Y12 reaction units (PRU) and Platelet Reactivity Index vasodilator-stimulated phosphoprotein phosphorylation (PRI-VASP) at 3 different times: at the sheath insertion prior to prasugrel LD, 4hours after prasugrel LD, and at discharge. Results Four hours after prasugrel LD, platelet reactivity did not differ between the clopidogrel/prasugrel group and the prasugrel group according to the VerifyNow assay (median PRU 23 [5-71] vs. 54 [5-91], respectively; P=0.18) and the VASP assay (median PRI 8.67 [4.51-16.85] versus 8.03 [4.82-21.72], respectively; P=1.0). No significant differences in PRU and PRI were observed at discharge. Few bleeding events were reported without any significant differences between the 2 groups. Conclusions Platelet reactivity with prasugrel 60mg added to a clopidogrel 600-mg LD was not significantly different compared with prasugrel 60mg alone in ACS patients undergoing PCI. (J Interven Cardiol 2014;27:365-372)
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U2 - 10.1111/joic.12139
DO - 10.1111/joic.12139
M3 - Article
C2 - 25041356
AN - SCOPUS:84904976659
SN - 0896-4327
VL - 27
SP - 365
EP - 372
JO - Journal of Interventional Cardiology
JF - Journal of Interventional Cardiology
IS - 4
ER -