TY  - BOOK
AU  - Chen, Fang
AU  - Kent, Kenneth M
AU  - Kitabata, Hironori
AU  - Loh, Joshua P
AU  - Pendyala, Lakshmana K
AU  - Pichard, Augusto D
AU  - Satler, Lowell F
AU  - Suddath, William O
AU  - Torguson, Rebecca
AU  - Waksman, Ron
TI  - Safety of reloading prasugrel in addition to clopidogrel loading in patients with acute coronary syndrome  undergoing percutaneous coronary intervention
SN  - 0002-9149
PY  - 2013///
KW  - *Acute Coronary Syndrome/th [Therapy]
KW  - *Percutaneous Coronary Intervention
KW  - *Piperazines/ad [Administration & Dosage]
KW  - *Platelet Aggregation Inhibitors/ad  [Administration & Dosage]
KW  - *Purinergic P2Y Receptor Antagonists/ad  [Administration & Dosage]
KW  - *Thiophenes/ad [Administration & Dosage]
KW  - *Ticlopidine/aa [Analogs & Derivatives]
KW  - Aspirin/ad [Administration & Dosage]
KW  - Chi-Square Distribution
KW  - Endpoint Determination
KW  - Female
KW  - Humans
KW  - Male
KW  - Middle Aged
KW  - Risk Factors
KW  - Statistics, Nonparametric
KW  - Ticlopidine/ad [Administration & Dosage]
KW  - Treatment Outcome
KW  - MedStar Heart & Vascular Institute
KW  - Journal Article
N1  - Available online from MWHC library: 1995 -  present, Available in print through MWHC library: 1999 -  2006
N2  - Patients with acute coronary syndrome undergoing  percutaneous coronary intervention (PCI) commonly receive a  loading dose of either clopidogrel or prasugrel, in addition  to aspirin. The present study aimed to assess the safety of  reloading prasugrel in patients who had initially received a  loading dose of clopidogrel compared to prasugrel loading  alone. The study included a cohort of 606 consecutive  patients with acute coronary syndrome who had received a  60-mg loading dose of prasugrel before PCI. These patients  were then categorized into clopidogrel preloading (300 or  600 mg) followed by prasugrel reloading (CP-load group, n =  90) and prasugrel loading only (P-load group, n = 516). Both  groups received a 10-mg maintenance dose of prasugrel after  PCI. The primary end point was in-hospital Thrombolysis In  Myocardial Infarction-defined major bleeding. The secondary  end points were other in-hospital bleeding complications and  major cardiovascular events. Patients in the CP-load group  compared to the P-load group were younger, with lower rates  of cardiovascular risk factors. Significantly more patients  in the CP-load group presented with biomarker-positive  myocardial infarction (80.0% vs 30.6%, p <=0.001) and  cardiogenic shock (5.6% vs 1.4%, p = 0.022). No significant  differences (p = NS) were seen in Thrombolysis In Myocardial  Infarction major bleeding (2.6% vs 2.8%), Thrombolysis In  Myocardial Infarction major or minor bleeding (12.2% vs  7.0%), the need for blood transfusion (2.6% vs 2.1%), and  vascular complications (1.3% vs 2.0%) between groups. The  CP-load group experienced more in-hospital major adverse  cardiac events (5.6% vs 1.6%, p = 0.031), urgent coronary  artery bypass grafting (3.3% vs 0.2%, p = 0.011), and longer  hospital and intensive care unit stays. In conclusion,  preloading with clopidogrel should not be prohibitive to  reloading with prasugrel in patients presenting with acute  coronary syndrome and undergoing PCI with respect to  bleeding and vascular complications. Copyright  2013  Elsevier Inc. All rights reserved
UR  - http://dx.doi.org/10.1016/j.amjcard.2012.11.058
ER  -