Switching patients from clopidogrel to prasugrel in acute coronary syndrome: impact of the clopidogrel loading dose on platelet reactivity.

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Citation: Journal of Interventional Cardiology. 27(4):365-72, 2014 Aug.PMID: 25041356Institution: MedStar Washington Hospital CenterForm of publication: Journal ArticleMedline article type(s): Clinical Trial | Journal Article | Multicenter Study | Research Support, Non-U.S. Gov'tSubject headings: *Acute Coronary Syndrome/th [Therapy] | *Platelet Activation/de [Drug Effects] | *Platelet Aggregation Inhibitors/ad [Administration & Dosage] | *Platelet Aggregation/de [Drug Effects] | *Prasugrel Hydrochloride/ad [Administration & Dosage] | *Ticlopidine/aa [Analogs & Derivatives] | Dose-Response Relationship, Drug | Female | Humans | Male | Middle Aged | Percutaneous Coronary Intervention | Ticlopidine/ad [Administration & Dosage]Year: 2014ISSN:
  • 0896-4327
Name of journal: Journal of interventional cardiologyAbstract: 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.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.Copyright © 2014, Wiley Periodicals, Inc.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.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.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.All authors: Chen F, Drenning D, Lhermusier T, Lipinski MJ, Marso S, Torguson R, Waksman RFiscal year: FY2015Digital Object Identifier: Date added to catalog: 2016-05-24
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Journal Article MedStar Authors Catalog Article 25041356 Available 25041356

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.

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.Copyright © 2014, Wiley Periodicals, Inc.

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.

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.

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.

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