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

Thibault Lhermusier, Michael J. Lipinski, David Drenning, Steven Marso, Fang Chen, Rebecca Torguson, Ron Waksman

Research output: Contribution to journalArticle

9 Citations (Scopus)

Abstract

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)

Original languageEnglish (US)
Pages (from-to)365-372
Number of pages8
JournalJournal of Interventional Cardiology
Volume27
Issue number4
DOIs
StatePublished - 2014

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clopidogrel
Acute Coronary Syndrome
Blood Platelets
Percutaneous Coronary Intervention
Prasugrel Hydrochloride

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine
  • Radiology Nuclear Medicine and imaging

Cite this

Switching patients from clopidogrel to prasugrel in acute coronary syndrome : Impact of the clopidogrel loading dose on platelet reactivity. / Lhermusier, Thibault; Lipinski, Michael J.; Drenning, David; Marso, Steven; Chen, Fang; Torguson, Rebecca; Waksman, Ron.

In: Journal of Interventional Cardiology, Vol. 27, No. 4, 2014, p. 365-372.

Research output: Contribution to journalArticle

Lhermusier, Thibault ; Lipinski, Michael J. ; Drenning, David ; Marso, Steven ; Chen, Fang ; Torguson, Rebecca ; Waksman, Ron. / Switching patients from clopidogrel to prasugrel in acute coronary syndrome : Impact of the clopidogrel loading dose on platelet reactivity. In: Journal of Interventional Cardiology. 2014 ; Vol. 27, No. 4. pp. 365-372.
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abstract = "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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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

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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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