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 Scopus citations

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 - Aug 2014

ASJC Scopus subject areas

  • Radiology Nuclear Medicine and imaging
  • Cardiology and Cardiovascular Medicine

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