Changes in P2Y12 reaction units after switching treatments from prasugrel to clopidogrel in Japanese patients with acute coronary syndrome followed by elective coronary stenting

Autor: Yoshihiro Fukumoto, Kyoko Umeji, Hiroshi Koiwaya, Yoritaka Otsuka, Yousuke Katsuda, Yoshio Katsuki, Yoshinobu Murasato, Ken-ichiro Sasaki, Yoshisato Shibata, Takafumi Ueno, Junichiro Shimamatsu, Tomohiro Kawasaki
Rok vydání: 2016
Předmět:
Male
medicine.medical_specialty
Acute coronary syndrome
Ticlopidine
Prasugrel
Thienopyridine
medicine.medical_treatment
030204 cardiovascular system & hematology
Prosthesis Implantation
Coronary artery disease
03 medical and health sciences
Percutaneous Coronary Intervention
0302 clinical medicine
Japan
Internal medicine
Coronary stent
medicine
Humans
Radiology
Nuclear Medicine and imaging
030212 general & internal medicine
Acute Coronary Syndrome
Aged
Polymorphism
Genetic
Aspirin
Maintenance dose
business.industry
Receptors
Purinergic
Percutaneous coronary intervention
General Medicine
Middle Aged
medicine.disease
Clopidogrel
Cytochrome P-450 CYP2C19
Anesthesia
Purinergic P2Y Receptor Antagonists
Cardiology
Female
Stents
Cardiology and Cardiovascular Medicine
business
Prasugrel Hydrochloride
Platelet Aggregation Inhibitors
medicine.drug
Zdroj: Cardiovascular Intervention and Therapeutics. 32:341-350
ISSN: 1868-4297
1868-4300
Popis: Patients with ischemic heart disease are administered a dual antiplatelet therapy after percutaneous coronary intervention. This consists of aspirin and thienopyridine, which can be switched from prasugrel to clopidogrel. However, the impact of switching is unknown. This study aimed to determine the efficacy and safety of switching from prasugrel to clopidogrel in Japanese patients. One-hundred and thirty-six patients with acute coronary syndrome scheduled to undergo percutaneous coronary intervention and patients with coronary artery disease requiring elective coronary stenting were enrolled. Patients were randomly assigned into the following groups: prasugrel for 6 weeks at loading/maintenance doses of 20/3.75 mg (Continued Group; n = 68) or prasugrel at 20/3.75 mg for 2 weeks followed by clopidogrel at 75 mg for 4 weeks (Switched Group; n = 68). Aspirin (loading dose/maintenance dose 324/81–100 mg/day) was coadministered in both groups. The primary endpoint was the mean P2Y12 reaction unit (PRU) at week 6 and the secondary endpoint was the PRU in groups subdivided based on the presence of CYP2C19 gene polymorphisms. At week 6, the PRU was significantly lower in the Continued Group relative to the Switched Group (140.7 and 183.0, respectively; P < 0.001), which was also evident after correction with the baseline values (144.1 vs. 176.6, respectively; P = 0.005). Extensive and poor metabolizers in the Switched Group, based on CYP2C19 gene polymorphisms, had significantly higher PRU values than those in the Continued Group. Thus, switching treatments from prasugrel to clopidogrel significantly increased the PRU in patients receiving antiplatelet therapy subsequent to percutaneous coronary intervention.
Databáze: OpenAIRE
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