Pharmacodynamic study of prasugrel or clopidogrel in non-ST-elevation acute coronary syndrome with CYP2C19 genetic variants undergoing percutaneous coronary intervention (PRAISE-GENE trial)
| Autor: | Enze Jin, Eun-Seok Shin, Long Zhe Guo, Moo Hyun Kim, Michael S. Lee, Soo Jin Kim, Jong Sung Park, Cai De Jin, Soe Hee Ann, Young-Rak Cho |
|---|---|
| Rok vydání: | 2019 |
| Předmět: |
Blood Platelets
medicine.medical_specialty Acute coronary syndrome Prasugrel Ticlopidine medicine.medical_treatment CYP2C19 030204 cardiovascular system & hematology 03 medical and health sciences 0302 clinical medicine Percutaneous Coronary Intervention Internal medicine Clinical endpoint medicine Humans 030212 general & internal medicine Acute Coronary Syndrome business.industry ST elevation Percutaneous coronary intervention medicine.disease Clopidogrel Cytochrome P-450 CYP2C19 Treatment Outcome Conventional PCI Cardiology Cardiology and Cardiovascular Medicine business Prasugrel Hydrochloride Platelet Aggregation Inhibitors medicine.drug |
| Zdroj: | International journal of cardiology. 305 |
| ISSN: | 1874-1754 |
| Popis: | The CYP2C19*2 or *3 loss-of-function (LOF) allele is associated with high platelet reactivity (HPR) on clopidogrel treatment. East Asians may benefit from a lower dose of prasugrel due to their more potent platelet inhibitory response. The impact of LOF alleles on the pharmacodynamic response to half-dose prasugrel in patients with non-ST-elevation acute coronary syndrome (NSTE-ACS) undergoing percutaneous coronary intervention (PCI) is unknown.Seventy patients with the LOF alleles were assigned to half-dose prasugrel (n = 35, 30-mg load followed by 5 mg daily) or clopidogrel (n = 35, 600-mg load followed by 75 mg daily). The primary endpoint was the rate of HPR, defined as VerifyNow-P2Y12 reaction unit (PRU)235, at 24 h post loading.Prasugrel achieved a lower PRU compared to clopidogrel after loading (119 [56-175] vs. 245 [189-299]), at 24 h (34 [8-58] vs. 196 [122-244]), and at 30 days (134 [98-189] vs. 203 [144-248]). Prasugrel had a lower rate of HPR after loading (5.7% vs. 57.1%, p0.001), at 24 h (2.9% vs. 28.6%, p=0.006), and at 30 days (11.4% vs. 34.3%, p=0.004). Prasugrel had a similar rate of optimal platelet reactivity at 30 days (71.4% vs. 60.0%, p=0.450). There was no significant difference in the occurrence of periprocedural myonecrosis within 48 h after PCI with clopidogrel and prasugrel (22.9% vs. 17.1%, p0.960).Half-dose prasugrel provided potent platelet inhibition in NSTE-ACS patients that were carriers of the CYP2C19*2 or *3 allele, with a lower rate of HPR. Periprocedural myonecrosis was not significantly different in the 2 groups. |
| Databáze: | OpenAIRE |
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