Platelet function normalization after a prasugrel loading-dose: time-dependent effect of platelet supplementation

Autor: Chiara Giannarelli, David A. Vorchheimer, Carlos G. Santos-Gallego, Joseph A. Jakubowski, Juan F. Viles-Gonzalez, Samantha Sartori, Valentin Fuster, D. S. Small, Mohammad Urooj Zafar, Sammy Elmariah, Juan J. Badimon
Rok vydání: 2013
Předmět:
Male
Prasugrel
Platelet Aggregation
Metabolite
Pharmacology
Cardiorespiratory Medicine and Haematology
Cardiovascular
antiplatelet
Piperazines
chemistry.chemical_compound
P2Y12
Platelet
Prospective Studies
Biotransformation
thienopyridine
Hematology
Anesthesia
Female
Drug
medicine.drug
Blood Platelets
Adult
Acute coronary syndrome
Thienopyridine
Clinical Sciences
Thiophenes
Platelet Transfusion
Loading dose
Article
Drug Administration Schedule
acute coronary syndrome
Dose-Response Relationship
Clinical Research
medicine
Humans
Acute Coronary Syndrome
Active metabolite
transfusion
Hemostasis
Dose-Response Relationship
Drug
Aspirin
business.industry
Platelet Count
medicine.disease
prasugrel
chemistry
Cardiovascular System & Hematology
business
Prasugrel Hydrochloride
Platelet Aggregation Inhibitors
Zdroj: Journal of thrombosis and haemostasis : JTH, vol 11, iss 1
Popis: Summary. Background: Hemostatic benefits of platelet transfusions in thienopyridine-treated acute coronary syndrome (ACS) patients may be compromised by residual metabolite in circulation.Objectives: To estimate the earliest time after a prasugrel loading-dose when added platelets are no longer inhibited by prasugrel's active metabolite.Methods: Baseline platelet reactivity of healthy subjects (n = 25, 30 ± 5 years, 68% male) on ASA 325 mg was tested using maximum platelet aggregation (MPA, ADP 20 μm) and VerifyNow® P2Y12 and was followed by a 60 mg prasugrel loading-dose. At 2, 6, 12 and 24 h post-dose, fresh concentrated platelets from untreated donors were added ex-vivo to subjects’ blood, raising platelet counts by 0% (control), 40%, 60% and 80%. To estimate the earliest time when prasugrel's active metabolite's inhibitory effect on the added platelets ceases, platelet function in supplemented samples was compared across time-points to identify the time when effect of supplementation on platelet function stabilized (i.e. the increase in platelet reactivity was statistically similar to that at the next time-point).Results: Supplemented samples showed concentration-dependent increases in platelet reactivity vs. respective controls by both MPA and VerifyNow® at all assessment time-points. For each supplementation level, platelet reactivity showed a sharp increase from 2 to 6 h but was stable (P = NS) between 6 and 12 h.Conclusions: The earliest measured time when supplemented platelets were not inhibited by circulating active metabolite of prasugrel was 6 h after a prasugrel loading-dose. These findings may have important implications for prasugrel-treated ACS patients requiring platelet transfusions during surgery.
Databáze: OpenAIRE
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