Pharmacodynamic effect of prasugrel 5 mg vs clopidogrel 150 mg in elderly patients with high on-clopidogrel platelet reactivity
| Autor: | Dimitrios Alexopoulos, Konstantinos Theodoropoulos, Eleni Mavronasiou, Periklis Davlouros, Theodora-Eleni Plakomyti, George Hahalis, Anastasia Damelou, Ioanna Xanthopoulou |
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| Rok vydání: | 2013 |
| Předmět: |
Male
medicine.medical_specialty Acute coronary syndrome Ticlopidine Prasugrel Platelet Aggregation Platelet Function Tests medicine.medical_treatment Thiophenes Gastroenterology Piperazines Percutaneous Coronary Intervention P2Y12 Internal medicine medicine Humans Prospective Studies cardiovascular diseases Acute Coronary Syndrome Aged Prasugrel Hydrochloride business.industry Standard treatment Percutaneous coronary intervention medicine.disease Clopidogrel Treatment Outcome Anesthesia Conventional PCI Female Cardiology and Cardiovascular Medicine business Platelet Aggregation Inhibitors medicine.drug |
| Zdroj: | American Heart Journal. 165:73-79 |
| ISSN: | 0002-8703 |
| DOI: | 10.1016/j.ahj.2012.10.008 |
| Popis: | Background Elderly patients with acute coronary syndrome (ACS) undergoing percutaneous coronary intervention (PCI) frequently exhibit high platelet reactivity (HPR) while on clopidogrel. In the elderly cohort, either prasugrel is not recommended or, if used, halving of the dose has been suggested. We aimed to test the hypothesis that in elderly patients exhibiting HPR after standard treatment with clopidogrel, prasugrel-reduced dose (5 mg) could be more effective than high-dose (150 mg) clopidogrel. Methods Consecutive elderly (≥75 years old) patients with ACS undergoing PCI and loaded with clopidogrel were considered for platelet reactivity (PR) assessment at 24 hours after PCI with the VerifyNow assay (Accumetrics Inc, San Diego, CA), measured in P2Y12 reaction units (PRU). Of 63 screened patients, 30 (47.6%) were found with HPR (defined as PRU ≥230) and 27 of them participated in a prospective, randomized, single-center, single-blind, investigator-initiated, crossover study of platelet inhibition by prasugrel 5 mg/d vs clopidogrel 150 mg/d, with a 15-day treatment period. Results The primary end point of PR at the end of the 2 study periods was lower in patients receiving low-dose prasugrel than those receiving high-dose clopidogrel (least squares estimates 190.8 [95% CI 161.5-220.1] and 240.8 [95% CI 211.0-270.6], respectively; P = .008). The secondary end point of HPR rate at the end of treatment periods was lower for prasugrel (8/24; 33.3%) compared with clopidogrel (16/24; 66.7%), P = .02. Conclusions In elderly patients with ACS undergoing PCI and exhibiting HPR after standard clopidogrel treatment, prasugrel 5 mg/d is significantly more efficacious than clopidogrel 150 mg/d in reducing PR and HPR rate. |
| Databáze: | OpenAIRE |
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