Thienopyridine reloading in clopidogrel-loaded patients undergoing percutaneous coronary interventions: The PRAISE study
| Autor: | Jong Sung Park, Long Zhe Guo, Victor L. Serebruany, Moo Hyun Kim, Tae Ho Park, Cai De Jin, Michael S. Lee, Young Rak Cho, Eun-Seok Shin, Soe Hee Ann, Kyungil Park |
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| Rok vydání: | 2016 |
| Předmět: |
Male
Acute coronary syndrome medicine.medical_specialty Ticlopidine Prasugrel Thienopyridine Pyridines medicine.medical_treatment 030204 cardiovascular system & hematology Loading dose 03 medical and health sciences Percutaneous Coronary Intervention 0302 clinical medicine Internal medicine medicine Clinical endpoint Humans Prospective Studies cardiovascular diseases 030212 general & internal medicine Aged business.industry Percutaneous coronary intervention Middle Aged Platelet Activation medicine.disease Clopidogrel Conventional PCI Cardiology Drug Therapy Combination Female Cardiology and Cardiovascular Medicine business Platelet Aggregation Inhibitors medicine.drug |
| Zdroj: | International Journal of Cardiology. 222:639-644 |
| ISSN: | 0167-5273 |
| Popis: | The impact of thienopyridine reloading on clinical outcomes, and residual high platelet reactivity (HPR) is unclear. We sought to compare the HRP-related effect of prasugrel and clopidogrel reloading in the already clopidogrel-loaded patients undergoing percutaneous coronary intervention (PCI).In this prospective, two-center, randomized, open-label study, patients with HPR who had undergone PCI after a clopidogrel (300-600mg) loading dose (LD) were enrolled. Among screened (n=153), HPR was determined in seventy-six patients, who were randomized to either repeated clopidogrel (300mg LD, followed by 75mg MD daily) or prasugrel (20mg LD, followed by 5mg MD daily). The primary endpoint was HPR at 24h after PCI, as determined by the VerifyNow assay. The rates of sustained high and low platelet reactivity, periprocedural myocardial injury (PMI) and 30-day clinical outcomes were also assessed.Higher inhibition of platelet reactive units (PRU) was observed in the prasugrel group than after clopidogrel reloading (Pre-PCI: 284.4±32.0 vs 279.5±32.5, p=0.504; Post-PCI: 100.0±67.0 vs 202.9±65.8, p0.001; 30days: 170.8±69.8 vs 215.1±62.4, p=0.007). There were less HRP post-PCI after prasugrel compared with the clopidogrel group (2.7 vs 36.1%, p0.001). However, reloading with prasugrel did not reduce PMI compared to clopidogrel (36.8% vs 39.5%, p=0.813).Prasugrel reloading led to a greater reduction in HPR, but similar with clopidogrel PMI in post-PCI patients. Larger randomized evidence is needed for optimization of loading strategies with thienopyridines.NCT01609647. |
| Databáze: | OpenAIRE |
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