Optimizing P2Y12 receptor inhibition in patients with acute coronary syndrome on the basis of platelet function testing: impact of prasugrel and high-dose clopidogrel

This study sought to evaluate the impact of treatment with prasugrel and high-dose clopidogrel on the basis of platelet function testing in patients with acute coronary syndrome (ACS) who are undergoing percutaneous coronary intervention (PCI). The clinical impact of treatment with prasugrel in pati...

Full description

Saved in:
Bibliographic Details
Published in:Journal of the American College of Cardiology Vol. 63; no. 11; p. 1061
Main Authors: Aradi, Dániel, Tornyos, Adrienn, Pintér, Tünde, Vorobcsuk, András, Kónyi, Attila, Faluközy, József, Veress, Gábor, Magyari, Balázs, Horváth, Iván G, Komócsi, András
Format: Journal Article
Language:English
Published: United States 25.03.2014
Subjects:
Acute Coronary Syndrome - diagnosis
Acute Coronary Syndrome - drug therapy
Acute Coronary Syndrome - mortality
Acute Coronary Syndrome - therapy
Aged
Angioplasty, Balloon, Coronary - methods
Cause of Death
Combined Modality Therapy
Confidence Intervals
Dose-Response Relationship, Drug
Drug Administration Schedule
Female
Follow-Up Studies
Hemorrhage - prevention & control
Humans
Kaplan-Meier Estimate
Male
Middle Aged
Myocardial Infarction - prevention & control
Piperazines - administration & dosage
Piperazines - adverse effects
Platelet Function Tests
Prasugrel Hydrochloride
Predictive Value of Tests
Proportional Hazards Models
Prospective Studies
Purinergic P2Y Receptor Antagonists - administration & dosage
Registries
Risk Assessment
Severity of Illness Index
Stents
Stroke - prevention & control
Survival Rate
Thiophenes - administration & dosage
Thiophenes - adverse effects
Thrombosis - prevention & control
Ticlopidine - administration & dosage
Ticlopidine - adverse effects
Ticlopidine - analogs & derivatives
Treatment Outcome
platelet function testing
prasugrel
bleeding
high platelet reactivity
stent thrombosis
PCI
high-dose clopidogrel
mortality
ISSN:1558-3597, 1558-3597
Online Access:Get more information
Tags: Add Tag
No Tags, Be the first to tag this record!
Description
Summary:This study sought to evaluate the impact of treatment with prasugrel and high-dose clopidogrel on the basis of platelet function testing in patients with acute coronary syndrome (ACS) who are undergoing percutaneous coronary intervention (PCI). The clinical impact of treatment with prasugrel in patients with ACS who have high platelet reactivity (HPR) is unknown. Patients with ACS who were pre-treated with clopidogrel and undergoing successful PCI were enrolled in a single-center, prospective registry. Platelet function was measured 12 to 36 h after PCI with the Multiplate device (Roche Diagnostics GmbH, Mannheim, Germany). Patients with HPR (>46 U) were switched to prasugrel or treated with high-dose clopidogrel, and those without HPR continued treatment with 75 mg of clopidogrel. A total of 741 consecutive patients were enrolled in the study between September 2011 and August 2012, and 219 of these patients (29.5%) had HPR. Although platelet reactivity decreased after treatment adjustments in those with HPR, prasugrel provided significantly more potent platelet inhibition compared with high-dose clopidogrel (p < 0.0001). Compared with patients without HPR, the risk of all-cause death, myocardial infarction, stent thrombosis, or stroke at 1 year was significantly higher in the high-dose clopidogrel group (hazard ratio [HR]: 2.27; 95% confidence interval [CI]: 1.45 to 3.55; p < 0.0001), and patients who were switched to prasugrel had similar outcomes (HR: 0.90; 95% CI: 0.44 to 1.81; p = 0.76). Bleeding Academic Research Consortium (BARC) type 3/5 bleeding was also more frequent in patients treated with high-dose clopidogrel (HR: 2.09; 95% CI: 1.05 to 4.17; p = 0.04) than in patients switched to prasugrel (HR: 0.45; 95% CI: 0.11 to 1.91; p = 0.28). In a multivariate model, HPR with high-dose clopidogrel, but not with prasugrel, was an independent predictor of the composite ischemic endpoint (HR: 1.90; 95% CI: 1.17 to 3.08; p = 0.01). Switching patients with ACS who have HPR to treatment with prasugrel reduces thrombotic and bleeding events to a level similar to that of those without HPR; however, there is a higher risk of both thrombotic and bleeding complications with high-dose clopidogrel.
Bibliography:ObjectType-Article-2
SourceType-Scholarly Journals-1
ObjectType-Feature-1
content type line 23
ObjectType-Undefined-3
ISSN:1558-3597
1558-3597
DOI:10.1016/j.jacc.2013.12.023