Medizinische Universität Graz - Research portal
Selected Publication:
SHR Neuro Cancer Cardio Lipid Metab Microb
Freynhofer, MK; Hein-Rothweiler, R; Haller, PM; Aradi, D; Dézsi, DA; Gross, L; Orban, M; Trenk, D; Geisler, T; Huczek, Z; Toth-Gayor, GG; Massberg, S; Huber, K; Sibbing, D.
Diurnal Variability of On-Treatment Platelet Reactivity in Clopidogrel versus Prasugrel Treated Acute Coronary Syndrome Patients: A Pre-Specified TROPICAL-ACS Sub-Study.
THROMB HAEMOSTASIS. 2019; 119(4): 660-667.
Doi: 10.1055/s-0038-1677549
Web of Science
PubMed
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- Co-authors Med Uni Graz
- Toth-Gayor Gabor
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- Abstract:
- Long-term evidence supports a clustering of cardiovascular events in the early morning and smaller mechanistic studies in aspirin-treated patients have shown increased platelet reactivity at the end of the dosing interval. Comparative pharmacodynamic analyses for different adenosine diphosphate (ADP) receptor inhibitors in percutaneous coronary intervention-treated acute coronary syndrome (ACS) patients are lacking and this pre-specified analysis from the randomized Testing Responsiveness To Platelet Inhibition On Chronic Antiplatelet Treatment For Acute Coronary Syndromes (TROPICAL-ACS) trial aimed for the first time at investigating diurnal variability of on-treatment platelet reactivity in clopidogrel versus prasugrel treated patients. TROPICAL-ACS randomized 2,610 ACS patients to either treatment with prasugrel (control group) or to a platelet function testing-guided de-escalation of anti-platelet treatment with a switch to clopidogrel (guided de-escalation group). This study design enabled a diurnal comparison of on-prasugrel versus on-clopidogrel treatment platelet reactivity under steady-state conditions. For 2,526 patients (97%), both the exact time of blood sampling and the ADP-induced platelet aggregation value (in units, Multiplate analyser) were available. Platelet reactivity in patients on clopidogrel (n = 1,265) was higher and subject to significant diurnal variability (p = 0.019) with a peaking of platelet reactivity in the early morning (5-10 a.m.). In prasugrel-treated patients (n = 1,261), there was no sign for diurnal variability (p = 0.174) or a peaking of platelet reactivity in the morning. The potent ADP receptor inhibitor prasugrel is not subject to diurnal variability while we observed a significant diurnal variability of on-clopidogrel platelet reactivity. The clinical impact of this observation may differ for patients with and without an adequate response to clopidogrel treatment and the issue of diurnal variability of platelet reactivity in ACS patients warrants further investigation. Georg Thieme Verlag KG Stuttgart · New York.
- Find related publications in this database (using NLM MeSH Indexing)
- Acute Coronary Syndrome - drug therapy
- Adenosine Diphosphate - chemistry
- Aged -
- Aspirin - administration & dosage
- Blood Platelets - drug effects
- Circadian Rhythm -
- Clopidogrel - administration & dosage
- Double-Blind Method -
- Drug Administration Schedule -
- Drug Delivery Systems -
- Female -
- Humans -
- Male -
- Middle Aged -
- Percutaneous Coronary Intervention -
- Platelet Activation - drug effects
- Platelet Aggregation - drug effects
- Platelet Aggregation Inhibitors - therapeutic use
- Platelet Function Tests -
- Prasugrel Hydrochloride - administration & dosage
- Receptors, Purinergic P2Y12 - metabolism
- Time Factors -
- Find related publications in this database (Keywords)
- acute coronary syndrome
- prasugrel
- clopidogrel
- diurnal variability
- circadian variability