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SHR Neuro Cancer Cardio Lipid Metab Microb

Aradi, D; Tornyos, A; Pintér, T; Vorobcsuk, A; Kónyi, A; Faluközy, J; Veress, G; Magyari, B; Horváth, IG; Komócsi, A.
Optimizing P2Y12 receptor inhibition in patients with acute coronary syndrome on the basis of platelet function testing: impact of prasugrel and high-dose clopidogrel.
J Am Coll Cardiol. 2014; 63(11): 1061-70. Doi: 10.1016/j.jacc.2013.12.023
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Co-authors Med Uni Graz: Tornyos Adrienn
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Abstract:: OBJECTIVES: 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). BACKGROUND: The clinical impact of treatment with prasugrel in patients with ACS who have high platelet reactivity (HPR) is unknown. METHODS: 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. RESULTS: 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). CONCLUSIONS: 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.
Find related publications in this database (using NLM MeSH Indexing): Acute Coronary Syndrome - diagnosis, drug therapy, mortality, therapy; Aged - administration & dosage; Angioplasty, Balloon, Coronary - methods; Cause of Death - administration & dosage; Clopidogrel - administration & dosage; Combined Modality Therapy - administration & dosage; Confidence Intervals - administration & dosage; Dose-Response Relationship, Drug - administration & dosage; Drug Administration Schedule - administration & dosage; Female - administration & dosage; Follow-Up Studies - administration & dosage; Hemorrhage - prevention & control; Humans - administration & dosage; Kaplan-Meier Estimate - administration & dosage; Male - administration & dosage; Middle Aged - administration & dosage; Myocardial Infarction - prevention & control; Piperazines - administration & dosage, adverse effects; Platelet Function Tests - administration & dosage; Prasugrel Hydrochloride - administration & dosage; Predictive Value of Tests - administration & dosage; Proportional Hazards Models - administration & dosage; Prospective Studies - administration & dosage; Purinergic P2Y Receptor Antagonists - administration & dosage; Registries - administration & dosage; Risk Assessment - administration & dosage; Severity of Illness Index - administration & dosage; Stents - administration & dosage; Stroke - prevention & control; Survival Rate - administration & dosage; Thiophenes - administration & dosage, adverse effects; Thrombosis - prevention & control; Ticlopidine - administration & dosage, adverse effects, analogs & derivatives; Treatment Outcome - administration & dosage
Find related publications in this database (Keywords): bleeding; high-dose clopidogrel; high platelet reactivity; mortality; PCI; platelet function testing; prasugrel; stent thrombosis