Prasugrel overcomes high on-clopidogrel platelet reactivity in the acute phase of acute coronary syndrome and maintains its antiplatelet potency at 30-day follow-up

Marek Koziński, Karolina Obońska, Katarzyna Stankowska, Eliano Pio Navarese, Tomasz Fabiszak, Wioleta Stolarek, Michał Kasprzak, Jolanta Maria Siller-Matula, Danuta Rość, Jacek Kubica, Stefano De Servi

Research output: Contribution to journalArticle

Abstract

Background: The aim of this study was to assess antiplatelet effect of prasugrel in acute coronary syndrome (ACS) patients with high on-treatment platelet reactivity (HTPR) on clopidogrel, undergoing percutaneous coronary intervention (PCI).

Methods: A prospective, platelet reactivity-guided, parallel-group, open-label study including 71 patients pretreated with clopidogrel 600 mg and assigned either to prasugrel (30 mg loading dose, 10 mg maintenance dose; n = 46) or clopidogrel (150 mg maintenance dose for 6 days and thereafter 75 mg maintenance dose; n = 25) regimen, based on vasodilator-stimulated phosphoprotein (VASP)-assessed platelet reactivity index (PRI; > 50% vs. ≤ 50%) measured next morning post-PCI.

Results: Median PRI value after switch to prasugrel sharply declined at 24 h (70.0 [61.3–75.6] vs. 11.9 [6.8–25.7]%; p <0.000001) and slightly but significantly rose between 24 h and 30 days (27.9 [15.5–46.8]%; p <0.0006). In contrast, median PRI values in the clopidogrel group were similar at baseline and at 24 h (25.1 [13.7–40.2] vs. 22.0 [18.4–36.8]%; p = NS) and then modestly rose at 30 days (30.3 [20.4–45.7]%; p <0.03). The prevalence of HTPR decreased in the prasugrel group between baseline and 24 h measurements (100.0 vs. 4.3%; p <0.0001). Rates of patients with HTPR at 24 h and 30 days were similar in both groups, so were the tendencies in patterns of platelet inhibition evaluated with multiple electrode aggregometry as compared with the VASP assay.

Conclusions: Our study indicates that prasugrel overcomes HTPR on clopidogrel in the acute phase of interventionally treated ACS and maintains its antiplatelet potency in 30-day follow-up. Potential clinical benefits of personalized antiplatelet prasugrel-based therapy warrant further investigation in clinical ACS trials.

Original languageEnglish
Pages (from-to)547-556
Number of pages10
JournalCardiology Journal
Volume21
Issue number5
DOIs
Publication statusPublished - 2014

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Keywords

  • Clopidogrel
  • High on-treatment platelet reactivity
  • Multiple electrode aggregometry
  • Prasugrel
  • VASP assay

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine
  • Medicine(all)

Cite this

Koziński, M., Obońska, K., Stankowska, K., Navarese, E. P., Fabiszak, T., Stolarek, W., Kasprzak, M., Siller-Matula, J. M., Rość, D., Kubica, J., & De Servi, S. (2014). Prasugrel overcomes high on-clopidogrel platelet reactivity in the acute phase of acute coronary syndrome and maintains its antiplatelet potency at 30-day follow-up. Cardiology Journal, 21(5), 547-556. https://doi.org/10.5603/CJ.a2014.0026