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Randomized Comparison of the Platelet Inhibitory Efficacy between Low Dose Prasugrel and Standard Dose Clopidogrel in Patients Who Underwent Percutaneous Coronary Intervention.

Jin HY, Yang TH, Choi KN, Seo JS, Jang JS, Kim DK, Kim DS - Korean Circ J (2014)

Bottom Line: Increased bleeding rates with standard dose prasugrel have led to increased questions about the effectiveness and safety of the lower maintenance dose.The prasugrel (5 mg) group had a significantly lower PRU value compared with that of 75 mg clopidogrel (174.6±60.2 vs. 223.4±72.9, p=0.022) group at 30 days, whereas the 10 mg prasugrel group showed a lower PRU value (71.9±34.4) compared with that of the 5 mg prasugrel (p<0.001).The rate of high on-treatment platelet reactivity (PRU >235) was significant lower in the 5 mg prasugrel group than that in the 75 mg clopidogrel group (15.0% vs. 56.5%, p=0.010).

View Article: PubMed Central - PubMed

Affiliation: Division of Cardiology, Department of Internal Medicine, Inje University College of Medicine, Busan Paik Hospital, Busan, Korea.

ABSTRACT

Background and objectives: Increased bleeding rates with standard dose prasugrel have led to increased questions about the effectiveness and safety of the lower maintenance dose. We compared platelet inhibitory efficacy between low dose prasugrel and standard dose clopidogrel in patients on maintenance dose dual antiplatelet therapy.

Subjects and methods: Forty-three patients who underwent percutaneous coronary intervention were randomized to receive 75 mg clopidogrel (n=23) or 5 mg prasugrel (n=20). Another 20 patients were allocated to 10 mg prasugrel as a reference comparison group. All patients (weight, ≥60 kg; age, <75 years) had been receiving 100 mg aspirin and 75 mg clopidogrel daily. The platelet function test was performed at baseline and 30 days after randomization. The primary endpoint was P2Y12 reaction unit (PRU) at 30 days between 5 mg prasugrel and 75 mg clopidogrel.

Results: No differences in baseline PRU values were observed among the three groups. The prasugrel (5 mg) group had a significantly lower PRU value compared with that of 75 mg clopidogrel (174.6±60.2 vs. 223.4±72.9, p=0.022) group at 30 days, whereas the 10 mg prasugrel group showed a lower PRU value (71.9±34.4) compared with that of the 5 mg prasugrel (p<0.001). The rate of high on-treatment platelet reactivity (PRU >235) was significant lower in the 5 mg prasugrel group than that in the 75 mg clopidogrel group (15.0% vs. 56.5%, p=0.010).

Conclusion: Prasugrel (5 mg) is more potent antiplatelet therapy than 75 mg clopidogrel in non-low body weight and non-elderly patients on a maintenance dose dual antiplatelet therapy.

No MeSH data available.


The rate of high on-treatment platelet reactivity (PRU >235) 30 days after randomization.
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Figure 3: The rate of high on-treatment platelet reactivity (PRU >235) 30 days after randomization.

Mentions: Baseline PRU values and percent platelet inhibition were not different among the three groups. At 30 days after randomization, the 5 mg prasugrel group had significantly lower PRU value compared with that of the 75 mg clopidogrel group (174.6±60.2 vs. 223.4±72.9, p=0.022), whereas the 10 mg prasugrel group showed a lower PRU value (71.9±34.4) compared with that of the 5 mg prasugrel group (p<0.001) (Fig. 2). Similarly, the 5 mg prasugrel group demonstrated a higher percent platelet inhibition compared to that of the 75 mg clopidogrel group at 30 days (Table 3). In addition, the percent change in the PURs was significantly higher in the 5 mg prasugrel than that in the 75 mg clopidogrel group (18.7±20.8 vs. -1.17±18.9, p=0.002) and higher in the 10 mg prasugrel (61.7±20.5) than that in the 5 mg prasugrel group (p<0.001). The proportion of baseline HTPR was similar in each group (p=0.392). At 30 days after switching to the study drugs, the rate of HTPR was significantly lower in the 5 mg prasugrel than that in the 75 mg clopidogrel group 15.0% vs. 56.5%, p=0.010) (Fig. 3). When we used a more sensitive PRU cut-off value (>208) predicting ischemic events, there were still differences in the rate of HTPR (30.0% vs. 60.9%) although statistical significance was borderline (p=0.067).


Randomized Comparison of the Platelet Inhibitory Efficacy between Low Dose Prasugrel and Standard Dose Clopidogrel in Patients Who Underwent Percutaneous Coronary Intervention.

Jin HY, Yang TH, Choi KN, Seo JS, Jang JS, Kim DK, Kim DS - Korean Circ J (2014)

The rate of high on-treatment platelet reactivity (PRU >235) 30 days after randomization.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC3958613&req=5

Figure 3: The rate of high on-treatment platelet reactivity (PRU >235) 30 days after randomization.
Mentions: Baseline PRU values and percent platelet inhibition were not different among the three groups. At 30 days after randomization, the 5 mg prasugrel group had significantly lower PRU value compared with that of the 75 mg clopidogrel group (174.6±60.2 vs. 223.4±72.9, p=0.022), whereas the 10 mg prasugrel group showed a lower PRU value (71.9±34.4) compared with that of the 5 mg prasugrel group (p<0.001) (Fig. 2). Similarly, the 5 mg prasugrel group demonstrated a higher percent platelet inhibition compared to that of the 75 mg clopidogrel group at 30 days (Table 3). In addition, the percent change in the PURs was significantly higher in the 5 mg prasugrel than that in the 75 mg clopidogrel group (18.7±20.8 vs. -1.17±18.9, p=0.002) and higher in the 10 mg prasugrel (61.7±20.5) than that in the 5 mg prasugrel group (p<0.001). The proportion of baseline HTPR was similar in each group (p=0.392). At 30 days after switching to the study drugs, the rate of HTPR was significantly lower in the 5 mg prasugrel than that in the 75 mg clopidogrel group 15.0% vs. 56.5%, p=0.010) (Fig. 3). When we used a more sensitive PRU cut-off value (>208) predicting ischemic events, there were still differences in the rate of HTPR (30.0% vs. 60.9%) although statistical significance was borderline (p=0.067).

Bottom Line: Increased bleeding rates with standard dose prasugrel have led to increased questions about the effectiveness and safety of the lower maintenance dose.The prasugrel (5 mg) group had a significantly lower PRU value compared with that of 75 mg clopidogrel (174.6±60.2 vs. 223.4±72.9, p=0.022) group at 30 days, whereas the 10 mg prasugrel group showed a lower PRU value (71.9±34.4) compared with that of the 5 mg prasugrel (p<0.001).The rate of high on-treatment platelet reactivity (PRU >235) was significant lower in the 5 mg prasugrel group than that in the 75 mg clopidogrel group (15.0% vs. 56.5%, p=0.010).

View Article: PubMed Central - PubMed

Affiliation: Division of Cardiology, Department of Internal Medicine, Inje University College of Medicine, Busan Paik Hospital, Busan, Korea.

ABSTRACT

Background and objectives: Increased bleeding rates with standard dose prasugrel have led to increased questions about the effectiveness and safety of the lower maintenance dose. We compared platelet inhibitory efficacy between low dose prasugrel and standard dose clopidogrel in patients on maintenance dose dual antiplatelet therapy.

Subjects and methods: Forty-three patients who underwent percutaneous coronary intervention were randomized to receive 75 mg clopidogrel (n=23) or 5 mg prasugrel (n=20). Another 20 patients were allocated to 10 mg prasugrel as a reference comparison group. All patients (weight, ≥60 kg; age, <75 years) had been receiving 100 mg aspirin and 75 mg clopidogrel daily. The platelet function test was performed at baseline and 30 days after randomization. The primary endpoint was P2Y12 reaction unit (PRU) at 30 days between 5 mg prasugrel and 75 mg clopidogrel.

Results: No differences in baseline PRU values were observed among the three groups. The prasugrel (5 mg) group had a significantly lower PRU value compared with that of 75 mg clopidogrel (174.6±60.2 vs. 223.4±72.9, p=0.022) group at 30 days, whereas the 10 mg prasugrel group showed a lower PRU value (71.9±34.4) compared with that of the 5 mg prasugrel (p<0.001). The rate of high on-treatment platelet reactivity (PRU >235) was significant lower in the 5 mg prasugrel group than that in the 75 mg clopidogrel group (15.0% vs. 56.5%, p=0.010).

Conclusion: Prasugrel (5 mg) is more potent antiplatelet therapy than 75 mg clopidogrel in non-low body weight and non-elderly patients on a maintenance dose dual antiplatelet therapy.

No MeSH data available.