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A pharmacodynamic comparison of 5 anti-platelet protocols in patients with ST-elevation myocardial infarction undergoing primary PCI.

Koul S, Andell P, Martinsson A, Smith JG, Scherstén F, Harnek J, Götberg M, Norström E, Björnsson S, Erlinge D - BMC Cardiovasc Disord (2014)

Bottom Line: Only 32% of patients receiving clopidogrel only were responders the day after PCI.Switching from an upstream bolus dose of clopidogrel to prasugrel at the time of PCI, appeared as a safe and feasible option with no tendency for overshoot or attenuation of platelet inhibition.Pre-hospital administration of ticagrelor was associated with a 50% good responder rate at completion of PCI.

View Article: PubMed Central - PubMed

Affiliation: Department of Cardiology, Lund University, Skåne University Hospital Lund, SE 221 85, Lund, Sweden. sasha.koul@med.lu.se.

ABSTRACT

Background: Despite advances in anti-platelet treatments, there still exists an early increase in both ischemic as well as bleeding events following primary PCI in patients with ST-elevation myocardial infarction (STEMI). Platelet inhibition data of different anti-platelet treatments in the acute phase of a myocardial infarction might offer some insight into these problems. The aim of this study was to evaluate the pharmacodynamic profile of 5 different anti-platelet treatments in the acute phase of STEMI in patients undergoing primary PCI.

Methods: A total of 223 STEMI patients undergoing primary PCI were prospectively included. Patients received either pre-hospital clopidogrel only, pre-hospital clopidogrel followed by prasugrel switch in the cath lab, prasugrel treatment only, pre-hospital clopidogrel followed by ticagrelor switch in the cath lab or pre-hospital ticagrelor only. Platelet reactivity was measured serially using vasodilator-stimulated phosphoprotein (VASP).

Results: Patients receiving pre-hospital clopidogrel followed by prasugrel switch showed similar platelet inhibition data as patients receiving prasugrel only, with more than 90% being good responders the day after PCI. Average time from prasugrel administration to a VASP value of <50% was 1.5 hours. In patients receiving pre-hospital ticagrelor, 50% were good responders at completion of PCI and average time to a VASP-value of <50% was 2.3 hours. Only 32% of patients receiving clopidogrel only were responders the day after PCI.

Conclusions: Switching from an upstream bolus dose of clopidogrel to prasugrel at the time of PCI, appeared as a safe and feasible option with no tendency for overshoot or attenuation of platelet inhibition. Pre-hospital administration of ticagrelor was associated with a 50% good responder rate at completion of PCI.

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Related in: MedlinePlus

Average VASP-PRI values. Box-plot of median and average VASP-PRI values in the various patient cohorts (boxes denote median and 25-75 percentile and whiskers denote 10-90 percentile with outliers. Plus sign in boxes denotes the average value).
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Fig2: Average VASP-PRI values. Box-plot of median and average VASP-PRI values in the various patient cohorts (boxes denote median and 25-75 percentile and whiskers denote 10-90 percentile with outliers. Plus sign in boxes denotes the average value).

Mentions: Patients in the clopidogrel upstream cohort had average VASP PRI-values of 74% before PCI, 74% after PCI and 56% the day after PCI, as shown in Table 2. The average VASP-PRI value the day after PCI was significantly lower than VAS-PRI values pre- and post-PCI (p < 0.001). No statistically significant difference was noted between VASP PRI-values pre-PCI and post-PCI (Figure 2). A total of 32% in the clopidogrel upstream group reached a VASP-PRI value of less than 50% the day after PCI. In the clopidogrel upstream group time-separation curves showed a weak linear association between time and clopidogrel response (Figure 3) with a model coefficient of determination (r2) of 0.17. An average time of 16.7 hours was noted between clopidogrel administration until a VASP-PRI value of 50% was reached according to the equation outlined in Figure 3. The rate of major in-hospital bleeding was 4%.Table 2


A pharmacodynamic comparison of 5 anti-platelet protocols in patients with ST-elevation myocardial infarction undergoing primary PCI.

Koul S, Andell P, Martinsson A, Smith JG, Scherstén F, Harnek J, Götberg M, Norström E, Björnsson S, Erlinge D - BMC Cardiovasc Disord (2014)

Average VASP-PRI values. Box-plot of median and average VASP-PRI values in the various patient cohorts (boxes denote median and 25-75 percentile and whiskers denote 10-90 percentile with outliers. Plus sign in boxes denotes the average value).
© Copyright Policy - open-access
Related In: Results  -  Collection

License 1 - License 2
Show All Figures
getmorefigures.php?uid=PMC4274705&req=5

Fig2: Average VASP-PRI values. Box-plot of median and average VASP-PRI values in the various patient cohorts (boxes denote median and 25-75 percentile and whiskers denote 10-90 percentile with outliers. Plus sign in boxes denotes the average value).
Mentions: Patients in the clopidogrel upstream cohort had average VASP PRI-values of 74% before PCI, 74% after PCI and 56% the day after PCI, as shown in Table 2. The average VASP-PRI value the day after PCI was significantly lower than VAS-PRI values pre- and post-PCI (p < 0.001). No statistically significant difference was noted between VASP PRI-values pre-PCI and post-PCI (Figure 2). A total of 32% in the clopidogrel upstream group reached a VASP-PRI value of less than 50% the day after PCI. In the clopidogrel upstream group time-separation curves showed a weak linear association between time and clopidogrel response (Figure 3) with a model coefficient of determination (r2) of 0.17. An average time of 16.7 hours was noted between clopidogrel administration until a VASP-PRI value of 50% was reached according to the equation outlined in Figure 3. The rate of major in-hospital bleeding was 4%.Table 2

Bottom Line: Only 32% of patients receiving clopidogrel only were responders the day after PCI.Switching from an upstream bolus dose of clopidogrel to prasugrel at the time of PCI, appeared as a safe and feasible option with no tendency for overshoot or attenuation of platelet inhibition.Pre-hospital administration of ticagrelor was associated with a 50% good responder rate at completion of PCI.

View Article: PubMed Central - PubMed

Affiliation: Department of Cardiology, Lund University, Skåne University Hospital Lund, SE 221 85, Lund, Sweden. sasha.koul@med.lu.se.

ABSTRACT

Background: Despite advances in anti-platelet treatments, there still exists an early increase in both ischemic as well as bleeding events following primary PCI in patients with ST-elevation myocardial infarction (STEMI). Platelet inhibition data of different anti-platelet treatments in the acute phase of a myocardial infarction might offer some insight into these problems. The aim of this study was to evaluate the pharmacodynamic profile of 5 different anti-platelet treatments in the acute phase of STEMI in patients undergoing primary PCI.

Methods: A total of 223 STEMI patients undergoing primary PCI were prospectively included. Patients received either pre-hospital clopidogrel only, pre-hospital clopidogrel followed by prasugrel switch in the cath lab, prasugrel treatment only, pre-hospital clopidogrel followed by ticagrelor switch in the cath lab or pre-hospital ticagrelor only. Platelet reactivity was measured serially using vasodilator-stimulated phosphoprotein (VASP).

Results: Patients receiving pre-hospital clopidogrel followed by prasugrel switch showed similar platelet inhibition data as patients receiving prasugrel only, with more than 90% being good responders the day after PCI. Average time from prasugrel administration to a VASP value of <50% was 1.5 hours. In patients receiving pre-hospital ticagrelor, 50% were good responders at completion of PCI and average time to a VASP-value of <50% was 2.3 hours. Only 32% of patients receiving clopidogrel only were responders the day after PCI.

Conclusions: Switching from an upstream bolus dose of clopidogrel to prasugrel at the time of PCI, appeared as a safe and feasible option with no tendency for overshoot or attenuation of platelet inhibition. Pre-hospital administration of ticagrelor was associated with a 50% good responder rate at completion of PCI.

Show MeSH
Related in: MedlinePlus