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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

Regression curve upstream clopidogrel-prasugrel cath lab. VASP values as function of time in upstream clopidogrel-prasugrel cath lab patients with a logarithmic regression plot.
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Fig4: Regression curve upstream clopidogrel-prasugrel cath lab. VASP values as function of time in upstream clopidogrel-prasugrel cath lab patients with a logarithmic regression plot.

Mentions: The average VASP-PRI values for the upstream clopidogrel-prasugrel switch cohort were 79% before PCI, 74% after PCI and 17% the day after PCI, as shown in Table 2. A statistically significant reduction was noted between VASP-PRI values pre- and post-PCI (p = 0.01) as well as between VASP PRI-values the day after PCI compared to pre- and post-PCI (p < 0.001, Figure 2). A total of 90% of patients reached the pre-specified cutoff value of VASP-PRI <50% the day after PCI (“good responders”). In time-separation curves for the upstream clopidogrel-prasugrel switch group (Figure 4), VASP-PRI appeared to follow an inversely logarithmic association with time, with an r2 of 0.66. Derived from the equation outlined in Figure 4 the average time from prasugrel administration to a VASP PRI-value of 50% was 90 minutes. The rate of major in-hospital bleeding was 1.1% in this cohort.Figure 4


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)

Regression curve upstream clopidogrel-prasugrel cath lab. VASP values as function of time in upstream clopidogrel-prasugrel cath lab patients with a logarithmic regression plot.
© Copyright Policy - open-access
Related In: Results  -  Collection

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

Fig4: Regression curve upstream clopidogrel-prasugrel cath lab. VASP values as function of time in upstream clopidogrel-prasugrel cath lab patients with a logarithmic regression plot.
Mentions: The average VASP-PRI values for the upstream clopidogrel-prasugrel switch cohort were 79% before PCI, 74% after PCI and 17% the day after PCI, as shown in Table 2. A statistically significant reduction was noted between VASP-PRI values pre- and post-PCI (p = 0.01) as well as between VASP PRI-values the day after PCI compared to pre- and post-PCI (p < 0.001, Figure 2). A total of 90% of patients reached the pre-specified cutoff value of VASP-PRI <50% the day after PCI (“good responders”). In time-separation curves for the upstream clopidogrel-prasugrel switch group (Figure 4), VASP-PRI appeared to follow an inversely logarithmic association with time, with an r2 of 0.66. Derived from the equation outlined in Figure 4 the average time from prasugrel administration to a VASP PRI-value of 50% was 90 minutes. The rate of major in-hospital bleeding was 1.1% in this cohort.Figure 4

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