Prasugrel Overcomes High On-Clopidogrel Platelet Reactivity Post-Stenting More Effectively Than High-Dose (150-mg) Clopidogrel

Alexopoulos, Dimitrios; Dimitropoulos, Gerasimos; Davlouros, Periklis; Xanthopoulou, Ioanna; Kassimis, George; Stavrou, Eleana F.; Hahalis, George; Athanassiadou, Aglaia

doi:10.1016/j.jcin.2010.12.011

Cited by 123 publications

(89 citation statements)

References 34 publications

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“…In contrast to most of other trials [21][22][23], we also investigated the antiplatelet effects of both prasugrel loading and maintenance doses in ACS patients exhibiting HTPR on clopidogrel. Due to the unique property of the VASP assay to reflect selectively the inhibition of the P2Y 12 receptor by antiplatelet agents, the VASP assay in contrast to other methods of platelet function monitoring may be applied in ACS patients treated with GP IIb/IIIa inhibitors.…”

Section: Discussionmentioning

confidence: 99%

“…This intensified platelet inhibition by prasugrel is believed to account for the reduction of ischemic events when compared with clopidogrel therapy in ACS patients undergoing PCI which was shown in the TRITON-TIMI 38 trial [4]. However, recent studies indicated that the phenomenon of HTPR also refers to subjects treated with prasugrel [20,21]. The prevalence of HTPR defined as the PRI value ≥ 50% measured 6-12 h after the administration of a 60 mg loading dose of prasugrel among 301 ACS patients successfully treated with PCI in a multicenter French study was 25.2% [19].…”

Section: Discussionmentioning

confidence: 99%

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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

et al. 2014

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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 (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 24 h (25.1 [13.7-40.2] vs. 22.0 [18.4-36.8 (30.3 [20.4-45.7 (Cardiol J 2014; 21, 5: 547-556) ]%; p < 0.0006). In contrast, median PRI values in the clopidogrel group were similar at baseline and at ]%; p = NS) and then modestly rose at 30 days

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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

et al. 2014

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“…A metaanalysis 35 comparing loading doses of 300 or 600 mg of clopidogrel found fewer cardiovascular complications with a higher dose, but a large randomized trial showed no effect on thrombosis-related complications in nonresponders. 36 Some authors suggest a dose-dependent strategy based on genotype 17 or switching to prasugrel, 37 as we did if follow-up PRT inhibition was inadequate.…”

mentioning

confidence: 88%

Incidence of Microemboli and Correlation with Platelet Inhibition in Aneurysmal Flow Diversion

Levitt¹,

Ghodke

Hallam

et al. 2013

AJNR Am J Neuroradiol

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SUMMARY: Flow-diverting stents have been associated with embolic and hemorrhagic complications, but the rate of procedure-related microemboli is unknown. Using transcranial Doppler sonography, we measured the rate of microemboli in 23 patients treated with flow-diverting stents. Patients received preprocedural dual antiplatelet medications and intraprocedural heparinization. Point-of-care platelet reactivity testing was performed before the procedure, and nonresponders (Ͼ213 P2Y12/ADP receptor reactivity units) received additional thienopyridine. Transcranial Doppler sonography was performed within 12-24 hours. Microemboli were detected in 3 patients (13%), 2 of whom were initially nonresponders. There was no association between the presence of microemboli and procedural or neurologic complications, aneurysm size, number of stents, or procedure time. Eight procedures (34.8%) required additional thienopyridine for inadequate platelet inhibition, and 3 required further treatment for persistent nonresponse to point-of-care platelet reactivity testing. There were 6 technical and 2 postoperative complications; none were associated with inadequate platelet inhibition or microemboli. The combination of routine point-of-care platelet reactivity testing and postprocedural microembolic monitoring may help identify patients at risk for thromboembolic complications after flow-diverting stents. ABBREVIATIONS:FDS ϭ flow-diverting stent; PRT ϭ point-of-care platelet reactivity testing; PRU ϭ P2Y12/adenosine diphosphate receptor reactivity units;

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“…Among clopidogrel‐treated patients with high on‐treatment platelet activity, prasugrel and ticagrelor have been shown to effectively inhibit platelet aggregation,9, 10, 11 but randomized controlled trials switching patients with high on‐clopidogrel platelet reactivity to prasugrel or ticagrelor have failed to show clinical benefit 12, 13, 14, 15, 16. Recurrent ischemic events while receiving clopidogrel therapy may affect physician decision making because of perceived clopidogrel “failure,” although these events may not necessarily reflect inadequate platelet inhibition.…”

mentioning

confidence: 99%

Antiplatelet Therapy Changes for Patients With Myocardial Infarction With Recurrent Ischemic Events: Insights Into Contemporary Practice From the TRANSLATE‐ACS (Treatment With ADP Receptor Inhibitors: Longitudinal Assessment of Treatment Patterns and Events After Acute Coronary Syndrome) Study

Kaltenbach

Peterson

Akhter

et al. 2018

JAHA

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BackgroundGuidelines recommend P2Y12 inhibitor therapy for 1 year after myocardial infarction (MI), yet little guidance is provided on antiplatelet management for patients with recurrent ischemic events during that year. We describe changes in P2Y12 inhibitor type among patients with recurrent ischemic events in the first year after MI.Methods and ResultsThe TRANSLATE‐ACS (Treatment With ADP Receptor Inhibitors: Longitudinal Assessment of Treatment Patterns and Events After Acute Coronary Syndrome) study enrolled 12 365 patients with MI treated with percutaneous coronary intervention. We examined whether P2Y12 inhibitor choice changed among patients with recurrent MI, stent thrombosis, and/or unplanned revascularization during the first year after MI, and modeled factors associated with P2Y12 inhibitor intensification (changing clopidogrel to prasugrel or ticagrelor). In the first year after MI, 1414 patients (11%) had a total of 1740 recurrent ischemic events (771 recurrent MIs, 969 unplanned revascularizations, and 165 stent thromboses). Median time to the first recurrent ischemic event was 154 days (25th–75th percentiles, 55–287 days). Of those with recurrent ischemic events, 101 of 1092 (9.3%) occurring in clopidogrel‐treated patients led to P2Y12 inhibitor intensification. Recurrent events involving stent thrombosis or MI were the strongest factors associated with P2Y12 inhibitor intensification, yet only 40% of patients with stent thrombosis and 14% of patients with recurrent MI had P2Y12 inhibitor intensification. Increasing age and longer time from the index MI were associated with lower likelihood for intensification.ConclusionsFew patients after MI with a recurrent ischemic event who were taking clopidogrel switched to a more potent P2Y12 inhibitor, even after stent thrombosis events. Specific guidance is needed for patients who have recurrent ischemic events, particularly when closely spaced.Clinical Trial RegistrationURL: https://www.clinicaltrials.gov. Unique identifier: NCT01088503.

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Prasugrel Overcomes High On-Clopidogrel Platelet Reactivity Post-Stenting More Effectively Than High-Dose (150-mg) Clopidogrel

Cited by 123 publications

References 34 publications

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

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

Incidence of Microemboli and Correlation with Platelet Inhibition in Aneurysmal Flow Diversion

Antiplatelet Therapy Changes for Patients With Myocardial Infarction With Recurrent Ischemic Events: Insights Into Contemporary Practice From the TRANSLATE‐ACS (Treatment With ADP Receptor Inhibitors: Longitudinal Assessment of Treatment Patterns and Events After Acute Coronary Syndrome) Study

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