Variability and treatment of high on-prasugrel platelet reactivity in patients with initial high on-clopidogrel platelet reactivity

Alexopoulos, Dimitrios; Plakomyti, Theodora-Eleni; Xanthopoulou, Ioanna

doi:10.1016/j.ijcard.2011.10.031

Cited by 6 publications

(1 citation statement)

References 9 publications

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“…Therefore, when a patient shows HPR on prasugrel 5 mg, we switch to prasugrel 10 mg. And when HPR on prasugrel 10 mg is exhibited by the patient, we switch to ticagrelor (Table 3). Some examples of switching to prasugrel 20 mg are described in the literature [84, 85]; however, the use of prasugrel 20 mg is off-label and therefore not favorable to be used in the clinic. Because ticagrelor can reduce platelet function to a very low level [86], and a direct pharmacodynamic comparison of ticagrelor and prasugrel showed lower platelet function levels for ticagrelor [87], we switch patients with HPR for prasugrel 10 mg to ticagrelor.…”

Section: Discussionmentioning

confidence: 99%

Towards Personalized Medicine Based on Platelet Function Testing for Stent Thrombosis Patients

2012

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Stent thrombosis (ST) is a severe and feared complication of coronary stenting. Patients who have suffered from ST are usually treated according to the “one-size-fits-all” dosing regimen of aspirin and clopidogrel. Many ST patients show high on-treatment platelet reactivity (HPR) despite this antiplatelet therapy (APT). It has been shown that HPR is a risk factor for major adverse cardiac events. Therefore, ST patients with HPR are at a high risk for recurrent atherothrombotic events. New insights into the variable response to clopidogrel and the advent of stronger P2Y12 inhibitors prasugrel and ticagrelor have changed the attention from a fixed APT treatment strategy towards “personalized APT strategies.” Strategies can be based on platelet function testing, which gives insight into the overall response of a patient to APT. At our outpatient ST clinic, we practice personalized APT based on platelet function testing to guide the cardiologist to a presumed optimal antiplatelet treatment of ST patients. Beside results of platelet function testing, comedication, clinical characteristics, and genetics have to be considered to decide on personalized APT. Ongoing studies have yet to reveal the optimal personalized APT strategy for cardiologists to prevent their patients from atherothrombotic and bleeding events.

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