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document
High Platelet Reactivity in Patients with Acute Coronary Syndromes Undergoing Percutaneous Coronary Intervention : Randomised Controlled Trial Comparing Prasugrel and Clopidogrel . BACKGROUND Prasugrel is more effective than clopidogrel in reducing platelet aggregation in acute coronary syndromes . Data available on prasugrel reloading in clopidogrel treated patients with high residual platelet reactivity ( HRPR ) i.e . poor responders , is limited . OBJECTIVES To determine the effects of prasugrel loading on platelet function in patients on clopidogrel and high platelet reactivity undergoing percutaneous coronary intervention for acute coronary syndrome ( ACS ) . PATIENTS Patients with ACS on clopidogrel who were scheduled for PCI found to have a platelet reactivity ≥40 AUC with the Multiplate Analyzer , i.e . " poor responders " were randomised to prasugrel ( 60 mg loading and 10 mg maintenance dose ) or clopidogrel ( 600 mg reloading and 150 mg maintenance dose ) . The primary outcome measure was proportion of patients with platelet reactivity < 40 AUC 4 hours after loading with study medication , and also at one hour ( secondary outcome ) . 44 patients were enrolled and the study was terminated early as clopidogrel use decreased sharply due to introduction of newer P2Y12 inhibitors . RESULTS At 4 hours after study medication 100 % of patients treated with prasugrel compared to 91 % of those treated with clopidogrel had platelet reactivity < 40 AUC ( p = 0.49 ) , while at 1 hour the proportions were 95 % and 64 % respectively ( p = 0.02 ) . Mean platelet reactivity at 4 and 1 hours after study medication in prasugrel and clopidogrel groups respectively were 12 versus 22 ( p = 0.005 ) and 19 versus 34 ( p = 0.01 ) respectively . CONCLUSIONS Routine platelet function testing identifies patients with high residual platelet reactivity ( " poor responders " ) on clopidogrel . A strategy of prasugrel rather than clopidogrel reloading results in earlier and more sustained suppression of platelet reactivity . Future trials need to identify if this translates into clinical benefit . TRIAL REGISTRATION ClinicalTrials.gov NCT01339026 .
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Intervention_Pharmacological
prasugrel
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Intervention_Pharmacological
clopidogrel
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Intervention_Physical
percutaneous coronary intervention
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Intervention_Pharmacological
clopidogrel
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Intervention_Physical
PCI
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Intervention_Pharmacological
clopidogrel
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Participant_Condition
Patients with Acute Coronary Syndromes Undergoing Percutaneous Coronary Intervention :
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Participant_Condition
acute coronary syndromes .
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Participant_Condition
patients on clopidogrel and high platelet reactivity undergoing percutaneous coronary intervention for acute coronary syndrome ( ACS ) .
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Participant_Condition
Patients with ACS
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Participant_Sample-size
44 patients were enrolled