Switching Acute Coronary Syndrome Patients From Prasugrel to Clopidogrel

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• 作者：Mathieu Kerneis ; MD^? ; Johanne Silvain ; MD ; PhD^? ; Jé ; ré ; mie Abtan ; MD^? ; Guillaume Cayla ; MD ; PhD^? ; ^&dagger ; ; Stephen A. O'Connor ; MBBCh^? ; Olivier Barthé ; lé ; my ; MD^? ; Jean-Baptiste Vignalou ; MD^? ; Farzin Beygui ; MD ; PhD^? ; Delphine Brugier ; PhD^? ; Ré ; jane Martin ; BCh^? ; Jean-Philippe Collet ; MD ; PhD^? ; Gilles Montalescot ; MD ; PhD^? ; ^{gilles.montalescot@psl.aphp.fr}
• 关键词：P2Y12 receptor antagonist ; platelet reactivity ; switch
• 刊名：JACC: Cardiovascular Interventions
• 出版年：2013
• 出版时间：February, 2013
• 年：2013
• 卷：6
• 期：2
• 页码：158-165
• 全文大小：1050 K

文摘

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Objectives

This study sought to assess the consequences of switching prasugrel to clopidogrel on platelet inhibition and clinical outcomes after an acute coronary syndrome (ACS).

Background

Many ACS patients are switched from prasugrel to clopidogrel within the recommended 1-year duration of treatment.

Methods

Platelet reactivity was measured with the VerifyNow P2Y₁₂ assay (Accumetrics, San Diego, California) in 300 ACS patients treated for 15 days with prasugrel 10 mg. Patients displaying low on-treatment platelet reactivity (LPR) and/or at high risk of bleeding were switched to clopidogrel 75 mg and tested again 15 days later. The rate of patients with high on-treatment platelet reactivity (HPR), P2Y₁₂ reaction units (PRU) >208, and LPR (PRU <0) were evaluated before and after the switch. Bleeding and ischemic events were also recorded.

Results

On a regimen of prasugrel 10 mg, the rate of patients with LPR was 45.6 % (n = 137), whereas 4.3 % (n = 13) had HPR. A group of 31 patients (10.3 % ) was switched to clopidogrel 75 mg, of whom 29 had LPR (93.5 % ) on a regimen of prasugrel. On-treatment platelet reactivity (PRU) increased from 14 ¡À 4 on a regimen of prasugrel to 155 ¡À15 on a regimen of clopidogrel (p = 0.0001), resulting in a much lower rate of patients with LPR (9.7 % ). The rate of patients with HPR increased from 0 % with prasugrel to 29 % (n = 9) with clopidogrel. The rate of minor bleeding decreased after the switch from 32.2 % to 9.7 % ; p = 0.03.

Conclusions

An LPR is frequent in patients treated with prasugrel 10 mg. Early switching from prasugrel 10 mg to clopidogrel 75 mg reduces the number of patients with LPR and minor bleeding events but unmasks a group of nonresponders to clopidogrel with unknown consequences on clinical outcomes.