A pharmacodynamic comparison of 5 anti-platelet protocols in patients with ST-elevation myocardial infarction undergoing primary PCI

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• 作者：Sasha Koul (1)
  Pontus Andell (1)
  Andreas Martinsson (1)
  J Gustav Smith (1)
  Fredrik Scherst茅n (1)
  Jan Harnek (1)
  Matthias G枚tberg (1)
  Eva Norstr枚m (2)
  Sven Bj枚rnsson (2)
  David Erlinge (1)
  
  1. Department of Cardiology ; Lund University ; Sk氓ne University Hospital Lund ; SE 221 85 ; Lund ; Sweden
  2. Department of Clinical Chemistry ; Sk氓ne University Hospital Malm枚 ; Malm枚 ; Sweden
  
• 关键词：Prasugrel ; Ticagrelor ; Clopidogrel ; Upstream ; STEMI
• 刊名：BMC Cardiovascular Disorders
• 出版年：2014
• 出版时间：December 2014
• 年：2014
• 卷：14
• 期：1
• 全文大小：1,729 KB
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  30. The pre-publication history for this paper can be accessed here:http://www.biomedcentral.com/1471-2261/14/189/prepub
  
• 刊物主题：Cardiology; Cardiac Surgery; Angiology; Blood Transfusion Medicine; Internal Medicine;
• 出版者：BioMed Central
• ISSN：1471-2261

文摘

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 VASP-value of 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.