Thienopyridine reloading in clopidogrel-loaded patients undergoing percutaneous coronary interventions: The PRAISE study

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• 作者：Long Zhe Guo ; MD^a ; ^b ; ^c ; Moo Hyun Kim ; MD^b ; ^c ; ^{kimmh@dau.ac.kr" class="auth_mail" title="E-mail the corresponding author} ; Eun Seok Shin ; MD^d ; Soe Hee Ann ; MD^d ; Cai De Jin ; MD^b ; ^c ; Young-Rak Cho ; MD^b ; Jong Sung Park ; MD^b ; Kyungil Park ; MD^b ; Tae-Ho Park ; MD^b ; Michael S. Lee ; MD^e ; Victor L. Serebruany ; MD^f
• 关键词：Prasugrel ; Clopidogrel ; Acute coronary syndrome ; Coronary interventions ; Platelet reactivity ; PRAISE
• 刊名：International Journal of Cardiology
• 出版年：2016
• 出版时间：1 November 2016
• 年：2016
• 卷：222
• 期：Complete
• 页码：639-644
• 全文大小：582 K

文摘

The impact of thienopyridine reloading on clinical outcomes, and residual high platelet reactivity (HPR) is unclear. We sought to compare the HRP-related effect of prasugrel and clopidogrel reloading in the already clopidogrel-loaded patients undergoing percutaneous coronary intervention (PCI).

Materials and methods

In this prospective, two-center, randomized, open-label study, patients with HPR who had undergone PCI after a clopidogrel (300–600 mg) loading dose (LD) were enrolled. Among screened (n = 153), HPR was determined in seventy-six patients, who were randomized to either repeated clopidogrel (300 mg LD, followed by 75 mg MD daily) or prasugrel (20 mg LD, followed by 5 mg MD daily). The primary endpoint was HPR at 24 h after PCI, as determined by the VerifyNow assay. The rates of sustained high and low platelet reactivity, periprocedural myocardial injury (PMI) and 30-day clinical outcomes were also assessed.

Results

Higher inhibition of platelet reactive units (PRU) was observed in the prasugrel group than after clopidogrel reloading (Pre-PCI: 284.4 ± 32.0 vs 279.5 ± 32.5, p = 0.504; Post-PCI: 100.0 ± 67.0 vs 202.9 ± 65.8, p < 0.001; 30 days: 170.8 ± 69.8 vs 215.1 ± 62.4, p = 0.007). There were less HRP post-PCI after prasugrel compared with the clopidogrel group (2.7 vs 36.1%, p < 0.001). However, reloading with prasugrel did not reduce PMI compared to clopidogrel (36.8% vs 39.5%, p = 0.813).

Conclusion

Prasugrel reloading led to a greater reduction in HPR, but similar with clopidogrel PMI in post-PCI patients. Larger randomized evidence is needed for optimization of loading strategies with thienopyridines.

Clinical Trial Registration Information: 1609647">NCT01609647.