Efficacy of prasugrel versus clopidogrel for early neurological deterioration in branch atheromatous disease: An exploratory study

• Published in: Neurology and clinical neuroscience 2024-11, Vol.12 (6), p.347-355
• Main Authors: Inoue, Hiroyasu, Oomura, Masahiro, Madokoro, Yuta, Taniguchi, Yoko, Suzuki, Kengo, Sato, Toyohiro, Fujioka, Teppei, Mizuno, Masayuki, Kawashima, Shoji, Okita, Kenji, Yoshimura, Kenichi, Matsukawa, Noriyuki
• Format: Article
• Language: English
• Subjects: Antiplatelet therapy; branch atheromatous disease; Cerebrovascular diseases; Clopidogrel; Cytochrome; Cytochrome P450; dual antiplatelet therapy; early neurological deterioration; Magnetic resonance imaging; prasugrel; Vascular diseases
• ISSN: 2049-4173; 2049-4173
• DOI: 10.1111/ncn3.12828

Background Dual antiplatelet therapy (DAPT) with clopidogrel is one of the initial treatment regimens for early neurological deterioration (END) in branch atheromatous disease (BAD). However, its effectiveness is affected by cytochrome P450 2C19 polymorphism. Prasugrel, with reduced cytochrome P450 2C19 interactions, has been approved for cerebrovascular diseases in Japan. Aim To explore the efficacy of DAPT with prasugrel and with clopidogrel in preventing END. Methods Patients with BAD, admitted within 48 h of symptom onset between June 2022 and September 2023, were enrolled. The primary endpoint was the proportion of patients with END within 7 days, which was defined as an increase of 1 point or more on the National Institutes of Health Stroke Scale (NIHSS). Patients meeting specific magnetic resonance imaging (MRI) criteria, including lesions of ≥15 mm in the lenticulostriate artery (LSA) region or infarcts extending to the ventral side of the paramedian pontine region, were included. The patients were randomly assigned to the clopidogrel with loading and prasugrel without loading groups and administered common medications. Results The study included 9 and 10 patients in clopidogrel and prasugrel groups, of whom 56% and 50% had END, respectively. The prasugrel group had earlier exacerbations after admission (days 0–1) than that of the clopidogrel group (days 1–2). The bleeding complications of both groups were not significantly different. Conclusion The two groups had similar proportions of patients with END, suggesting comparable efficacies of both drugs for patients with BAD.