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

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). In t...

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Published in:International journal of cardiology 2016-11, Vol.222, p.639-644
Main Authors: Guo, Long Zhe, Kim, Moo Hyun, Shin, Eun Seok, Ann, Soe Hee, De Jin, Cai, Cho, Young-Rak, Park, Jong Sung, Park, Kyungil, Park, Tae-Ho, Lee, Michael S., Serebruany, Victor L.
Format: Article
Language:English
Subjects:
Acute coronary syndrome
Aged
Clopidogrel
Coronary interventions
Drug Therapy, Combination
Female
Humans
Male
Middle Aged
Percutaneous Coronary Intervention - adverse effects
Percutaneous Coronary Intervention - trends
Platelet Activation - drug effects
Platelet Activation - physiology
Platelet Aggregation Inhibitors - administration & dosage
Platelet reactivity
PRAISE
Prasugrel
Prospective Studies
Pyridines - administration & dosage
Ticlopidine - administration & dosage
Ticlopidine - analogs & derivatives
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Summary: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). In this prospective, two-center, randomized, open-label study, patients with HPR who had undergone PCI after a clopidogrel (300–600mg) loading dose (LD) were enrolled. Among screened (n=153), HPR was determined in seventy-six patients, who were randomized to either repeated clopidogrel (300mg LD, followed by 75mg MD daily) or prasugrel (20mg LD, followed by 5mg MD daily). The primary endpoint was HPR at 24h 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. 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
ISSN:0167-5273
1874-1754
DOI:10.1016/j.ijcard.2016.08.027