The individual variability to platelet response of clopidogrel is related to several mechanisms with high intrinsic platelet reactivity, variability in drug metabolism, drug interactions, etc. The hepatic cytochrome P450 system plays a key role in the metabolism of clopidogrel, and the CYP2C19 allele loss of function is associated with high platelet reactivity with clopidogrel use and an increased risk of adverse events after angioplasty. 

This prospective randomized study evaluated the efficacy of prasugrel (10 mg / day) , ticagrelor (90 mg each 12h ) or high-dose clopidogrel ( 150 mg / day) in patients with high platelet reactivity with standard doses of clopidogrel . Both prasugrel and ticagrelor were effective in reducing platelet activity at 15 and 30 days, without differences between the two drugs.

The clopidogrel double dose did not reach the goal to 15 days, but it could reduce the reactivity to 30 days. In patients with genotype variation prasugrel was superior to ticagrelor.

G. Sardella
2014-05-22

Title: TRIPLETE RESET trial: a comparison of therapy with ticagrelor, prasugrel and high clopidogrel dose in PCI patients with high-on treatment platelet reactivity and genotype variation