Courtesy of Dr. Carlos Fava. The benefit of dual antiplatelet therapy in acute coronary syndromes (ACS) has been proven long ago, and both prasugrel and ticagrelor have offered best results than clopidogrel. However, nowadays, it is unclear which of them is superior in the long term, taking into account the fact that one starts to...
Elderly patients are at elevated risk of both ischemic and bleeding complications after an acute coronary syndrome (ACS), and display higher platelet reactivity under clopidogrel when compared to younger patients. A 5-mg dose of prasugrel would provide more predictable platelet inhibition than clopidogrel in elderly populations, without the risk of bleeding entailed by the full...
Diabetic patients are increased risk of thrombotic events, which is why an effective antiplatelet therapy is crucial for these patients. Both prasugrel and ticagrelor have shown to reduce thrombotic complications further than clopidogrel. Subgroup analyzes of the most important studies testing prasugrel and ticagrelor vs. clopidogrel have shown that diabetic patients receiving the new...
The choice of prasugrel or ticagrelor for patients with acute myocardial infarction undergoing primary angioplasty makes no difference, at least in the short term. This study was terminated prematurely and thus lost statistical power, which means that any interpretation of the lack of difference between the two antiplatelet drugs must take into account such...
Original Title: Pharmacodynamic Effects of Switching from Prasugrel to Ticagrelor Results of the Prospective, Randomized SWAP-3 Study Reference: J Am Coll Cardiol Intv. 2016;() Epub ahead of print. Courtesy of Dr. Agustín Vecchia. At present, the pharmacodynamic effects of switching from prasugrel to ticagrelor in patients under dual APT remain unknown. The present prospective, randomized,...
Original Title: Prasugrel in Clopidogrel Nonresponders Undergoing Percutaneous Coronary Intervention (RECLOSE-3 study). Reference: Valenti R, et al. JACC Cardiovasc Interv. 2015 Oct;8(12):1563-70. Clopidogrel Nonresponders have higher risk of adverse events (cardiovascular death and stent thrombosis) compared to responders. Studies published so far have failed to demonstrate the use of platelet function tests in ACS patient...
Métodos e Resultados: Os não-respondedores ao clopidogrel foram identificados por reatividade plaquetária residual ≥ 70% e o teste foi repetido após a mudança para o tratamento com prasugrel. O desfecho primário do estudo foi mortalidade cardíaca em 2 anos e os desfechos secundários foram o composto de morte cardíaca, infarto do miocárdio, e trombose de...
Article The TAXUS Liberté Post Approval study included patients treated with TAXUS paclitaxel DES receiving prasugrel for 12 to 30 months. Primary end point was a combination of death, infarction or stroke that resulted in 3.7% after 30 months vs. 8.8% after 12 months of prasugrel administration (p<0.001). Death and stroke rates were similar between...
Platelet inhibition is critical in reducing atherothrombotic risk in the short and long term after an acute coronary syndrome, especially if the patient has received coronary angioplasty. Few data are available in the real world in terms of safety and efficacy of prasugrel versus clopidogrel in this clinical context. This registry involved 12227 patients undergoing...
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...