News | October 23, 2012

Tailored Therapy Using Clopidogrel is Superior to Prasugrel in Reducing High Platelet Reactivity

October 23, 2012 — A study found that a tailored therapy approach that adjusts the loading dose of clopidogrel according to measured platelet reactivity is superior to prasugrel therapy in reducing high platelet reactivity (a risk factor for worse outcomes) in patients with acute coronary syndrome (ACS). Results of the trial were presented Monday at the 24th annual Transcatheter Cardiovascular Therapeutics (TCT) scientific symposium, sponsored by the Cardiovascular Research Foundation (CRF).

High on-treatment platelet reactivity (HTPR) following clopidogrel and prasugrel is often responsible for repeat occurrences of ischemic events in patients with acute coronary syndrome undergoing angioplasty or percutaneous coronary intervention (PCI). In this study, researchers enrolled 177 patients undergoing PCI for ACS in a prospective multicenter randomized trial comparing a strategy of clopidogrel loading dose-adjustment (CDA) according to platelet reactivity (PR) monitoring with standard prasugrel therapy. Platelet activity was assessed by the vasodilator-stimulated phosphoprotein (VASP) index. CDA according to PR was performed using up to three additional loading doses of clopidogrel to obtain a VASP less than 50 percent. The primary endpoint of the study was the rate of HTPR (which was defined as a VASP index greater than or equal to 50 percent) on discharge. A secondary endpoint was the rate of patients with a VASP less than 16 percent, which is associated with bleedings.

Compared to the first 600 mg loading dose of clopidogrel, the prasugrel group had greater platelet inhibition and a lower rate of patients with HTPR (25.8±23.4 versus 45.5±21.7 percent; p<0.0001 and 15.7 versus 43 percent; p<0.0001). Similarly, more potent platelet inhibition through CDA significantly reduced PR and the rate of HTPR compared to a single loading dose of clopidogrel (30.9±13.9 percent; p<0.0001 and 43 to 2.3 percent; p<0.001).

Following CDA, the rate of patients with HTPR was significantly lower in the CDA group compared to the prasugrel group (2.3 versus 15.7 percent; p=0.005). In addition, fewer patients in the CDA group had a VASP less than 16 percent on discharge (14.6 percent versus 53.4 percent; p<0.0001).

“These results indicate that a strategy of platelet reactivity monitoring is superior to standard prasugrel therapy, reducing the rate of high on-treatment platelet reactivity in patients with acute coronary syndrome. It also seems to prevent excessive platelet reactivity inhibition. These findings suggest that platelet reactivity monitoring could help tailor therapy in patients at high bleeding or ischemic risk,” said lead investigator, Laurent Bonello, M.D., from the Hôpital Universitaire Nord in Marseille, France.

The trial was funded by the Assistance Publique-Hopitaux de Marseille. Bonello reported lecture and consultant fees from AstraZeneca, Eli Lilly, Sanofi and a research grant for AstraZeneca.

For more information: www.crf.org

Related Content

Thrombolytic Science Initiates Phase 2 Trial of Novel Ischemic Stroke Treatment Regimen
News | Antiplatelet and Anticoagulation Therapies | September 07, 2018
A new Phase 2 clinical trial looks to confirm the efficacy and safety of Thrombolytic Science LLC’s (TSI) sequential...
Bleeds and Benefit With Aspirin Balanced in Diabetes Patients
News | Antiplatelet and Anticoagulation Therapies | September 05, 2018
Aspirin prevented serious vascular events in patients with diabetes who did not already have cardiovascular disease,...
Extended Post-Hospital Oral Anticoagulant Use Reduces Non-Fatal Blood Clots
News | Antiplatelet and Anticoagulation Therapies | August 31, 2018
Use of an oral anticoagulant in medically ill patients for 45 days following hospital discharge reduces the rate of non...
AFib Patients Want More Information About Anticoagulation Reversal
News | Antiplatelet and Anticoagulation Therapies | June 27, 2018
Results from a 902-person, five-country survey of people living with atrial fibrillation (AF) reinforce the importance...
Lower Oral DOAC Anticoagulant Use Associated With More Thromboembolic Events Than Warfarin. #HRS 2018
News | Antiplatelet and Anticoagulation Therapies | May 18, 2018
May 18, 2018 — Nearly half of patients prescribed warfarin and just under one third of those using newer direct oral
The U.S. Food and Drug Administration (FDA) has approved Portola Pharmaceuticals' Andexxa, the first antidote indicated for patients treated with rivaroxaban (Xarelto) and apixaban (Eliquis), when reversal of anticoagulation is needed due to life-threatening or uncontrolled bleeding.

The U.S. Food and Drug Administration (FDA) has approved Portola Pharmaceuticals' Andexxa, the first antidote indicated for patients treated with rivaroxaban (Xarelto) and apixaban (Eliquis), when reversal of anticoagulation is needed due to life-threatening or uncontrolled bleeding.

 

Feature | Antiplatelet and Anticoagulation Therapies | May 07, 2018
The U.S. Food and Drug Administration (FDA) has approved Portola Pharmaceuticals' Andexxa, the first antidote indicated...
The largest trial to date for short-term DAPT concluded the practice cannot be deemed safe due to a higher adverse event rate. Image courtesy of the American Heart Association. #ACC18

The largest trial to date for short-term DAPT concluded the practice cannot be deemed safe due to a higher adverse event rate. Image courtesy of the American Heart Association.

News | Antiplatelet and Anticoagulation Therapies | March 19, 2018
The combined rate of death from any cause, heart attack or stroke within 18 months was not significantly different in...
The Xarelto booth at ACC.18

The Xarelto booth at the 2018 American College of Cardiology meeting. 

News | Antiplatelet and Anticoagulation Therapies | March 14, 2018
March 14, 2018 — A late-breaking analysis of the landmark COMPASS study presented at the American College of Cardiolo
Xarelto Reduces Ischemic Stroke for Coronary and Peripheral Artery Disease Patients
News | Antiplatelet and Anticoagulation Therapies | February 19, 2018
A late-breaking analysis of the landmark COMPASS study was presented at the 2018 International Stroke Conference (ISC...
Abbott Begins Enrollment in XIENCE 28 GLOBAL DAPT Trial
News | Antiplatelet and Anticoagulation Therapies | February 13, 2018
Abbott announced the first patient has been enrolled in a clinical trial evaluating 28 days of dual antiplatelet...
Overlay Init