This article is more than 5 years old. Information may no longer be current.

Early switch from prasugrel to clopidogrel may influence outcomes

Add topic to email alerts

Receive an email when new articles are posted on

Please provide your email address to receive an email when new articles are posted on .

Subscribe

Added to email alerts

You've successfully added to your alerts. You will receive an email when new content is published.

Click Here to Manage Email Alerts

You've successfully added to your alerts. You will receive an email when new content is published.

Click Here to Manage Email Alerts

Back to Healio

We were unable to process your request. Please try again later. If you continue to have this issue please contact customerservice@slackinc.com.

Back to Healio

Early switching from prasugrel 10 mg to clopidogrel 75 mg reduces the number of patients with low on-treatment platelet reactivity and minor bleeding events, but unmasked a group of nonresponders to clopidogrel with unknown consequences on clinical outcomes, study results found.

To assess the consequences of switching prasugrel (Effient, Eli Lilly/Daiichi Sankyo) to clopidogrel (Plavix, Sanofi-Aventis) on platelet inhibition and clinical outcomes in patients after an ACS, researchers measured platelet reactivity in 300 patients treated for 15 days with prasugrel 10 mg. Patients who had low on-treatment platelet reactivity (LPR) and/or a high bleeding risk were switched to clopidogrel 75 mg and tested after 15 days of follow-up.

On a regimen of prasugrel 10 mg, 137 patients (45.6%) had LPR and 13 patients had high on-treatment platelet reactivity (HPR). A group of 31 patients (10.3%) was switched to clopidogrel 75 mg, resulting in 29 (93.5%) having LPR on a regimen of prasugrel. On-treatment platelet reactivity increased from 14 ± 4 for those on a prasugrel regimen to 155 ± 15 for those on a clopidogrel regimen (P=.0001), resulting in 9.7% of patients having LPR. Patients with HPR increased from 0% with prasugrel to nine (29%) with clopidogrel. The rate of minor bleeding decreased after the switch, from 32.2% to 9.7% (P=.03).

 

Dominick J. Angiolillo

In an accompanying editorial, Dominick J. Angiolillo, MD, PHD, and Fabiana Rollini, MD, both from the University of Florida, College of Medicine – Jacksonville, wrote that, ultimately, no conclusions regarding safety and efficacy should be made on the basis of the clinical findings from this study, which was limited to only 15 days of observation in a highly selected population.

“Of note, most studies to date have failed to demonstrate that modification of P2Y12 receptor inhibiting antiplatelet treatment regimen on the basis of the results of platelet function testing can impact safety and efficacy, underscoring that routine testing is still not ready for primetime,” they wrote.

For more information:

Angiolillo DJ. J Am Coll Cardiol Intv. 2013;6:166-168.

Kerneis M. J Am Coll Cardiol Intv. 2013;6:158-165.

Disclosure: Kerneis and Rollini report no relevant financial disclosures. See the full study for a list of Angiolillo’s disclosures.