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Periprocedural prasugrel may have benefits for PCI in STEMI
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Dual antiplatelet therapy with prasugrel yielded lower platelet reactivity units than triple antiplatelet therapy with cilostazol before PCI and before discharge in a cohort of individuals with STEMI, according to recent findings.
Antiplatelet therapy has played an important role in reducing thromboembolic events in patients with STEMI by inhibiting platelet aggregation. However, periprocedural inhibition of platelet aggregation using antiplatelets is less thoroughly described.
The current prospective study was a comparison of two periprocedural inhibition of platelet aggregation strategies — aspirin plus prasugrel (Effient, Daiichi Sankyo/Eli Lilly) and cilostazol plus clopidogrel and aspirin (triple antiplatelet therapy) — in a cohort of 70 clopidogrel-naïve patients with STEMI undergoing primary PCI. Overall, 37 patients were assigned a prasugrel loading dose of 60 mg, while 33 patients in the triple antiplatelet therapy group were assigned a loading dose of 300-mg aspirin, 600-mg clopidogrel and 200-mg cilostazol.
Platelet reactivity units (PRU) or percent inhibition by the VerifyNow P2Y12 assay before PCI and before discharge served as the primary outcome measure.
Drug loading to pre-PCI time was 25.4 ± 10.42 minutes in the prasugrel cohort and 25.5 ± 10.56 minutes in the triple therapy cohort (P=.957).
Before PCI, PRU was 269.1 ± 71.69 in the prasugrel group and 306.5 ± 48.67 in the triple antiplatelet therapy group (P=.012).
Prasugrel was associated with lower PRU than triple antiplatelet therapy at pre-discharge (108.2 ± 60.51 vs. 238.1 ± 73.40). Prasugrel also yielded higher percent inhibition at pre-discharge (63.6 ± 18.51% vs. 16.8 ± 17.91%; P<.001).
In-hospital bleeding complication rates were similar between the two groups.
“Our study demonstrates that prasugrel could produce a significantly greater periprocedural as well as in-hospital [inhibition of platelet aggregation] compared with [triple antiplatelet therapy] in patients with STEMI undergoing primary PCI,” the researchers concluded.
Disclosure: The study was funded by grants from the Research Foundation of the Korean Society of Cardiology Korea Healthcare 323 Technology R&D project.
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