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TRIGGER-PCI: Prasugrel associated with consistent decrease in platelet reactivity in CAD patients after elective PCI
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Switching from clopidogrel to prasugrel resulted in effective platelet inhibition in patients with high on-treatment platelet reactivity, according to recent study results.
Researchers enrolled 423 patients with stable CAD with high on-treatment platelet reactivity (.208 P2Y12 reaction units [PRUs]) after successful, elective percutaneous coronary intervention with at least one drug-eluting stent in the TRIGGER-PCI study. Patients were randomly assigned to prasugrel 10 mg daily (n=212; Effient, Eli Lilly) or clopidogrel 75 mg daily (n=211; Plavix, Sanofi-Aventis). At 3 and 6 months, platelet reactivity was reassessed.
The composite of CV death or MI through 6-month follow-up was the primary efficacy measure, and non-CABG-related major bleeding classified by the TIMI hemorrhage classification scheme was the primary safety endpoint.
Median PRU decreased from 245 at baseline to 80 at 3 months in patients assigned to prasugrel vs. 249 to 241 in patients assigned to clopidogrel (P,.001 vs. prasugrel). At 6 months, study results showed that the primary efficacy endpoint of cardiac death or MI occurred in no patients in the prasugrel group vs. one patient on clopidogrel. The primary safety endpoint of non-CABG-related major bleeding occurred in 1.4% of patients assigned prasugrel vs. 0.5% of those assigned clopidogrel.
Although these data support the use of prasugrel to achieve effective platelet inhibition, researchers could not demonstrate the clinical utility of switching patients from clopidogrel to prasugrel because of the low rate of adverse ischemic events after PCI with contemporary drug-eluting stents in patients with stable CAD.
“Future randomized trials are warranted to examine the risk-benefit ratio of allocating higher-risk patients with stable CAD and high on-clopidogrel platelet reactivity to more potent platelet inhibition before and after PCI,” the researchers concluded. “These studies can build on the pharmacodynamic data from TRIGGER-PCI, which demonstrates the efficacy of prasugrel in overcoming high on-treatment platelet reactivity on clopidogrel in patients with stable CAD.”
Disclosure: Researchers report financial ties with Abbott Vascular, Accumetrics, Arena Pharmaceuticals, AstraZeneca, Bayer-Schering, Boston Scientific, Bristol-Myers Squibb, Cordis, Daiichi Sankyo, Eisai, Eli Lilly Co., Evolva, GlaxoSmithKline, Medicure, Medtronic, Merck, Novartis, Otsuka, Portol, Sanofi-Aventis, Schering-Plough and The Medicines Company.
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