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RECLOSE 3: Prasugrel treatment may benefit clopidogrel nonresponders
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New data from the RECLOSE-3 study suggest that clopidogrel nonresponsiveness may be a modifiable risk factor for cardiac mortality and stent thrombosis after PCI.
Researchers screened 1,550 patients undergoing PCI who received a 600-mg loading dose of clopidogrel. Of those, 302 were classified as clopidogrel nonresponders (residual platelet reactivity > 70% on adenosine diphosphate [ADP] test). The nonresponders were switched to prasugrel 10 mg per day at the time of PCI. The researchers then compared the 302 clopidogrel nonresponders who received prasugrel in the RECLOSE-3 study with 248 clopidogrel nonresponders who did not receive prasugrel in the RECLOSE 2-ACS study.
After switching to prasugrel, the result of the ADP test was 47.1%. Only 26 of the 302 patients had an ADP test greater than 70%.
The primary endpoint, cardiac mortality at 2 years, occurred in 4% of clopidogrel nonresponders in the RECLOSE-3 study vs. 9.7% of clopidogrel nonresponders in the RECLOSE 2-ACS study (P = .007). Patients switched to prasugrel also had a lower rate of a composite of cardiac death and MI (6.6% in RECLOSE-3 vs. 13% in RECLOSE 2-ACS; P = .012) and probable/definite stent thrombosis (0.7% in RECLOSE-3 vs. 4.4% in RECLOSE 2-ACS; P = .004). Multivariable analysis indicated an inverse relationship between prasugrel treatment and 2-year cardiac mortality in clopidogrel nonresponders (HR = 0.32; P = .036). Rates of major bleeding were similar in both studies.
“The RECLOSE-3 study shows that clopidogrel nonresponders switching to prasugrel treatment is associated with a 2-year cardiac mortality rate nearly identical to the population of clopidogrel nonresponders in the RECLOSE 2-ACS [study],” the researchers concluded. “Clopidogrel nonresponsiveness can be overcome by prasugrel treatment.” – by Rob Volansky
Disclosure: The researchers report no relevant financial disclosures.
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