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Open Access 01-03-2020 | Clopidogrel | Original Article

Prasugrel effectively reduces the platelet reactivity units in patients with genetically metabolic dysfunction of cytochrome P450 2C19 who are treated with long-term dual antiplatelet therapy after undergoing drug-eluting stent implantation

Authors: Junichiro Shimamatsu, Ken-ichiro Sasaki, Yoshio Katsuki, Tomohiro Kawasaki, Yoshinobu Murasato, Hidehiko Ajisaka, Hiroyoshi Yokoi, Hideki Tashiro, Atsushi Harada, Yuji Hirakawa, Yuta Ishizaki, Takashi Ishimatsu, Kotaro Kagiyama, Yoshihiro Fukumoto, Tatsuyuki Kakuma, Takafumi Ueno

Published in: Heart and Vessels | Issue 3/2020

Abstract

Dual antiplatelet therapy (DAPT) with aspirin and P2Y₁₂ inhibitor is administered following percutaneous coronary intervention (PCI) with coronary stent implantation. Several studies have reported the effects of switching between P2Y₁₂ inhibitors on platelet reactivity (P2Y₁₂ reaction units: PRU), from acute to late phase after PCI. However, the effect of switching at very late phase is unknown. This study examined the effect on PRU in Japanese coronary heart disease patients with long-term DAPT (aspirin + clopidogrel) when switching from clopidogrel to prasugrel. Ninety-six patients were enrolled in this study. The median DAPT duration at enrollment was 1824.0 days. Twenty-three patients with PRU ≥ 208 at enrollment were randomly assigned into either continuing to receive clopidogrel (Continued Group; n = 11) or switching to prasugrel (Switched Group; n = 12). The primary endpoint was the rate of patients who achieved PRU < 208 at the end of 12 weeks of treatment, which was significantly higher in Switched Group relative to Continued Group (90.0% vs. 36.4%; P = 0.024). The secondary endpoint was the PRU at week 12 in groups subdivided according to cytochrome P450 (CYP) 2C19 genotypes. At week 12, extensive metabolizers (EM Group) had 202.3 ± 60.0 and 174.5 ± 22.3 in Continued Group and Switched Group (P = 0.591), respectively; intermediate and poor metabolizers (non-EM Group) had 229.4 ± 36.9 and 148.4 ± 48.4 in Continued Group and Switched Group (P = 0.002), respectively. The PRU for non-EM Group was significantly reduced in Switched Group. Thus, for patients with long-term DAPT (aspirin + clopidogrel) after PCI with coronary stent implantation, switching from clopidogrel to prasugrel resulted in a stable reduction in PRU, regardless of CYP2C19 polymorphism.

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Title: Prasugrel effectively reduces the platelet reactivity units in patients with genetically metabolic dysfunction of cytochrome P450 2C19 who are treated with long-term dual antiplatelet therapy after undergoing drug-eluting stent implantation
Authors: Junichiro Shimamatsu
Ken-ichiro Sasaki
Yoshio Katsuki
Tomohiro Kawasaki
Yoshinobu Murasato
Hidehiko Ajisaka
Hiroyoshi Yokoi
Hideki Tashiro
Atsushi Harada
Yuji Hirakawa
Yuta Ishizaki
Takashi Ishimatsu
Kotaro Kagiyama
Yoshihiro Fukumoto
Tatsuyuki Kakuma
Takafumi Ueno
Publication date: 01-03-2020
Publisher: Springer Japan
Keywords: Clopidogrel
Prasugrel
Published in: Heart and Vessels / Issue 3/2020
Print ISSN: 0910-8327
Electronic ISSN: 1615-2573
DOI: https://doi.org/10.1007/s00380-019-01499-7

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Prasugrel effectively reduces the platelet reactivity units in patients with genetically metabolic dysfunction of cytochrome P450 2C19 who are treated with long-term dual antiplatelet therapy after undergoing drug-eluting stent implantation

Abstract

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