Circulation Journal Official Journal of the Japanese Circulation Society http://www. j-circ.or.jp let agent approved for the reduction of atherothrombotic cardiovascular events in patients presenting with ACS and undergoing percutaneous coronary intervention. 11,12 Several studies have reported greater, more rapid and more consistent platelet inhibition with prasugrel than with clopidogrel in healthy subjects as well as in patients with stable coronary artery disease. 13-15 Preclinical studies indicate that prasugrel is approximately 10-fold more potent than clopidogrel at inhibiting platelet aggregation, inhibiting thrombus formation and prolonging bleeding times. 16 The benefit of prasugrel relative to clopidogrel, however, can be accompanied by a higher risk of major bleeding. The large TRITON-TIMI 38 study provided the first conclusive evidence that prasugrel is associated with excess bleeding relative to clopidogrel (2.4% vs. 1.8%, P=0.03). 12 Although the approved LD is 60 mg, previous studies with prasugrel suggest that active metabolite exposure and pharmacodynamic response may be higher in Asian than in Caucasian subjects. 17 These findings prompted the current study, in which the pharmacodynamic responses to a lower prasugrel LD were ual anti-platelet therapy (aspirin and clopidogrel) is often recommended for patients undergoing stent implantation with acute coronary syndrome (ACS). 1-3 Clopidogrel is a thienopyridine prodrug, which, given orally, is metabolized to an active sulfhydryl form that binds to and irreversibly antagonizes the P2Y12 class of platelet adenosine diphosphate (ADP) receptor. 4 When an approved clopidogrel loading dose (LD) regimen of 600 mg is compared to a 300-mg LD, more rapid onset and a higher level of platelet inhibition can be achieved. 5,6 While the mechanisms of patient variability and resistance to clopidogrel therapy are not fully understood, genetic, clinical and cellular factors have been investigated. 7,8 Several studies have found that clopidogrel resistance has a significant correlation with higher risk of cardiovascular events. 9,10
Editorial p 1150As with other thienopyridines, prasugrel is an oral antiplate- Background: Previous studies involving a loading dose (LD) of 60 mg prasugrel have suggested that active metabolite exposure and pharmacodynamic responses may be higher in persons of Asian ethnicity than in Caucasian subjects. The aim of this study was to determine the pharmacodynamic effect of an LD of 30 mg prasugrel and 600 mg clopidogrel in healthy Korean volunteers.
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