Crushed Prasugrel Tablets in Patients With STEMI Undergoing Primary Percutaneous Coronary Intervention

Abstract

In STEMI patients undergoing PPCI, crushed prasugrel leads to faster drug absorption, and consequently, more prompt and potent antiplatelet effects compared with whole tablet ingestion. (Pharmacological Effects of Crushing Prasugrel in STEMI Patients; NCT02212028).

Pharmacodynamic Assessment of Platelet Reactivity After a Loading Dose of Prasugrel or Clopidogrel in Patients With ST-Segment Elevation Myocardial Infarction

“…20- 22 In addition, previous studies of East Asian have suggested elevated therapeutic level of platelet reactivity following PCI or ACS, compared with reports from studies of Westerners. 13,20, 23 There is a paucity of data about platelet reactivity for Japanese STEMI patients within 2 h of loading, although PRASFIT-ACS demonstrated a 20-mg loading dose of prasugrel provided stronger platelet inhibition than clopidogrel at 2-4 h after loading in ACS patients. Moreover, a recent study reported that door-to-balloon time was almost 60 min, 24 and the incidence of intraprocedural thrombotic events was greater in patients with STEMI compared with non-ST-segment elevation ACS.…”

The year in cardiology 2016: Acute coronary syndromes

“…18 In STEMI patients undergoing primary PCI delayed antiplatelet effects of oral P2Y 12 inhibitors, including prasugrel, have been observed. Rollini et al 19 investigated the bioavailablity of crushed prasugrel tablets vs. whole prasugrel tablets. The study showed that compared with whole tablets, crushed prasugrel led to reduced P2Y 12 reaction units by 30 min post-loading dose, which persisted at 1, 2, and 4 h post-loading dose.…”

P2Y 12 Receptor Antagonists and Morphine

“…Similarly, in a larger study, involving 108 STEMI patients treated with prasugrel, platelet reactivity at the end of primary PCI was 90.1 units in those who received morphine compared with 43.5 units in patients who did not (P<0.001). 15 On the other hand, in the CRUSH study (Pharmacological Effects of Crushing Prasugrel in STEMI Patients), 16 differences regarding the pharmacokinetic profile of the active metabolite of prasugrel were statistically nonsignificant with or without morphine, regardless of whether crushed or whole tablets were administered, both in terms of total exposure (P=0.198 and 0.286, for whole and crushed tablets, respectively) and exposure over the first 2 hours (P=0.459 and 0.776, for whole and crushed tablets, respectively) to the active metabolite. These findings are certainly hypothesis generating; however, the small sample size, the nonrandomized use of morphine, and the secondary or post hoc nature of most of these observations raise some doubt as to the true significance of the morphine effect on P2Y 12 receptor antagonist effectiveness in real life.…”