Dual antiplatelet therapy in coronary artery disease: from the past to the future prospective

Mangieri, Antonio; Gallo, Francesco; Sticchi, Alessandro; Khokhar, Arif; Laricchia, Alessandra; Giannini, Francesco; Colombo, Antonio

doi:10.1007/s12928-020-00642-w

Cited by 40 publications

(23 citation statements)

References 74 publications

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“…According to our results, tailored risk stratification for HPR by each P2Y12 inhibitor may be relevant in clinical practice 34) , and the severity of the determinant of HPR probably plays a role. For…”

Section: Impact Of Clinical and Genetic Factors On Hprmentioning

confidence: 62%

Differential Impact of Clinical and Genetic Factors on High Platelet Reactivity in Patients with Coronary Artery Disease Treated with Clopidogrel and Prasugrel

Saito

Nishi

Wakabayashi

et al. 2022

JAT

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High platelet reactivity (HPR) is associated with increased risks of thrombotic events in patients with coronary artery disease. The recently developed ABCD-GENE score identified five clinical and genetic factors (age, body mass index, chronic kidney disease, diabetes, and the CYP2C19 loss-of-function allele) for HPR, although the significance of various stages of each factor is unclear.Methods: Four prospective studies were pooled, in which platelet reactivity was measured using the VerifyNow assay with clopidogrel and prasugrel; genotyping of CYP2C19 was also performed. Each component of the ABCD-GENE score was divided into three subcategories. VerifyNow P2Y12 reactivity units 208 were defined as HPR.Results: A total of 184 patients were included, of which 111 (60%) and 51 (28%) had HPR with clopidogrel and prasugrel. Chronic kidney disease had an impact on HPR on both clopidogrel and prasugrel, whereas the impact of diabetes was more evident in patients treated with prasugrel. Although the number of CYP2C19 lossof-function alleles was clearly associated with a likelihood of HPR with clopidogrel, P2Y12 reactivity units with prasugrel treatment were also significantly and progressively higher in patients with more CYP2C19 loss-offunction alleles.Conclusions: Clinical and genetic factors had a differential effect on a P2Y12 inhibitor reactivity with clopidogrel and prasugrel in patients with coronary artery disease. The severity of the factors also had a different impact on HPR.consisting of aspirin and a P2Y12 inhibitor, is the cornerstone of the antithrombotic regimen in patients undergoing PCI 2) . Currently, P2Y12 inhibitors of choice include clopidogrel, prasugrel, and ticagrelor 3) . Although clopidogrel is widely used in PCI, prasugrel and ticagrelor are the guideline-recommended P2Y12 inhibitors as a part of DAPT because of their potency Copyright©2021 Japan Atherosclerosis Society This article is distributed under the terms of the latest version of CC BY-NC-SA defined by the Creative Commons Attribution License.

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Section: Impact Of Clinical and Genetic Factors On Hprmentioning

confidence: 62%

Differential Impact of Clinical and Genetic Factors on High Platelet Reactivity in Patients with Coronary Artery Disease Treated with Clopidogrel and Prasugrel

Saito

Nishi

Wakabayashi

et al. 2022

JAT

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“…12 In this regard, P2Y12 inhibitor monotherapy may be more suitable for SAPT than aspirin monotherapy. 25 To the best of our knowledge, the present study is the first comparison of aspirin and P2Y12 inhibitor monotherapy after DAPT; we found no differences in clinical adverse events between these 2 monotherapies. However, because this study was originally designed to evaluate the non-inferiority of 3-month DAPT after BP-SES implantation, the number of subjects may not be sufficient to assess the effects of P2Y12 inhibitor monotherapy on clinical outcomes.…”

Section: Baseline Characteristicsmentioning

confidence: 46%

1-Year Safety of 3-Month Dual Antiplatelet Therapy Followed by Aspirin or P2Y<sub>12</sub> Receptor Inhibitor Monotherapy Using a Bioabsorbable Polymer Sirolimus-Eluting Stent

Kozuma

Kinoshita

Hioki

et al. 2020

Circ J

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“…Patients with CAD who were taking DAPT (aspirin and prasugrel) plus either vonoprazan or PPIs were enrolled in the study, including patients with the following clinical presentations: (1) those undergoing scheduled follow-up coronary angiography (CAG) after previous PCI; and (2) patients with stable angina pectoris (SAP) and ACS who were scheduled to undergo PCI. Patients were excluded if they were taking other antithrombotic agents, had a platelet count ≤10×10 4 /µL, or had severe liver dysfunction (Child-Pugh Class C).…”

Section: Patient Populationmentioning

confidence: 99%

“…1 Although clopidogrel is a widely used P2Y12 receptor inhibitor, it shows modest antiplatelet effects with significant interpatient variability, primarily because of the presence of cytochrome P450 (CYP) 2C19 *2 and/or *3 loss-of-function alleles. 2,3 This genetic variation is responsible for the variability in platelet reactivity on clopidogrel, which is more frequent in Japanese than Caucasian populations. 2,3 Prasugrel is a recently developed P2Y12 receptor inhibitor that causes more consistent, rapid and pronounced inhibition of platelet activity than clopidogrel.…”

mentioning

confidence: 99%

“…2,3 This genetic variation is responsible for the variability in platelet reactivity on clopidogrel, which is more frequent in Japanese than Caucasian populations. 2,3 Prasugrel is a recently developed P2Y12 receptor inhibitor that causes more consistent, rapid and pronounced inhibition of platelet activity than clopidogrel. Because prasugrel is predominantly metabolized to its active form by CYP3A4, its antiplatelet effects are not affected by CYP2C19 polymor-myocardial infarction (AMI) and unstable angina pectoris.…”

mentioning

confidence: 99%

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Effects of Vonoprazan on the Antiplatelet Function of Prasugrel Assessed by the VerifyNow P2Y<sub>12</sub> Assay in Patients With Coronary Artery Disease

et al. 2021

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Background: Vonoprazan is a potassium-competitive acid blocker increasingly used in Japan to prevent upper gastrointestinal bleeding in patients undergoing dual antiplatelet therapy (DAPT) after percutaneous coronary intervention (PCI). Cytochrome P450 (CYP) 3A4 is involved in the primary metabolism of both vonoprazan and prasugrel. This raises concern about the possibility of a CYP3A4-mediated drug-drug interaction between vonoprazan and prasugrel that may lead to attenuation of prasugrel’s antiplatelet effect. Methods and Results: We evaluated 88 PCI patients who were taking either vonoprazan (n=45) or proton pump inhibitors (PPIs; n=43) in combination with DAPT (aspirin and prasugrel). Platelet reactivity on prasugrel was assessed using the VerifyNow P2Y 12 assay. The primary endpoint was comparison of P2Y 12 reaction units (PRU) between patients on vonoprazan and PPIs. PRU >208 and <85 were defined as high (HPR) and low (LPR) on-treatment platelet reactivity for prasugrel. PRU was comparable between patients receiving vonoprazan and PPIs (169±52 vs. 179±61, respectively; P=0.75). There were no significant differences between the vonoprazan and PPI groups in the prevalence of HPR (22% vs. 37%, respectively; P=0.16) and LPR (4 vs. 7%, respectively; P=0.48). The results were consistent regardless of the type of clinical presentation and DAPT duration. Conclusions: PRU under DAPT with aspirin plus prasugrel in patients receiving vonoprazan was not significantly different from that in patients receiving PPIs after PCI in routine clinical practice.

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Dual antiplatelet therapy in coronary artery disease: from the past to the future prospective

Cited by 40 publications

References 74 publications

Differential Impact of Clinical and Genetic Factors on High Platelet Reactivity in Patients with Coronary Artery Disease Treated with Clopidogrel and Prasugrel

Differential Impact of Clinical and Genetic Factors on High Platelet Reactivity in Patients with Coronary Artery Disease Treated with Clopidogrel and Prasugrel

1-Year Safety of 3-Month Dual Antiplatelet Therapy Followed by Aspirin or P2Y<sub>12</sub> Receptor Inhibitor Monotherapy Using a Bioabsorbable Polymer Sirolimus-Eluting Stent

Effects of Vonoprazan on the Antiplatelet Function of Prasugrel Assessed by the VerifyNow P2Y<sub>12</sub> Assay in Patients With Coronary Artery Disease

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