Efficacy of 2.5-mg Prasugrel in Elderly or Low-Body-Weight Patients

Wakabayashi, Shigeo; Ariyoshi, Noritaka; Kitahara, Hideki; Fujii, Kenichi; Fujimoto, Yoshihide; Kobayashi, Yoshio

doi:10.1253/circj.cj-18-0337

Cited by 13 publications

(9 citation statements)

References 20 publications

(3 reference statements)

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“…Four prospective studies have been conducted to evaluate antiplatelet effects in patients undergoing PCI at Chiba University Hospital (Table 1) [10][11][12][13] . PCI procedures were performed according to local standards, with contemporary drug-eluting stents and intracoronary imaging [14][15][16][17] .…”

Section: Study Populationmentioning

confidence: 99%

“…All patients received aspirin (100 mg daily) as a part of DAPT and no oral anticoagulation. Each study included patients with (1) CCS without renal insufficiency and low body weight (≤ 50 kg) 10) , (2) maintenance hemodialysis 11) , (3) age ≥ 75 years and/or body weight 50 kg 12) , and (4) ACS 13) . The major exclusion criteria are shown in Table 1.…”

Section: Introductionmentioning

confidence: 99%

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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: Study Populationmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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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“…Similarly, the optimal cut-off value of PRU for a high risk of bleeding complications in Japanese patients is unknown. However, PRU 95 was used as LPR in previous studies including Japanese patients [39].…”

Section: Study Limitationsmentioning

confidence: 99%

Increased platelet inhibition after switching from prasugrel to low-dose ticagrelor in Japanese patients with prior myocardial infarction

Tateishi

Saito

Kitahara

et al. 2020

Journal of Cardiology

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Background: Ticagrelor and prasugrel are novel and potent P2Y12 inhibitors. Ticagrelor 90 mg or 60 mg twice daily is known to reduce ischemic events but be associated with an increased risk of bleeding in patients with prior myocardial infarction in Western countries. Although ticagrelor 90 mg twice daily was tested in a randomized clinical trial in East Asia, the clinical significance of ticagrelor 60 mg twice daily is unclear. This study aimed to evaluate platelet inhibition of low-dose ticagrelor compared to prasugrel in Japanese patients. Methods: A total of 33 patients with prior myocardial infarction (>3 months) who received aspirin and prasugrel 3.75 mg once daily were enrolled. Prasugrel was switched to ticagrelor 60 mg twice daily. Platelet inhibition was assessed by VerifyNow assay (Accumetrics, San Diego, CA, USA) at baseline and 14 days after switching to ticagrelor. P2Y12 reaction unit (PRU) 95 was defined as low on-treatment platelet reactivity (LPR) and PRU ! 262 as high on-treatment platelet reactivity. Results: Ticagrelor treatment resulted in significantly lower PRU [10 (7-39) vs. 143 (102-201), p < 0.001] and a higher rate of LPR (94% vs. 24%, p < 0.001), compared to prasugrel treatment. Neither patients treated with ticagrelor nor prasugrel had high on-treatment platelet reactivity. During 2-week follow-up on ticagrelor therapy, no major bleeding occurred in both groups, while four minor bleeding events were observed. Conclusion:In Japanese patients with prior myocardial infarction, significantly lower PRU and a higher rate of LPR were observed on ticagrelor 60 mg twice daily compared to prasugrel 3.75 mg once daily.

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“…Interestingly, dosing of antiplatelet agents is also a possible therapeutic challenge. Several platelet function testing and clinical studies have reported that efficacy and safety of aspirin and P2Y 12 inhibitors depend on patients' age or body weight [24,25]. However, the significance of tailoring dose of antiplatelet therapy have not been proven, especially in the settings of triple therapy.…”

Section: Which Agents and How Long?mentioning

confidence: 99%

Triple therapy: A review of antithrombotic treatment for patients with atrial fibrillation undergoing percutaneous coronary intervention

Saito

Kobayashi

2019

Journal of Cardiology

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Efficacy of 2.5-mg Prasugrel in Elderly or Low-Body-Weight Patients

Abstract: Prasugrel 2.5 mg may be more appropriate in elderly or lower-body-weight Japanese patients.

Cited by 13 publications

References 20 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

Increased platelet inhibition after switching from prasugrel to low-dose ticagrelor in Japanese patients with prior myocardial infarction

Triple therapy: A review of antithrombotic treatment for patients with atrial fibrillation undergoing percutaneous coronary intervention

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