Randomized Comparison of the Platelet Inhibitory Efficacy between Low Dose Prasugrel and Standard Dose Clopidogrel in Patients Who Underwent Percutaneous Coronary Intervention

Abstract

Background and Objectives Increased bleeding rates with standard dose prasugrel have led to increased questions about the effectiveness and safety of the lower maintenance dose. We compared platelet inhibitory efficacy between low dose prasugrel and standard dose clopidogrel in patients on maintenance dose dual antiplatelet therapy. Subjects and Methods Forty-three patients who underwent percutaneous coronary intervention were randomized to receive 75 mg clopidogrel (n=23) or 5 mg prasugrel (n=20). Another 20 patients were allocated to 10 mg prasugrel as a reference comparison group. All patients (weight, ≥60 kg; age, <75 years) had been receiving 100 mg aspirin and 75 mg clopidogrel daily. The platelet function test was performed at baseline and 30 days after randomization. The primary endpoint was P2Y 12 reaction unit (PRU) at 30 days between 5 mg prasugrel and 75 mg clopidogrel. Results No differences in baseline PRU values were observed among the three groups. The prasugrel (5 mg) group had a significantly lower PRU value compared with that of 75 mg clopidogrel (174.6±60.2 vs. 223.4±72.9, p=0.022) group at 30 days, whereas the 10 mg prasugrel group showed a lower PRU value (71.9±34.4) compared with that of the 5 mg prasugrel (p<0.001). The rate of high on-treatment platelet reactivity (PRU >235) was significant lower in the 5 mg prasugrel group than that in the 75 mg clopidogrel group (15.0% vs. 56.5%, p=0.010). Conclusion Prasugrel (5 mg) is more potent antiplatelet therapy than 75 mg clopidogrel in non-low body weight and non-elderly patients on a maintenance dose dual antiplatelet therapy.

Systematic review with meta‐analysis: the risk of gastrointestinal bleeding in patients taking third‐generation P2Y12 inhibitors compared with clopidogrel

“…A total of 80 potential eligible studies were then reviewed for full‐text evaluations, of which 39 articles were excluded because they did not meet the inclusion criteria (Table S1). Finally, 41 RCTs were included in the meta‐analysis with 23 trials comparing ticagrelor with clopidogrel and 18 trials comparing prasugrel with clopidogrel, in which bleeding data from ClinicalTrial.gov were used for the study of Ge 2010 . The selection steps and specific excluding reasons were shown in Figure .…”

Lower Loading Dose of Prasugrel Compared with Conventional Loading Doses of Clopidogrel and Prasugrel in Korean Patients Undergoing Elective Coronary Angiography: A Randomized Controlled Study Evaluating Pharmacodynamic Efficacy

“… 8) We compared it with a conventional 60 mg prasugrel LD group, revealing a similar platelet inhibition in both groups in Korean CAD patients. 19) …”

Anti-platelet effects of epigallocatechin-3-gallate in addition to the concomitant aspirin, clopidogrel or ticagrelor treatment

“…Anti-platelet therapy is fundamental for primary and secondary prevention of cardiovascular diseases [ 1 , 2 ]. Aspirin and clopidogrel are the most widely used anti-platelet agents in cardiovascular diseases.…”