Residual Platelet Reactivity, Bleedings, and Adherence to Treatment in Patients Having Coronary Stent Implantation Treated With Prasugrel

CYP2C19*2 and *17 Alleles Have a Significant Impact on Platelet Response and Bleeding Risk in Patients Treated With Prasugrel After Acute Coronary Syndrome

“…This discrepancy could be explained by the patient characteristics, with higher body mass index and incidence of diabetes in the Michelson's study (20). Recently, results from several studies performed were in line with our results, with a low rate (Ͻ10%) of patients with HTPR while treated with prasugrel 10 mg daily (21)(22)(23). However, in the present study, we still observed variability of response to prasugrel, which could be explained by the relatively high incidence of factors known to influence thienopyridine metabolism, including prasugrel, such as acute myocardial infarction, diabetes, and patients with a high body mass index.…”

Adherence to antiplatelet therapy after percutaneous coronary intervention

“…Furthermore, the proportion of patients assuming DAPT ranged from 86 to 93% within 12 months from discharge in studies based on direct interview of patients. [18][19][20][21] The data on the poor adherence reported in our study are higher than the other studies for dual antiplatelets based on self-reported data but consistent with the results reported in the studies based on an administrative database 9 and in a recent systematic review. 22 Anyway, this result is surprising and it may be due to other factors that could not be measured.…”

“…However, the discontinuation of antiplatelet therapy could depend on a patient decision or medical decision not associated with the risk of bleeding events or surgical procedures. 19 In fact, Parodi et al 21 reported that the adherence to treatment with prasugrel did not seem to be affected by the bleeding events that occurred during the followup period.…”

Chronic kidney disease has a significant impact on platelet inhibition of new P2Y12 inhibitors

“…prasugrel and ticagrelor) [4]. Clinical studies have linked on-treatment platelet reactivity (PR) to the occurrence of ischemic and bleeding complications [5,6] and platelet testing could be included in global estimation of ischemic versus bleeding risk on new P2Y12 inhibitors. Observed in 35% to 40% of ACS patients, chronic kidney disease (CKD) undoubtedly affects the outcome of percutaneous coronary stenting [7].…”