Variability of prasugrel antiplatelet effect in patients with acute coronary syndrome

Abstract

Background. Many reports have demonstrated excessive variability in response to clopidogrel, the most commonly used P2Y12 receptor antagonist. Clopidogrel resistant patients are at increased risk of cardiovascular (CV) events. Prasugrel is a new P2Y12 inhibitor that provides greater and faster platelet inhibition and reduces CV events more effectively than clopidogrel. The aim of this study was to evaluate the variability and efficacy of prasugrel antiplatelet activity in patients presenting with acute coronary syndrome (ACS). Materials and methods. The study was designed as a prospective, single-center, non-randomized, observational trial. Platelet reactivity (PR) was assessed with the VeryfyNow assay three times during hospitalization in forty-two patients undergoing percutaneous coronary intervention (PCI) for ACS and treated with standard doses of prasugrel. Results. Platelet aggregation with prasugrel displayed relatively high variability. The platelet aggregation was lowest on the 3 rd day of the treatment at 4 p.m. and was significantly different from the measurements obtained on the 3 rd and 4 th day in the morning (6.0 v. 8.5 U; p = 0.0005 and 6.0 v. 36.5 U; p < 0.00001, respectively), with the latter two differing significantly from each other (p = 0.002). All participants were successfully treated with prasugrel achieving PR < 208 PRU in each measurement, whereas 42.9-80.9% (depending on sampling point) of patients presented very low platelet activity. The subgroups of stable and persistent low PR included a higher percentage of active smokers (73.3 v. 40.7%; p = 0.04 and 80.0 v. 43.8%; p = 0.04, respectively). Conclusions. Prasugrel treatment is associated with high variability of PR. Nonetheless, prasugrel is a highly effective antiplatelet drug. Active smoking may predispose to strong and stable on-prasugrel platelet inhibition.

Creative scientific dispute — different points of view on the protocol and execution of the ISAR-REACT 5 trial

“…In this aspect, this action resembles convincing ones who are already convinced as prasugrel needs no defense. The effectiveness and predictability of prasugrel has been demonstrated in numerous publications, also those coming from our research team [11,17,25,26,35,38,39,46,60,62,69], and undeniably prasugrel holds a strong position in multiple guidelines.…”

Effectiveness and Safety of Enteric-Coated vs Uncoated Aspirin in Patients With Cardiovascular Disease

“…Acid-reducing medications, such as proton pump inhibitors and histamine type 2 receptor antagonists, used to buffer aspirin within the stomach, have been shown to affect dissolution of the enteric formulations of aspirin by altering the pH, composition, and ionic strength in the stomach. 19 The effect on the ability of enteric-coated aspirin to inhibit platelet aggregation has been mixed, with 1 study 20 showing no effect with lansoprazole and another study 21 showing reduced platelet aggregation when pantoprazole was given with entericcoated aspirin. Although the pharmacodynamics suggest that enteric-coated aspirin may be less effective than uncoated aspirin, there are no studies, to our knowledge, addressing the question of whether combining ARM with enteric-coated aspirin will result in more adverse clinical outcomes.…”

Knowledge about health and disease in obese patients after myocardial infarction. An observational study

“…The increasing number of overweight and obese people is a global social, economic, and medical problem [1][2][3][4]. According to estimates published in The Global Burden of Disease Study 2013 [3], the percentage of people with BMI above 25 kg/m 2 in 2013 was 37% in men and 38% in women.…”