Author + information
- Joshua Loh,
- Lakshmana Pendyala,
- Hironori Kitabata,
- Salem Badr,
- Danny Dvir,
- Israel Barbash,
- Sa'ar Minha,
- Rebecca Torguson,
- Kenneth Kent,
- Lowell Satler,
- William Suddath,
- Augusto Pichard and
- Ron Waksman
Patients with acute coronary syndrome (ACS) undergoing percutaneous coronary intervention (PCI) are commonly loaded with either clopidogrel or prasugrel in addition to aspirin. This study aimed to assess the safety of reloading prasugrel in patients initially loaded with clopidogrel, when compared to prasugrel loading alone.
The study included a cohort of 606 consecutive ACS patients who received a prasugrel 60–mg loading dose before PCI. These patients were categorized into clopidogrel preloading (300– or 600–mg) followed by prasugrel reloading (CP–load group, n=90) and prasugrel loading only (P–load group, n=516). Both groups received prasugrel 10 mg as maintenance dose following PCI. The primary end point was in–hospital Thrombolysis In Myocardial Infarction (TIMI)–defined major bleeding; secondary end points were other in–hospital bleeding and vascular complications.
Patients in the CP–load were younger, with lower rates of cardiovascular risk factors. Significantly more patients in the CP–load group presented with biomarker positive myocardial infarction (80.0 vs. 30.6%, p=<0.001) and cardiogenic shock (5.6 vs. 1.4%, p=0.022). There were no significant differences (p=NS) in TIMI major bleeding (2.6 vs. 2.8%), TIMI major or minor bleeding (12.2 vs. 7.0%), need for blood transfusion (2.6 vs. 2.1%) and vascular complications (1.3 vs. 2.0%) between the CP–load and P–load groups. The C–P load group experienced more in–hospital major adverse cardiac events (5.6 vs. 1.6%, p=0.031), urgent coronary artery bypass grafting (3.3 vs. 0.2%, p=0.011) and longer hospital (3.2 vs. 2.4 days, p=0.014) and intensive care unit (0.8 vs. 0.3 days, p <0.001) stays.
For patients with ACS who are subjected to PCI and were loaded with clopidogrel prior to arrival to the catheterization laboratory, it is safe to reload with prasugrel in the catheterization laboratory with respect to in–hospital bleeding and vascular complications.
Poster Sessions, Expo North
Monday, March 11, 2013, 9:45 a.m.–10:30 a.m.
Session Title: Acute Coronary Syndrome and Acute Myocardial Infarction
Abstract Category: 40. TCT@ACC–i2: ACS/AMI/Hemodynamic Support
Presentation Number: 2113–260
- 2013 American College of Cardiology Foundation