Author + information
- Daniel Aradi,
- Tunde Pinter,
- Balazs Magyari,
- Attila Konyi,
- András Vorobcsuk,
- Ivan G. Horvath and
- András Komócsi
High on–clopidogrel platelet reactivity (HPR) is associated with thrombotic events after PCI. We aimed to determine the clinical impact of intensifying P2Y12–receptor inhibition in patients with HPR while keeping others on generic clopidogrel.
From September 2011, consecutive ACS patients undergoing PCI and stenting who were pretreated with 600 mg clopidogrel were enrolled into a registry. Six to 24 hours after clopidogrel loading dose, platelet reactivity was assessed with the Multiplate device. Patients with HPR (ADP test ≥47U) received either prasugrel (60 mg bolus+10 mg) or high–dose clopidogrel (repeated loading doses of 600 mg clopidogrel+75/150 mg) according to the clinicians’ decisions. Primary efficacy endpoints were vascular mortality and definite/probable stent thrombosis (ST), while TIMI major bleeding events were recorded as safety measures.
Here we report the results of 9–month enrollment into the registry, during that 563 ACS patients were included. Mean follow–up time was 200 days. Based on Multiplate assessments, 141 patients (25%) showed HPR; prasugrel was used in 54%, while high–dose clopidogrel in 46% of the cases. Despite the treatment adjustment, patients with HPR tended to remain at higher risk for vascular mortality or ST versus others without HPR (10[7.09%] vs. 16[3.79%], p=0.11). In patients with HPR, prasugrel was significantly more effective to reduce vascular mortality or stent thrombosis compared to high–dose clopidogrel (3[3.95%] vs. 7[10.77%], p=0.02). ST was significantly higher in the high–dose clopidogrel compared to the prasugrel group or to those without HPR (4.69% vs. 1.33% vs. 1.10%, respectively; p=0.03). TIMI major and minor bleeding events were not statistically different between patient groups.
In consecutive high–risk ACS patients with HPR after PCI, prasugrel was more effective in reducing the risk of vascular mortality or ST compared to high–dose clopidogrel. ACS patients identified without HPR by the Multiplate assay had a remarkably low rate of thrombotic events on low–dose generic clopidogrel.
Poster Sessions, Expo North
Monday, March 11, 2013, 9:45 a.m.–10:30 a.m.
Session Title: Adjunct Pharmacology
Abstract Category: 39. TCT@ACC–i2: Adjunct Pharmacology
Presentation Number: 2115–224
- 2013 American College of Cardiology Foundation