Prasugrel achieves greater inhibition of platelet aggregation and a lower rate of non-responders compared with clopidogrel in aspirin-treated patients with stable coronary artery disease

European Heart Journal
Tomas JernbergLars Wallentin

Abstract

This study was designed to compare the degree of inhibition of platelet aggregation (IPA) of prasugrel with that of clopidogrel in stable aspirin-treated patients with coronary artery disease (CAD). Subjects (n=101) were randomly assigned to the following loading dose (LD) (day 1)/maintenance dose (MD) (days 2-28) combinations: prasugrel, 40 mg/5 mg; 40 mg/7.5 mg; 60 mg/10 mg; 60 mg/15 mg; or clopidogrel, 300 mg/75 mg. Turbidometric platelet aggregation was measured at multiple timepoints during the study. At 4 h after dosing, with 20 microM ADP, both prasugrel LDs achieved significantly higher mean IPA levels (60.6% and 68.4 vs. 30.0%, respectively; all P<0.0001) and lower percentage (3 vs. 52%, P<0.0001) of pharmacodynamic non-responders (defined as IPA <20%) than clopidogrel. Prasugrel 10 and 15 mg MDs achieved consistently higher mean IPA than clopidogrel 75 mg at day 28 (all P<0.0001). At pre-MD on day 28, there were no non-responders in the 10 and 15 mg prasugrel group, compared with 45% in the clopidogrel group (P=0.0007). In this population, prasugrel (40-60 mg LD and 10-15 mg MD) achieves greater IPA and a lower proportion of pharmacodynamic non-responders compared with the approved clopidogrel dosing.

Associated Clinical Trials

References

Sep 12, 1998·Annals of Internal Medicine·P J SharisJ Loscalzo
Aug 25, 2001·The New England Journal of Medicine·S YusufUNKNOWN Clopidogrel in Unstable Angina to Prevent Recurrent Events Trial Investigators
Nov 19, 2002·JAMA : the Journal of the American Medical Association·Steven R SteinhublUNKNOWN CREDO Investigators. Clopidogrel for the Reduction of Events During Observation
Apr 26, 2003·The American Journal of Cardiology·Paul A Gurbel, Kevin P Bliden
Jun 25, 2003·Catheterization and Cardiovascular Interventions : Official Journal of the Society for Cardiac Angiography & Interventions·Paul BarraganMartin Eigenthaler
Nov 30, 2004·Thrombosis Research·Waiel M SamaraPaul A Gurbel

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Citations

Nov 22, 2008·Journal of Pharmacokinetics and Pharmacodynamics·C Steven ErnestRebecca E Wrishko
Dec 21, 2011·Journal of Thrombosis and Thrombolysis·Peter DammanStefan K James
Nov 9, 2011·Nature Medicine·Shaun P Jackson
Nov 6, 2007·The New England Journal of Medicine·Stephen D WiviottUNKNOWN TRITON-TIMI 38 Investigators
Sep 1, 2009·The New England Journal of Medicine·Lars WallentinMona Thorsén
May 14, 2009·European Heart Journal·Alan D MichelsonUNKNOWN TRITON-TIMI 38 Investigators
Apr 28, 2009·International Journal of Clinical Practice·A SiddiqueG Y H Lip
Jan 16, 2007·BMJ : British Medical Journal·Andrew J Wiper, David H Roberts
Mar 8, 2013·Thrombosis and Haemostasis·E L GroveR F Storey
Dec 25, 2008·Circulation Journal : Official Journal of the Japanese Circulation Society·Kozo HoshinoTakeshi Kimura
Mar 1, 2012·Vascular Health and Risk Management·Rakesh K SharmaJames D Marsh
May 14, 2009·Vascular Health and Risk Management·Filippo Marzot, Vittorio Pengo
May 30, 2009·Vascular Health and Risk Management·Zuzana Motovska, Petr Widimsky
Nov 10, 2009·Vascular Health and Risk Management·Nicholas B Norgard, Mazen Abu-Fadel
Feb 16, 2011·Biomarkers in Medicine·Matthew J Price, Colin M Barker
Feb 16, 2011·Biomarkers in Medicine·Joseph A Jakubowski
May 20, 2009·Future Cardiology·Erik L Grove, Steen D Kristensen
May 20, 2009·Future Cardiology·Marzia LotrionteGiuseppe G L Biondi-Zoccai
Jul 9, 2010·Future Cardiology·Masafumi UenoDominick J Angiolillo
Jun 1, 2010·The Consultant Pharmacist : the Journal of the American Society of Consultant Pharmacists·Maisha Kelly Freeman
Jan 1, 2008·Future Cardiology·Jochem W van WerkumJurriën M Ten Berg
Apr 26, 2014·Future Cardiology·Julie H Oestreich, Paul P Dobesh
May 13, 2014·European Heart Journal·Stefanie SchulzUNKNOWN Bavarian Reperfusion Alternatives Evaluation (BRAVE) 4 Investigators
Dec 20, 2012·Current Cardiology Reports·Andrew R Harper, Matthew J Price
Sep 1, 2007·Platelets·Govinda J WeerakkodyKenneth J Winters
Nov 12, 2010·Hospital Practice·Charles V Pollack
Apr 22, 2009·Expert Review of Cardiovascular Therapy·Piera CapranzanoDominick J Angiolillo
Jul 13, 2012·Expert Opinion on Pharmacotherapy·Young-Hoon JeongPaul A Gurbel
Apr 30, 2013·Expert Review of Cardiovascular Therapy·David C YangDmitriy N Feldman
Mar 1, 2009·Expert Review of Clinical Pharmacology·Julie H Oestreich, Steven R Steinhubl
Sep 1, 2011·Expert Review of Cardiovascular Therapy·Isabell BernlochnerDirk Sibbing
Sep 3, 2013·Expert Review of Cardiovascular Therapy·Marc LaineLaurent Bonello

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