Randomized Comparison of Different Thienopyridine Loading Strategies in Patients Undergoing Elective Coronary Intervention: The ExcelsiorLOAD Trial

JACC. Cardiovascular Interventions
Willibald HochholzerChristian M Valina

Abstract

This randomized trial investigated to what extent loading with prasugrel can provide a more rapid peri-interventional antiplatelet effect than clopidogrel 600 mg. Effective platelet inhibition at the start of a percutaneous coronary intervention (PCI) reduces the risk of ischemic complications. With clopidogrel administered immediately before a PCI, effective platelet inhibition is delayed by 2 h. Prasugrel has the potential of shortening this period. We randomly assigned 300 P2Y12 receptor blocker-naive patients undergoing an elective PCI to loading with clopidogrel 600 mg, prasugrel 30 mg, or prasugrel 60 mg immediately before the PCI. Platelet function was assessed serially by impedance aggregometry. The primary endpoint was the proportion of patients with high on-treatment platelet reactivity at 60 min after loading defined as ≥468 aggregation units × minute (Multiplate Analyzer, Roche Diagnostics, Mannheim, Germany). The 3 groups were well balanced with respect to clinical and angiographic characteristics. At 60 min, 33% of the patients assigned to prasugrel 60 mg, 37% of patients assigned to prasugrel 30 mg, but 55% of those assigned to clopidogrel had high on-treatment platelet reactivity (p < 0.001). At any time point s...Continue Reading

References

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Citations

Nov 5, 2016·Platelets·Michael AmannWillibald Hochholzer
Oct 30, 2016·Thrombosis and Haemostasis·Christian StratzWillibald Hochholzer
May 4, 2017·Current Opinion in Cardiology·Birgit Vogel, Usman Baber
Jul 16, 2016·Journal of the American College of Cardiology·Christian StratzWillibald Hochholzer
Jul 16, 2016·Journal of the American College of Cardiology·Neal S Kleiman
Jun 13, 2020·Circulation. Cardiovascular Interventions·Thomas D Stuckey
Jan 4, 2017·European Heart Journal·Carlo Di MarioWilliam Wijns
Feb 12, 2017·Current Cardiology Reports·Amit V Patel, Sripal Bangalore
Jan 8, 2021·International Journal of Cardiology·Willibald Hochholzer, Christian M Valina

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