Thienopyridine reloading in clopidogrel-loaded patients undergoing percutaneous coronary interventions: The PRAISE study

Long Zhe Guo, Moo Hyun Kim, Eun Seok Shin, Soe Hee Ann, Cai De Jin, Young Rak Cho, Jong Sung Park, Kyungil Park, Tae Ho Park, Michael S. Lee, Victor L. Serebruany

Research output: Contribution to journalArticlepeer-review

3 Scopus citations

Abstract

Objective The impact of thienopyridine reloading on clinical outcomes, and residual high platelet reactivity (HPR) is unclear. We sought to compare the HRP-related effect of prasugrel and clopidogrel reloading in the already clopidogrel-loaded patients undergoing percutaneous coronary intervention (PCI). Materials and methods In this prospective, two-center, randomized, open-label study, patients with HPR who had undergone PCI after a clopidogrel (300–600 mg) loading dose (LD) were enrolled. Among screened (n = 153), HPR was determined in seventy-six patients, who were randomized to either repeated clopidogrel (300 mg LD, followed by 75 mg MD daily) or prasugrel (20 mg LD, followed by 5 mg MD daily). The primary endpoint was HPR at 24 h after PCI, as determined by the VerifyNow assay. The rates of sustained high and low platelet reactivity, periprocedural myocardial injury (PMI) and 30-day clinical outcomes were also assessed. Results Higher inhibition of platelet reactive units (PRU) was observed in the prasugrel group than after clopidogrel reloading (Pre-PCI: 284.4 ± 32.0 vs 279.5 ± 32.5, p = 0.504; Post-PCI: 100.0 ± 67.0 vs 202.9 ± 65.8, p < 0.001; 30 days: 170.8 ± 69.8 vs 215.1 ± 62.4, p = 0.007). There were less HRP post-PCI after prasugrel compared with the clopidogrel group (2.7 vs 36.1%, p < 0.001). However, reloading with prasugrel did not reduce PMI compared to clopidogrel (36.8% vs 39.5%, p = 0.813). Conclusion Prasugrel reloading led to a greater reduction in HPR, but similar with clopidogrel PMI in post-PCI patients. Larger randomized evidence is needed for optimization of loading strategies with thienopyridines. Clinical Trial Registration Information: NCT01609647.

Original languageEnglish (US)
Pages (from-to)639-644
Number of pages6
JournalInternational Journal of Cardiology
Volume222
DOIs
StatePublished - Nov 1 2016

Keywords

  • Acute coronary syndrome
  • Clopidogrel
  • Coronary interventions
  • Platelet reactivity
  • PRAISE
  • Prasugrel

ASJC Scopus subject areas

  • General Medicine
  • Cardiology and Cardiovascular Medicine

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