Efficacy of 2.5-mg prasugrel in elderly or low-body-weight patients

Shinichi Wakabayashi, Noritaka Ariyoshi, Hideki Kitahara, Kenichi Fujii, Yoshihide Fujimoto, Yoshio Kobayashi

Research output: Contribution to journalArticle

2 Citations (Scopus)

Abstract

Background: Due to concern about bleeding complications, a maintenance dose of prasugrel 2.5 mg may be used in elderly or low-body-weight patients in Japan. There is little information, however, on the efficacy and safety of a 2.5-mg maintenance dose of prasugrel. Methods and Results: In this single-center, prospective, open-label, cross-over study, a total of 44 elderly (≥75 years old) or low body-weight (<50 kg) Japanese patients >1 month after percutaneous coronary intervention who were treated with aspirin 81–100mg and clopidogrel 75 mg were randomized to either prasugrel 2.5 mg or 3.75 mg instead of clopidogrel for 14 days, with a cross-over directly to the alternate treatment for another 14 days. Platelet inhibition was assessed with the VerifyNow assay (Accumetrics, San Diego, CA, USA) at 3 time points: baseline; day 14; and day 28. P2Y12 reaction units (PRU) ≤95 was defined as low on-treatment platelet reactivity (LPR), and PRU ≥262 as high on-treatment platelet reactivity (HPR). The prevalence of LPR was 2.2% in patients treated with clopidogrel, 2.2% in those with prasugrel 2.5 mg, and 22.7% in those with prasugrel 3.75 mg (P<0.001). Clopidogrel resulted in the higher prevalence of HPR compared with 2.5-mg and 3.75-mg prasugrel (40.9% vs. 18.2% vs. 6.8%, P<0.001). Conclusions: Prasugrel 2.5 mg may be more appropriate in elderly or lower-body-weight Japanese patients.

Original languageEnglish
Pages (from-to)2326-2331
Number of pages6
JournalCirculation Journal
Volume82
Issue number9
DOIs
Publication statusPublished - Jan 1 2018

Fingerprint

clopidogrel
Body Weight
Blood Platelets
Percutaneous Coronary Intervention
Prasugrel Hydrochloride
Cross-Over Studies
Aspirin
Japan
Therapeutics
Hemorrhage
Safety

Keywords

  • Elderly
  • Low body weight
  • Percutaneous coronary intervention
  • Platelet resistance
  • Prasugrel

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

Cite this

Wakabayashi, S., Ariyoshi, N., Kitahara, H., Fujii, K., Fujimoto, Y., & Kobayashi, Y. (2018). Efficacy of 2.5-mg prasugrel in elderly or low-body-weight patients. Circulation Journal, 82(9), 2326-2331. https://doi.org/10.1253/circj.CJ-18-0337

Efficacy of 2.5-mg prasugrel in elderly or low-body-weight patients. / Wakabayashi, Shinichi; Ariyoshi, Noritaka; Kitahara, Hideki; Fujii, Kenichi; Fujimoto, Yoshihide; Kobayashi, Yoshio.

In: Circulation Journal, Vol. 82, No. 9, 01.01.2018, p. 2326-2331.

Research output: Contribution to journalArticle

Wakabayashi, S, Ariyoshi, N, Kitahara, H, Fujii, K, Fujimoto, Y & Kobayashi, Y 2018, 'Efficacy of 2.5-mg prasugrel in elderly or low-body-weight patients', Circulation Journal, vol. 82, no. 9, pp. 2326-2331. https://doi.org/10.1253/circj.CJ-18-0337
Wakabayashi S, Ariyoshi N, Kitahara H, Fujii K, Fujimoto Y, Kobayashi Y. Efficacy of 2.5-mg prasugrel in elderly or low-body-weight patients. Circulation Journal. 2018 Jan 1;82(9):2326-2331. https://doi.org/10.1253/circj.CJ-18-0337
Wakabayashi, Shinichi ; Ariyoshi, Noritaka ; Kitahara, Hideki ; Fujii, Kenichi ; Fujimoto, Yoshihide ; Kobayashi, Yoshio. / Efficacy of 2.5-mg prasugrel in elderly or low-body-weight patients. In: Circulation Journal. 2018 ; Vol. 82, No. 9. pp. 2326-2331.
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abstract = "Background: Due to concern about bleeding complications, a maintenance dose of prasugrel 2.5 mg may be used in elderly or low-body-weight patients in Japan. There is little information, however, on the efficacy and safety of a 2.5-mg maintenance dose of prasugrel. Methods and Results: In this single-center, prospective, open-label, cross-over study, a total of 44 elderly (≥75 years old) or low body-weight (<50 kg) Japanese patients >1 month after percutaneous coronary intervention who were treated with aspirin 81–100mg and clopidogrel 75 mg were randomized to either prasugrel 2.5 mg or 3.75 mg instead of clopidogrel for 14 days, with a cross-over directly to the alternate treatment for another 14 days. Platelet inhibition was assessed with the VerifyNow assay (Accumetrics, San Diego, CA, USA) at 3 time points: baseline; day 14; and day 28. P2Y12 reaction units (PRU) ≤95 was defined as low on-treatment platelet reactivity (LPR), and PRU ≥262 as high on-treatment platelet reactivity (HPR). The prevalence of LPR was 2.2{\%} in patients treated with clopidogrel, 2.2{\%} in those with prasugrel 2.5 mg, and 22.7{\%} in those with prasugrel 3.75 mg (P<0.001). Clopidogrel resulted in the higher prevalence of HPR compared with 2.5-mg and 3.75-mg prasugrel (40.9{\%} vs. 18.2{\%} vs. 6.8{\%}, P<0.001). Conclusions: Prasugrel 2.5 mg may be more appropriate in elderly or lower-body-weight Japanese patients.",
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AB - Background: Due to concern about bleeding complications, a maintenance dose of prasugrel 2.5 mg may be used in elderly or low-body-weight patients in Japan. There is little information, however, on the efficacy and safety of a 2.5-mg maintenance dose of prasugrel. Methods and Results: In this single-center, prospective, open-label, cross-over study, a total of 44 elderly (≥75 years old) or low body-weight (<50 kg) Japanese patients >1 month after percutaneous coronary intervention who were treated with aspirin 81–100mg and clopidogrel 75 mg were randomized to either prasugrel 2.5 mg or 3.75 mg instead of clopidogrel for 14 days, with a cross-over directly to the alternate treatment for another 14 days. Platelet inhibition was assessed with the VerifyNow assay (Accumetrics, San Diego, CA, USA) at 3 time points: baseline; day 14; and day 28. P2Y12 reaction units (PRU) ≤95 was defined as low on-treatment platelet reactivity (LPR), and PRU ≥262 as high on-treatment platelet reactivity (HPR). The prevalence of LPR was 2.2% in patients treated with clopidogrel, 2.2% in those with prasugrel 2.5 mg, and 22.7% in those with prasugrel 3.75 mg (P<0.001). Clopidogrel resulted in the higher prevalence of HPR compared with 2.5-mg and 3.75-mg prasugrel (40.9% vs. 18.2% vs. 6.8%, P<0.001). Conclusions: Prasugrel 2.5 mg may be more appropriate in elderly or lower-body-weight Japanese patients.

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