Increased platelet inhibition after switching from maintenance clopidogrel to prasugrel in japanese patients with stable coronary artery disease

Takeshi Nishi, Noritaka Ariyoshi, Takashi Nakayama, Yoshihide Fujimoto, Kazumasa Sugimoto, Masayuki Takahara, Shinichi Wakabayashi, Masaya Koshizaka, Hideki Hanaoka, Yoshio Kobayashi

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12 Citations (Scopus)

Abstract

Background: The pharmacodynamic effects of changing from standard-dose clopidogrel to low-dose (3.75 mg) prasugrel in Japanese patients are largely unknown. Methods and Results: A total of 53 consecutive Japanese patients with stable coronary artery disease (CAD) who received aspirin and clopidogrel were enrolled. Clopidogrel was switched to 3.75 mg prasugrel. At day 14, prasugrel was switched to 75 mg clopidogrel. Platelet reactivity was measured using the VerifyNow assay at baseline, day 14, and day 28. VerifyNow P2Y12 reaction units (PRU) >208 was defined as high on-treatment platelet reactivity (HPR). The prevalence of HPR (18.9% vs. 41.5% vs. 44.2%, P<0.001) and the PRU level (154.3±54.2 vs. 196.2±55.5 vs. 194.6±55.8, P<0.001) were significantly lower on prasugrel maintenance therapy compared with the clopidogrel therapy before and after switching. The CYP2C19 genotypes that account for the 3 phenotypes (ie, extensive metabolizer, intermediate metabolizer, and poor metabolizer) had a significant impact on platelet reactivity with clopidogrel (174.9±54.0 vs. 193.1±56.5 vs. 240.6±25.4 PRU, P<0.001) but not prasugrel (147.0±51.9 vs. 147.5±58.3 vs. 184.4±38.3 PRU, P=0.15). Conclusions: Low-dose prasugrel achieves stronger platelet inhibition than clopidogrel in Japanese patients with stable CAD.

Original languageEnglish
Pages (from-to)2439-2444
Number of pages6
JournalCirculation Journal
Volume79
Issue number11
DOIs
Publication statusPublished - Oct 23 2015
Externally publishedYes

Keywords

  • Clopidogrel
  • Percutaneous coronary intervention
  • Platelet resistance
  • Prasugrel

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

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    Nishi, T., Ariyoshi, N., Nakayama, T., Fujimoto, Y., Sugimoto, K., Takahara, M., Wakabayashi, S., Koshizaka, M., Hanaoka, H., & Kobayashi, Y. (2015). Increased platelet inhibition after switching from maintenance clopidogrel to prasugrel in japanese patients with stable coronary artery disease. Circulation Journal, 79(11), 2439-2444. https://doi.org/10.1253/circj.CJ-15-0546