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Clopidogrel pretreatment of patients with ST-elevation myocardial infarction does not affect platelet reactivity

Thomas G Nührenberg1, Dietmar Trenk, Stefan Leggewie

  • 1Klinik für Kardiologie und Angiologie II, Universitäts-Herzzentrum Freiburg · Bad Krozingen , Südring 15, , D-79189 Bad Krozingen , Germany.

Platelets
|December 11, 2012
PubMed

Insights

Prasugrel loading before percutaneous coronary intervention (PCI) for ST-elevation myocardial infarction (STEMI) is effective regardless of prior clopidogrel use. Platelet reactivity remains consistent, supporting prasugrel administration even in pretreated patients.

Area of Science:

  • Cardiology
  • Pharmacology
  • Interventional Cardiology

Background:

  • Current guidelines recommend prasugrel or ticagrelor for ST-elevation myocardial infarction (STEMI) patients undergoing percutaneous coronary intervention (PCI).
  • Data support ticagrelor use regardless of prior clopidogrel, but similar data for prasugrel are lacking.
  • Investigating prasugrel's efficacy in clopidogrel-naïve versus pretreated STEMI patients is crucial.

Purpose of the Study:

  • To assess platelet reactivity after prasugrel loading in STEMI patients pretreated with clopidogrel versus those treatment-naïve.
  • To determine if prior clopidogrel administration impacts prasugrel's antiplatelet effect.

Main Methods:

  • Forty-seven STEMI patients undergoing primary PCI were studied.
  • Patients received either prasugrel alone or prasugrel after clopidogrel loading.
  • Platelet reactivity was measured using VerifyNow™ P2Y12, light transmission aggregometry (LTA), and multiple electrode impedance aggregometry (MEIA).

Main Results:

  • No significant difference in platelet reactivity was observed on day 1 post-PCI between the two groups.
  • Platelet reactivity unit (PRU) values were similar: 10 [8-31] for clopidogrel + prasugrel vs. 9 [6-60] for prasugrel alone.
  • The proportion of patients with bleeding risk markers was comparable across groups.

Conclusions:

  • Prasugrel loading demonstrates consistent antiplatelet effects in STEMI patients, irrespective of prior clopidogrel pretreatment.
  • These findings suggest that withholding prasugrel due to prior clopidogrel use is not supported.
  • Prasugrel can be safely administered as a loading dose before PCI in STEMI patients, even if they have received clopidogrel.

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