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Microfluidics in Assessing Platelet Function
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Decrease in high on-treatment platelet reactivity (HPR) prevalence on switching from clopidogrel to prasugrel:
Jorge F Saucedo1, Dominick J Angiolillo, Roger DeRaad
1University of Oklahoma Health Sciences Center, 920 Stanton L Young Blvd, WP 3010, Oklahoma City, OK 73104, USA. Jorge-Saucedo@ouhsc.edu
Thrombosis and Haemostasis
|December 11, 2012
Summary
Switching acute coronary syndrome patients from clopidogrel to prasugrel significantly reduced high platelet reactivity (HPR). This strategy may offer an alternative for managing HPR, regardless of CYP2C19 genotype.
Area of Science:
- Cardiology
- Pharmacology
- Clinical Trials
Background:
- High platelet reactivity (HPR) is a concern in acute coronary syndrome (ACS) patients treated with antiplatelet therapy.
- The impact of switching from clopidogrel to prasugrel during the maintenance phase on HPR prevalence is not well understood.
- Genetic variations in cytochrome P450 (CYP) 2C19 can influence clopidogrel efficacy.
Purpose of the Study:
- To evaluate the effect of switching antiplatelet therapy from clopidogrel to prasugrel on HPR prevalence in ACS patients.
- To assess HPR using multiple definitions after switching to prasugrel maintenance dose, with or without a loading dose.
Main Methods:
- Analysis of 95 ACS patients from the SWAP study who switched from clopidogrel to prasugrel.
- HPR assessed at multiple time points using maximum platelet aggregation (MPA) >65% (primary), MPA >50%, P2Y12 reaction units (PRU) >235, and platelet reactivity index (PRI) ≥ 50%.
- Genetic analysis of CYP2C19 in 56 patients.
Main Results:
- Baseline HPR prevalence (MPA >65%) was 27.4% before switching to prasugrel.
- Switching to prasugrel significantly reduced HPR prevalence at seven days across multiple definitions (e.g., MPA >65%: 21.2% vs. 4.5%, p<0.05).
- Reduced HPR with prasugrel was observed in patients with and without reduced function CYP2C19 alleles.
Conclusions:
- Switching ACS patients from clopidogrel to prasugrel during maintenance therapy is associated with a significant reduction in HPR.
- This switch may serve as an alternative strategy for managing HPR in ACS patients, irrespective of their CYP2C19 genotype.
- Further research is warranted to confirm these findings and optimize antiplatelet strategies.
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