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Prasugrel in critically ill patients.

Christian Schoergenhofer, Eva-Luise Hobl, Thomas Staudinger

  • 1Bernd Jilma, MD, Währinger Gürtel 18-20, 1090 Vienna, Austria, Tel.: +43 1 40400 29810, Fax: +43 1 40400 29980,

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Summary
This summary is machine-generated.

Critically ill patients show poor response to prasugrel, with high platelet reactivity and variable drug levels. Absorption, metabolism, and inflammation may explain these findings in intensive care settings.

Keywords:
Antiplatelet drugsintensive care unitpharmacodynamicspharmacokineticsplatelet function

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Area of Science:

  • Cardiology
  • Pharmacology
  • Intensive Care Medicine

Background:

  • Prasugrel is indicated for myocardial infarction.
  • Its efficacy in critically ill patients is unknown.

Purpose of the Study:

  • To measure antiplatelet effects and pharmacokinetics of prasugrel in critically ill patients.
  • To assess prasugrel's effectiveness in intensive care unit (ICU) patients.

Main Methods:

  • Prospective trial of 23 critically ill patients receiving 10 mg prasugrel daily.
  • Assessed adenosine diphosphate (ADP)-induced platelet aggregation and vasodilator-stimulated phosphoprotein (VASP-P) phosphorylation.
  • Measured plasma levels of prasugrel's active metabolite.

Main Results:

  • 65% of patients had high on-treatment platelet reactivity to ADP.
  • 74% showed high platelet function under high shear rates.
  • Only 26% had insufficient inhibition by VASP-P assay.
  • Highly variable plasma levels of prasugrel active metabolite observed (CV ~70%).

Conclusions:

  • Prasugrel's antiplatelet effect is highly variable in critically ill patients.
  • Poor absorption/metabolism and heightened platelet reactivity due to inflammation may contribute.
  • Further research is needed to optimize prasugrel therapy in this population.