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Related Experiment Video

Updated: Oct 11, 2025

Microfluidics in Assessing Platelet Function

Microfluidics in Assessing Platelet Function

Published on: November 8, 2024

High On-Treatment Platelet Reactivity Associated With Prasugrel.

William D Cahoon¹, Amanda L Kroll¹, Denise K Lowe¹

¹Virginia Commonwealth University Health Systems, Richmond, VA, USA.

The Journal of Pharmacy Technology : Jpt : Official Publication of the Association of Pharmacy Technicians

|December 3, 2021

Summary

High on-treatment platelet reactivity (HTPR) occurred with prasugrel despite initial response, leading to treatment failure. Switching to ticagrelor achieved adequate platelet inhibition and prevented further cardiac events in this patient.

Keywords:

adherence adverse drug reactions antiplatelets cardiology cardiovascular drugs

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Area of Science:

Cardiology
Pharmacology
Clinical Medicine

Background:

High on-treatment platelet reactivity (HTPR) is linked to adverse cardiovascular events.
Prasugrel is a P2Y12 inhibitor used to prevent thrombotic events.
Understanding HTPR is crucial for optimizing antiplatelet therapy.

Observation:

A patient with prior myocardial infarction (MI) on maintenance prasugrel developed HTPR.
Despite an initial adequate response, HTPR recurred during maintenance therapy.
The patient experienced recurrent ischemia attributed to HTPR on prasugrel.

Findings:

A P2Y12 assay confirmed HTPR (331 PRU) initially, which normalized after a prasugrel reload (118 PRU).
HTPR recurred (278 PRU) during maintenance prasugrel therapy, prompting a switch to ticagrelor.
Ticagrelor effectively inhibited platelet reactivity (97 PRU) and resolved ischemia.

Implications:

This case highlights the potential for HTPR with prasugrel maintenance therapy, even after initial adequate response.
Recognizing and managing HTPR is critical for preventing treatment failure and adverse cardiac events.
Further research is needed to determine the incidence, risk factors, and optimal management strategies for HTPR with prasugrel.