A. Darlington (1), A. Tello-Montoliu (1), F. Rollini (1), M. Ueno (1), J. L. Ferreiro (1), R. Patel (1), B. Desai (1), L. A. Guzman (1), T. A. Bass (1), D. J. Angiolillo (1)
(1) University of Florida College of Medicine-Jacksonville, Jacksonville, Florida, USA
obesity, Coronary artery disease, clopidogrel, Platelet function, prasugrel
Increased body weight is independently associated with impaired clopidogrel pharmacodynamic (PD) response. Prasugrel has more potent PD effects compared with clopidogrel, although its PD effects in obese patients are unknown. The aim of this prospective, randomised, study was to compare the PD effects of standard-dose prasugrel [60 mg loading dose (LD)/10 mg daily maintenance dose (MD)] with high-dose clopidogrel (900 mg LD/150 mg daily MD) in non-diabetic obese [body mass index (BMI) ≥30 kg/m²] patients, with coronary artery disease (CAD) on aspirin therapy. PD assessments (baseline, 2 hours post-LD and 6 ± 2 days after MD) were conducted using four platelet function assays, and the platelet reactivity index (PRI) assessed by VASP was used for sample size estimation. A total of 42 patients with a BMI of 36.42 ± 5.6 kg/m² completed the study. There were no differences in baseline PD measures between groups. At 2 hours post-LD, prasugrel was associated with lower PRI compared with clopidogrel (24.3 ± 5.5 vs 58.7 ± 5.7, p≤0.001), with consistent findings for all assays. At one-week, PRI values on prasugrel MD were lower than clopidogrel MD without reaching statistical significance (34.7 ± 5.8 vs 42.9 ± 5.8, p=0.32), with consistent findings for all assays. Accordingly, rates of high on-treatment platelet reactivity were markedly reduced after prasugrel LD, but not after MD. In conclusion, in non-diabetic obese patients with CAD, standard prasugrel dosing achieved more potent PD effects than high-dose clopidogrel in the acute phase of treatment, but this was not sustained during maintenance phase treatment. Whether an intensified prasugrel regimen is required in obese patients warrants investigation.
K. Schrör1, K. Huber2
Hämostaseologie 2007 27 5: 351-355
Transferring from clopidogrel loading dose to prasugrel loading dose in acute coronary syndrome patients
High on-treatment platelet reactivity analysis of the TRIPLET trial
J. G. Diodati (1), J. F. Saucedo (2), T. E. Cardillo (3), J. A. Jakubowski (3), C. Henneges (4), M. B. Effron (3), F. R. Lipkin (5), J. R. Walker (5), S. Duvvuru (3), S. S. Sundseth (6), H. N. Fisher (7), D. J. Angiolillo (8)
Thromb Haemost 2014 112 2: -
O. Ö. Braun (1), D. J. Angiolillo (2), J. L. Ferreiro (3), J. A. Jakubowski (4), K. J. Winters (4), M. B. Effron (4), S. Duvvuru (4), T. M. Costigan (4), S. Sundseth (5), J. R. Walker (6), J. F. Saucedo (7), N. S. Kleiman (8), C. Varenhorst (9)
Thromb Haemost 2013 110 6: 1223-1231
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