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A pharmacodynamic study of the optimal P2Y12 inhibitor regimen for East Asian patients with acute coronary syndrome
The Korean Journal of Internal Medicine ; : 620-628, 2015.
Article in English | WPRIM | ID: wpr-216629
ABSTRACT
BACKGROUND/

AIMS:

Newer P2Y12 inhibitors, such as prasugrel and ticagrelor, have greater antiplatelet efficacy but may increase the risk of bleeding. In this study, we compared the pharmacodynamic efficacy of prasugrel and ticagrelor in East Asian patients with acute coronary syndrome (ACS).

METHODS:

We selected 83 ACS patients undergoing percutaneous coronary intervention who were discharged with 90 mg ticagrelor twice daily (n = 24), 10 mg prasugrel daily (n = 39) or 5 mg prasugrel daily (n = 20). After 2 to 4 weeks, on-treatment platelet reactivity (OPR) was assessed in terms of P2Y12 reaction units (PRUs) using the VerifyNow P2Y12 assay (Accumetrics). We compared East Asian (85 < PRU < or = 275) and Caucasian (85 < PRU < or = 208) criteria for assessing the therapeutic window of OPR.

RESULTS:

OPR was lowest in the ticagrelor group, followed by the 10 mg prasugrel and 5 mg prasugrel groups (49.1 ± 29.9 vs. 83.7 ± 57.1 vs. 168.5 ± 60.8, respectively; p < 0.001). The 5 mg prasugrel group had the highest proportion of patients with OPR values within the therapeutic window, followed by the 10 mg prasugrel and ticagrelor groups (90.0% vs. 46.2% vs. 12.5%, respectively; p < 0.001 for East Asian criteria; 60.0% vs. 43.6% vs. 12.5%, respectively; p < 0.001 for Caucasian criteria).

CONCLUSIONS:

Short-term administration of 5 mg prasugrel facilitated maintenance within the therapeutic window of OPR compared with the 10 mg prasugrel and ticagrelor groups. Thus, 5 mg prasugrel daily may be the optimal antiplatelet regimen for stabilized East Asian ACS patients.
Subject(s)

Full text: Available Index: WPRIM (Western Pacific) Main subject: Platelet Function Tests / Time Factors / Blood Platelets / Drug Administration Schedule / Platelet Aggregation Inhibitors / Adenosine / Pilot Projects / Retrospective Studies / Risk Factors / Treatment Outcome Type of study: Etiology study / Observational study / Risk factors Limits: Aged / Female / Humans / Male Country/Region as subject: Asia Language: English Journal: The Korean Journal of Internal Medicine Year: 2015 Type: Article

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Full text: Available Index: WPRIM (Western Pacific) Main subject: Platelet Function Tests / Time Factors / Blood Platelets / Drug Administration Schedule / Platelet Aggregation Inhibitors / Adenosine / Pilot Projects / Retrospective Studies / Risk Factors / Treatment Outcome Type of study: Etiology study / Observational study / Risk factors Limits: Aged / Female / Humans / Male Country/Region as subject: Asia Language: English Journal: The Korean Journal of Internal Medicine Year: 2015 Type: Article