Korean Circ J.  2014 Nov;44(6):386-393. 10.4070/kcj.2014.44.6.386.

Lower Loading Dose of Prasugrel Compared with Conventional Loading Doses of Clopidogrel and Prasugrel in Korean Patients Undergoing Elective Coronary Angiography: A Randomized Controlled Study Evaluating Pharmacodynamic Efficacy

• Lee DH
• Kim MH
• Guo LZ
• Park MK
• Yi SJ

• KMID: 2223854
• DOI: http://doi.org/10.4070/kcj.2014.44.6.386

Abstract

BACKGROUND AND OBJECTIVES
Although prasugrel allows for rapid and potent platelet inhibition, the efficacy and safety of lower doses of prasugrel for patients of East Asian ethnicity has not yet been investigated. We compared the effect of a lower loading dose (LD) of prasugrel with conventional LDs of clopidogrel and prasugrel in Korean patients.
SUBJECTS AND METHODS
Forty-three Korean patients undergoing coronary angiography were enrolled in the study. Participants were randomly administered LDs of clopidogrel 600 mg, prasugrel 30 mg or prasugrel 60 mg prior to coronary angiography. Platelet reactivity was assessed at baseline and at the time of peak platelet inhibition using light transmission aggregometry (LTA), the VerifyNow assay, and multiple electrode aggregometry.
RESULTS
Although baseline platelet reactivity between the groups showed no significant differences, at the time of peak platelet inhibition, the prasugrel 30 mg (18.9+/-10.0%) and 60 mg groups (13.8+/-10.8%) showed significantly more potent platelet inhibition than the clopidogrel 600 mg group (52.9+/-15.8%; p<0.001) by LTA. However, there were no significant differences between the prasugrel 30 mg and 60 mg groups (p=0.549).
CONCLUSION
The loading effect of prasugrel 30 mg was more potent than clopidogrel 600 mg and was not significantly different from prasugrel 60 mg.

Keyword

Prasugrel; Clopidogrel; Platelet function tests; Population heterogeneity; Coronary artery disease

MeSH Terms

Asian Continental Ancestry Group
Blood Platelets
Coronary Angiography*
Coronary Artery Disease
Electrodes
Humans
Platelet Function Tests
Population Characteristics
Prasugrel Hydrochloride

Figure

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  Fig. 1 Platelet reactivity at baseline and peak platelet inhibition. Platelet reactivity measured at baseline (A, B, and C) and at the time of peak platelet inhibition (D, E, and F) using LTA, VerifyNow, and MEA. The baseline platelet reactivity values were statistically identical between study groups, whereas platelet reactivity at the time of peak platelet inhibition exhibited significant differences. Although platelet reactivity values for the clopidogrel 600 mg group were significantly higher than both prasugrel groups, there was no statistical difference between the prasugrel 30 mg and 60 mg groups. LTA: light transmission aggregometry, MEA: multiple electrode aggregometry.

• 

  Fig. 2 Comparison of inhibition (%) between study groups. Percent inhibition was significantly lower in the clopidogrel 600 mg group than for both prasugrel groups. However, there was no statistical difference between the prasugrel groups. LTA: light transmission aggregometry, MEA: multiple electrode aggregometry.

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