Greater inhibition of platelet aggregation and reduced response variability with prasugrel versus clopidogrel: an integrated analysis.
Multiple studies report response variability to a 300-mg clopidogrel loading dose (LD). Pooled platelet aggregometry data compared responses (change in maximal platelet aggregation [DeltaMPA] or inhibition of platelet aggregation [IPA]) to clopidogrel 300-mg (n = 131) or prasugrel 60-mg (n = 109) LDs. Poor responder rates were determined using empiric criteria (IPA < 10% and DeltaMPA < 10% for 20 microM and 5 microM adenosine diphosphate [ADP]) and Bayesian model-based criteria (IPA < 20% and DeltaMPA < 15% for 20 microM ADP; IPA < 25% and DeltaMPA < 20% for 5 microM ADP). Prasugrel achieved greater DeltaMPA and IPA from 2 to 24 hours post-LD (P < .001). For 20 microM ADP, poor responder rates for clopidogrel ranged from 17% to 43%; no prasugrel poor responders were observed. Regardless of the criterion, prasugrel 60 mg achieved greater IPA and fewer poor responders than the clopidogrel 300-mg LD.
Weerakkody
Govinda J
GJ
Lilly Research Laboratories, Eli Lilly and Company, Indianapolis, Indiana 46285, USA. weerakkody_govinda@lilly.com
Jakubowski
Joseph A
JA
Brandt
John T
JT
Payne
Christopher D
CD
Naganuma
Hideo
H
Winters
Kenneth J
KJ
D000244:Adenosine Diphosphate; D000293:Adolescent; D000328:Adult; D000368:Aged; D001499:Bayes Theorem; D017321:Clinical Trials, Phase I as Topic; D000077144:Clopidogrel; D016208:Databases, Factual; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010879:Piperazines / Q000494:pharmacology*; D010974:Platelet Aggregation / Q000187:drug effects*; D010975:Platelet Aggregation Inhibitors / Q000494:pharmacology*; D010979:Platelet Function Tests; D000068799:Prasugrel Hydrochloride; D013876:Thiophenes / Q000494:pharmacology*; D013988:Ticlopidine / Q000031:analogs & derivatives* / Q000494:pharmacology; D016896:Treatment Outcome
D010879:Piperazines; D010975:Platelet Aggregation Inhibitors; D013876:Thiophenes; D000244:Adenosine Diphosphate; D000077144:Clopidogrel; D000068799:Prasugrel Hydrochloride; D013988:Ticlopidine