title: A pilot study of prasugrel followed by post-procedural maintenance with clopidogrel in patients receiving percutaneous coronary intervention.
abstract: BACKGROUND
  Dual anti-platelet therapy including clopidogrel or prasugrel is standard of care for patients receiving stents. Prasugrel has quicker onset so it can be loaded later than clopidogrel with greater efficacy. However, prasugrel is much more expensive than clopidogrel.
  
  
  OBJECTIVE
  To describe the incidence of 30-day death from cardiovascular causes, myocardial infarction, unstable angina requiring intervention, and minor and major bleeding in patients loaded with 60 mg of prasugrel prior to percutaneous coronary intervention (PCI) and then continued on 75 mg of clopidogrel daily after the procedure.
  
  
  METHODS
  We reviewed sequential medical records of 102 patients (Mean age: 67.8, male 68.6%, smokers: 22.6%, BMI: 29.5%, hypertension: 90.2%, DM: 33.3%, average ejection fraction: 49.7%) who underwent PCI (3.9% STEMI, 12.7% NSTEMI, 35.3% unstable angina and 48.1% electively) at Baylor University Medical Center between October 2009 and December 2011 who were loaded with prasugrel 60 mg prior to procedure, and then continued on 75 mg clopidogrel daily.
  
  
  RESULTS
  None of the patients died or experienced a myocardial infarction (MI) within 30 days of the procedure. Three patients experienced unstable angina requiring intervention but none had in-stent thrombosis or restenosis on repeat angiography. None of the patients experienced a major bleeding event. One patient developed a gastrointestinal bleed which did not require blood transfusion and the bleeding it resolved on discontinuation of the clopidogrel.
  
  
  CONCLUSIONS
  In this retrospective pilot study, a strategy of loading patients needing PCI with prasugrel 60 mg immediately prior to coronary intervention, then continuation of anti-platelet therapy with 75 mg clopidogrel daily was safe and effective.
authors.affiliation: Baylor University Medical Center / Jack and Jane Hamilton Heart and Vascular Hospital, Dallas, TX 75226, USA.
authors.forename: Mina M
authors.initials: MM
authors.lastname: Benjamin
authors.forename: Giovanni
authors.initials: G
authors.lastname: Filardo
authors.forename: Michael S
authors.initials: MS
authors.lastname: Donsky
authors.forename: Jeffrey M
authors.initials: JM
authors.lastname: Schussler
mesh_terms: D000368:Aged; D000077144:Clopidogrel; D005260:Female; D006801:Humans; D008297:Male; D062645:Percutaneous Coronary Intervention; D010865:Pilot Projects; D010879:Piperazines / Q000627:therapeutic use*; D010975:Platelet Aggregation Inhibitors / Q000627:therapeutic use*; D011182:Postoperative Care; D000068799:Prasugrel Hydrochloride; D011300:Preoperative Care; D012189:Retrospective Studies; D013876:Thiophenes / Q000627:therapeutic use*; D013988:Ticlopidine / Q000031:analogs & derivatives* / Q000627:therapeutic use
chemical_list: D010879:Piperazines; D010975:Platelet Aggregation Inhibitors; D013876:Thiophenes; D000077144:Clopidogrel; D000068799:Prasugrel Hydrochloride; D013988:Ticlopidine