First report of a subacute stent thrombosis in a prasugrel resistant patient successfully managed with ticagrelor.
Prasugrel is a widely used antiplatelet agent in the setting of percutaneous coronary intervention. In case of resistance to this third-generation thienopyridine, choices of alternative drugs remain limited. Here, we describe a case of a 49-year-old man with stent thrombosis occurring 5 days after drug-eluting stent implantation despite a well-conducted antiplatelet therapy with aspirin and prasugrel. Evaluation of platelet functions by different tests revealed prasugrel resistance. Genotyping for various CYP single-nucleotide polymorphisms showed that the patient carried mutant alleles encoding enzymes CYP2B6 and CYP2C9 involved in prasugrel metabolic pathway. Strikingly, an adequate platelet response was rapidly obtained after switching from prasugrel to ticagrelor.
Laboratoire d'Hématologie, Hôpital Cardiologique du Haut-Lévêque , CHU de Bordeaux, Pessac , France .
Mathieu
M
Fiore
Alice
A
Horovitz
Anne-Cecile
AC
Pons
Lionel
L
Leroux
Frederic
F
Casassus
D000241:Adenosine / Q000031:analogs & derivatives* / Q000627:therapeutic use; D004351:Drug Resistance; D006801:Humans; D008297:Male; D008875:Middle Aged; D010879:Piperazines / Q000009:adverse effects*; D000068799:Prasugrel Hydrochloride; D058921:Purinergic P2Y Receptor Antagonists / Q000627:therapeutic use*; D013876:Thiophenes / Q000009:adverse effects*; D013927:Thrombosis / Q000188:drug therapy* / Q000209:etiology; D000077486:Ticagrelor
D010879:Piperazines; D058921:Purinergic P2Y Receptor Antagonists; D013876:Thiophenes; D000068799:Prasugrel Hydrochloride; D000077486:Ticagrelor; D000241:Adenosine
Stent thrombosis; VASP; Verify Now; prasugrel resistance; ticagrelor