title: A pharmacodynamic comparison of 5 anti-platelet protocols in patients with ST-elevation myocardial infarction undergoing primary PCI.
abstract: BACKGROUND
  Despite advances in anti-platelet treatments, there still exists an early increase in both ischemic as well as bleeding events following primary PCI in patients with ST-elevation myocardial infarction (STEMI). Platelet inhibition data of different anti-platelet treatments in the acute phase of a myocardial infarction might offer some insight into these problems. The aim of this study was to evaluate the pharmacodynamic profile of 5 different anti-platelet treatments in the acute phase of STEMI in patients undergoing primary PCI.
  
  
  METHODS
  A total of 223 STEMI patients undergoing primary PCI were prospectively included. Patients received either pre-hospital clopidogrel only, pre-hospital clopidogrel followed by prasugrel switch in the cath lab, prasugrel treatment only, pre-hospital clopidogrel followed by ticagrelor switch in the cath lab or pre-hospital ticagrelor only. Platelet reactivity was measured serially using vasodilator-stimulated phosphoprotein (VASP).
  
  
  RESULTS
  Patients receiving pre-hospital clopidogrel followed by prasugrel switch showed similar platelet inhibition data as patients receiving prasugrel only, with more than 90% being good responders the day after PCI. Average time from prasugrel administration to a VASP value of <50% was 1.5 hours. In patients receiving pre-hospital ticagrelor, 50% were good responders at completion of PCI and average time to a VASP-value of <50% was 2.3 hours. Only 32% of patients receiving clopidogrel only were responders the day after PCI.
  
  
  CONCLUSIONS
  Switching from an upstream bolus dose of clopidogrel to prasugrel at the time of PCI, appeared as a safe and feasible option with no tendency for overshoot or attenuation of platelet inhibition. Pre-hospital administration of ticagrelor was associated with a 50% good responder rate at completion of PCI.
authors.affiliation: Department of Cardiology, Lund University, Skåne University Hospital Lund, SE 221 85, Lund, Sweden. sasha.koul@med.lu.se.
authors.forename: Sasha
authors.initials: S
authors.lastname: Koul
authors.forename: Pontus
authors.initials: P
authors.lastname: Andell
authors.forename: Andreas
authors.initials: A
authors.lastname: Martinsson
authors.forename: J Gustav
authors.initials: JG
authors.lastname: Smith
authors.forename: Fredrik
authors.initials: F
authors.lastname: Scherstén
authors.forename: Jan
authors.initials: J
authors.lastname: Harnek
authors.forename: Matthias
authors.initials: M
authors.lastname: Götberg
authors.forename: Eva
authors.initials: E
authors.lastname: Norström
authors.forename: Sven
authors.initials: S
authors.lastname: Björnsson
authors.forename: David
authors.initials: D
authors.lastname: Erlinge
mesh_terms: D000241:Adenosine / Q000009:adverse effects / Q000031:analogs & derivatives / Q000494:pharmacology / Q000627:therapeutic use; D000368:Aged; D001792:Blood Platelets / Q000187:drug effects*; D002985:Clinical Protocols; D000077144:Clopidogrel; D004334:Drug Administration Schedule; D004562:Electrocardiography; D005260:Female; D006470:Hemorrhage / Q000139:chemically induced; D006801:Humans; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000188:drug therapy* / Q000601:surgery*; D062645:Percutaneous Coronary Intervention; D010879:Piperazines / Q000009:adverse effects / Q000494:pharmacology / Q000627:therapeutic use; D010975:Platelet Aggregation Inhibitors / Q000009:adverse effects / Q000494:pharmacology* / Q000627:therapeutic use*; D000068799:Prasugrel Hydrochloride; D011446:Prospective Studies; D013876:Thiophenes / Q000009:adverse effects / Q000494:pharmacology / Q000627:therapeutic use; D000077486:Ticagrelor; D013988:Ticlopidine / Q000009:adverse effects / Q000031:analogs & derivatives / Q000494:pharmacology / Q000627:therapeutic use
chemical_list: D010879:Piperazines; D010975:Platelet Aggregation Inhibitors; D013876:Thiophenes; D000077144:Clopidogrel; D000068799:Prasugrel Hydrochloride; D000077486:Ticagrelor; D000241:Adenosine; D013988:Ticlopidine