title: In-hospital switching from clopidogrel to prasugrel following thrombolysis for ST-elevation myocardial infarction: a 3-year single center experience.
abstract: BACKGROUND
  Prasugrel has proved its superiority over clopidogrel for reducing ischemic events among patients with ST elevation myocardial infarction (STEMI) undergoing urgent percutaneous coronary intervention (PCI). Data on switching of antiplatelet therapy in acute coronary syndrome patients in clinical practice are very limited. Importantly, the safety of in-hospital switching from clopidogrel to prasugrel following thrombolysis has not been addressed.
  
  
  METHODS
  We reviewed consecutive STEMI patients from February 2011 to April 2014 who were transferred to a tertiary center after receiving thrombolysis and a loading dose of clopidogrel in a non-PCI-capable center. If not contraindicated, these patients were reloaded and treated with prasugrel. A control group, three times larger, was selected from patients who underwent primary PCI and were initially treated with prasugrel. In-hospital outcomes were examined.
  
  
  RESULTS
  Cases (n=45, 13% female, mean age 56 years) and controls (n=135, 11% female, mean age 54 years) did not differ significantly with respect to MI location, left ventricular systolic function, and extent of coronary artery disease. Mean time from thrombolysis to prasugrel loading was 32±19 hours. No significant differences were found between cases and controls in TIMI major or minor bleeding (0% vs. 3%), overall mortality (0% vs. 1.5%), and hospitalization length (4.8 vs. 5.5 days).
  
  
  CONCLUSIONS
  In-hospital reloading and subsequent maintenance therapy with prasugrel in patients who received thrombolysis and a loading dose of clopidogrel appears to be as safe as in STEMI patients managed by primary PCI; however, larger studies are needed to verify these results.
authors.affiliation: Department of Cardiology, Soroka University Medical Center, Faculty of Health Science, Ben-Gurion University of The Negev, Beer Sheva, Israel.
authors.forename: Tsahi T
authors.initials: TT
authors.lastname: Lerman
authors.affiliation: Department of Cardiology, Soroka University Medical Center, Faculty of Health Science, Ben-Gurion University of The Negev, Beer Sheva, Israel.
authors.forename: Doron
authors.initials: D
authors.lastname: Zahger
authors.affiliation: Department of Emergency Medicine, Yoseftal Medical Center, Eilat, Faculty Of Health Science, Ben-Gurion University of The Negev, Beer Sheva, Israel.
authors.forename: Jacob
authors.initials: J
authors.lastname: Arad
authors.affiliation: Department of Cardiology, Soroka University Medical Center, Faculty of Health Science, Ben-Gurion University of The Negev, Beer Sheva, Israel.
authors.forename: Harel
authors.initials: H
authors.lastname: Gilutz
authors.affiliation: Department of Cardiology, Soroka University Medical Center, Faculty of Health Science, Ben-Gurion University of The Negev, Beer Sheva, Israel.
authors.forename: Olga
authors.initials: O
authors.lastname: Reitblat
authors.affiliation: Department of Cardiology, Soroka University Medical Center, Faculty of Health Science, Ben-Gurion University of The Negev, Beer Sheva, Israel ashimony@bgu.ac.il.
authors.forename: Avi
authors.initials: A
authors.lastname: Shimony
mesh_terms: D000368:Aged; D000077144:Clopidogrel; D005260:Female; D006760:Hospitalization; D006801:Humans; D008297:Male; D008875:Middle Aged; D062645:Percutaneous Coronary Intervention / Q000009:adverse effects*; D000068799:Prasugrel Hydrochloride / Q000008:administration & dosage* / Q000627:therapeutic use; D000072657:ST Elevation Myocardial Infarction / Q000188:drug therapy*; D063128:Tertiary Health Care; D013927:Thrombosis / Q000139:chemically induced / Q000517:prevention & control*; D013988:Ticlopidine / Q000008:administration & dosage / Q000031:analogs & derivatives* / Q000627:therapeutic use
chemical_list: D000077144:Clopidogrel; D000068799:Prasugrel Hydrochloride; D013988:Ticlopidine
keywords: Clopidogrel; Prasugrel; ST-elevation myocardial infarction; Thrombolysis