title: Impact of Switching From Prasugrel to Clopidogrel Shortly After a Percutaneous Coronary Intervention Without a Loading Dose of Clopidogrel.
abstract: OBJECTIVE
  To determine the safety and efficacy of administering prasugrel at the time of percutaneous coronary intervention (PCI), and switching to clopidogrel, without reloading.
  
  
  BACKGROUND
  Prasugrel has faster onset of action and appears to be of greater benefit than clopidogrel, particularly early after PCI. However, long-term prasugrel increases bleeding. Many physicians at Geisinger Medical Center (GMC) administer prasugrel before PCI and switch to clopidogrel afterward. The safety and efficacy of this strategy has not been studied.
  
  
  METHODS
  We performed a retrospective study using electronic medical records and identified patients at GMC who underwent PCI between February 1, 2009 and January 31, 2012 and received a loading dose of prasugrel with a subsequent switch to clopidogrel, without reloading. The primary endpoint was major adverse cardiovascular event (MACE), defined as death, myocardial infarction (MI), stroke, or stent thrombosis, 7 days after the first dose of clopidogrel. Secondary endpoints included MACE at 30 days, individual MACE components at 7 and 30 days post procedure, and bleeding as defined by the Bleeding Academic Research Consortium (BARC) at 1 day and 30 days.
  
  
  RESULTS
  A total of 151 patients met inclusion criteria. One patient suffered a MACE on day 7 (0.7%; 95% confidence interval, 0.03%-3.33%). One patient had an MI between 8-30 days. Two patients had BARC bleeding (type 2 and type 3b) 30 days post PCI.
  
  
  CONCLUSIONS
  In this small, retrospective analysis, the results of loading patients with prasugrel for PCI and switching them to clopidogrel without a loading dose appear to be encouraging.
authors.forename: Eddy
authors.initials: E
authors.lastname: Mizrahi
authors.forename: Ramya Smitha
authors.initials: RS
authors.lastname: Suryadevara
authors.forename: Kulpreet
authors.initials: K
authors.lastname: Barn
authors.forename: Gouthami
authors.initials: G
authors.lastname: Boga
authors.forename: Mian Muhammad Ali
authors.initials: MM
authors.lastname: Akram
authors.forename: Ibrahim
authors.initials: I
authors.lastname: Ismail-Sayed
authors.forename: Yvette M
authors.initials: YM
authors.lastname: Henry
authors.forename: Melissa A
authors.initials: MA
authors.lastname: Troup
authors.affiliation: North Shore-LIJ System Administration, 145 Community Drive, Great Neck, NY 11021 USA. pberger@nshs.edu.
authors.forename: Peter B
authors.initials: PB
authors.lastname: Berger
mesh_terms: D000077144:Clopidogrel; D017023:Coronary Angiography; D003324:Coronary Artery Disease / Q000175:diagnosis / Q000628:therapy*; D004305:Dose-Response Relationship, Drug; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D062645:Percutaneous Coronary Intervention; D010975:Platelet Aggregation Inhibitors / Q000008:administration & dosage; D011182:Postoperative Care / Q000379:methods*; D000068799:Prasugrel Hydrochloride / Q000008:administration & dosage*; D058921:Purinergic P2Y Receptor Antagonists / Q000008:administration & dosage; D012189:Retrospective Studies; D013988:Ticlopidine / Q000008:administration & dosage / Q000031:analogs & derivatives*; D013997:Time Factors; D016896:Treatment Outcome
chemical_list: D010975:Platelet Aggregation Inhibitors; D058921:Purinergic P2Y Receptor Antagonists; D000077144:Clopidogrel; D000068799:Prasugrel Hydrochloride; D013988:Ticlopidine