title: Thienopyridine reloading in clopidogrel-loaded patients undergoing percutaneous coronary interventions: The PRAISE study.
abstract: OBJECTIVE
  The impact of thienopyridine reloading on clinical outcomes, and residual high platelet reactivity (HPR) is unclear. We sought to compare the HRP-related effect of prasugrel and clopidogrel reloading in the already clopidogrel-loaded patients undergoing percutaneous coronary intervention (PCI).
  
  
  METHODS
  In this prospective, two-center, randomized, open-label study, patients with HPR who had undergone PCI after a clopidogrel (300-600mg) loading dose (LD) were enrolled. Among screened (n=153), HPR was determined in seventy-six patients, who were randomized to either repeated clopidogrel (300mg LD, followed by 75mg MD daily) or prasugrel (20mg LD, followed by 5mg MD daily). The primary endpoint was HPR at 24h after PCI, as determined by the VerifyNow assay. The rates of sustained high and low platelet reactivity, periprocedural myocardial injury (PMI) and 30-day clinical outcomes were also assessed.
  
  
  RESULTS
  Higher inhibition of platelet reactive units (PRU) was observed in the prasugrel group than after clopidogrel reloading (Pre-PCI: 284.4±32.0 vs 279.5±32.5, p=0.504; Post-PCI: 100.0±67.0 vs 202.9±65.8, p<0.001; 30days: 170.8±69.8 vs 215.1±62.4, p=0.007). There were less HRP post-PCI after prasugrel compared with the clopidogrel group (2.7 vs 36.1%, p<0.001). However, reloading with prasugrel did not reduce PMI compared to clopidogrel (36.8% vs 39.5%, p=0.813).
  
  
  CONCLUSIONS
  Prasugrel reloading led to a greater reduction in HPR, but similar with clopidogrel PMI in post-PCI patients. Larger randomized evidence is needed for optimization of loading strategies with thienopyridines.
  
  
  BACKGROUND
  NCT01609647.
authors: Department of Cardiology, The Fourth Affiliated Hospital of Harbin Medical University, Harbin, China; Department of Cardiology, Dong-A University Hospital, Busan, South Korea; Clinical Trial Center, Dong-A University Hospital, Busan, South Korea.
authors: Long Zhe
authors: LZ
authors: Guo
authors: Department of Cardiology, Dong-A University Hospital, Busan, South Korea; Clinical Trial Center, Dong-A University Hospital, Busan, South Korea. Electronic address: kimmh@dau.ac.kr.
authors: Moo Hyun
authors: MH
authors: Kim
authors: Division of Cardiology, Ulsan University Hospital, University of Ulsan College of Medicine, Ulsan, South Korea.
authors: Eun Seok
authors: ES
authors: Shin
authors: Division of Cardiology, Ulsan University Hospital, University of Ulsan College of Medicine, Ulsan, South Korea.
authors: Soe Hee
authors: SH
authors: Ann
authors: Department of Cardiology, Dong-A University Hospital, Busan, South Korea; Clinical Trial Center, Dong-A University Hospital, Busan, South Korea.
authors: Cai
authors: C
authors: De Jin
authors: Department of Cardiology, Dong-A University Hospital, Busan, South Korea.
authors: Young-Rak
authors: YR
authors: Cho
authors: Department of Cardiology, Dong-A University Hospital, Busan, South Korea.
authors: Jong Sung
authors: JS
authors: Park
authors: Department of Cardiology, Dong-A University Hospital, Busan, South Korea.
authors: Kyungil
authors: K
authors: Park
authors: Department of Cardiology, Dong-A University Hospital, Busan, South Korea.
authors: Tae-Ho
authors: TH
authors: Park
authors: UCLA Medical Center, Los Angeles, California, USA.
authors: Michael S
authors: MS
authors: Lee
authors: Johns Hopkins University, Baltimore, MD, USA.
authors: Victor L
authors: VL
authors: Serebruany
mesh_terms: D000368:Aged; D000077144:Clopidogrel; D004359:Drug Therapy, Combination; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D062645:Percutaneous Coronary Intervention / Q000009:adverse effects / Q000639:trends*; D015539:Platelet Activation / Q000187:drug effects* / Q000502:physiology*; D010975:Platelet Aggregation Inhibitors / Q000008:administration & dosage*; D011446:Prospective Studies; D011725:Pyridines / Q000008:administration & dosage*; D013988:Ticlopidine / Q000008:administration & dosage / Q000031:analogs & derivatives*
chemical_list: D010975:Platelet Aggregation Inhibitors; D011725:Pyridines; C446540:thienopyridine; D000077144:Clopidogrel; D013988:Ticlopidine
keywords: Acute coronary syndrome; Clopidogrel; Coronary interventions; PRAISE; Platelet reactivity; Prasugrel