Journal of Thrombosis and Thrombolysis

, Volume 38, Issue 3, pp 395–401

Switching from clopidogrel to prasugrel in patients having coronary stent implantation

  • Guido Parodi
  • Giuseppe De Luca
  • Benedetta Bellandi
  • Vincenzo Comito
  • Renato Valenti
  • Rossella Marcucci
  • Nazario Carrabba
  • Angela Migliorini
  • R. N. Erica Ramazzotti
  • Gian Franco Gensini
  • Rosanna Abbate
  • David Antoniucci
Article

DOI: 10.1007/s11239-013-1040-7

Cite this article as:
Parodi, G., De Luca, G., Bellandi, B. et al. J Thromb Thrombolysis (2014) 38: 395. doi:10.1007/s11239-013-1040-7

Abstract

There are very few clinical data concerning the safety of switching from clopidogrel to prasugrel in patients undergoing coronary stenting. However, in the daily activity, clinicians face the decision of switching patients at high-risk of thrombotic events from clopidogrel to prasugrel. Thus, we sought to evaluate clinical events in patients undergoing coronary stent implantation and prasugrel therapy with (SWITCH group) or without (NAÏVE group) prior clopidogrel therapy. A total of 454 patients with stable or unstable coronary artery disease, aged 70 ± 10 years, underwent non-emergent stent implantation and received prasugrel therapy. Of these, 315 (69 %) patients received clopidogrel before switching to prasugrel therapy. In 239 patients with high residual platelet reactivity (HRPR) on clopidogrel, prasugrel decreased platelet aggregation from 72 ± 11 to 43 ± 16 % (p < 0.001). There was no difference in in-hospital major or minor TIMI bleeding (2.8 vs. 4.3 %; p = 0.411) between the SWITCH and NAÏVE groups as well as in mortality, acute stent thrombosis, reinfarction and stroke rates. At multivariable analysis, independent predictors of bleeding were female gender (OR 5.56 [1.41–19.88] p = 0.014) and chronic renal failure (OR 6.27 [1.59–21.65] p = 0.009), but switching therapy did not. This result was confirmed after switching propensity score adjustment (c-statistic 0.81; Hosmer–Lemeshow test p = 860). Switching from clopidogrel to prasugrel in patients undergoing non-emergent coronary stent implantation seems to be tolerated with no overt signs of increased bleeding.

Keywords

PrasugrelStentSwitchingBleedingAcute coronary syndromes

Copyright information

© Springer Science+Business Media New York 2014

Authors and Affiliations

  • Guido Parodi
    • 1
  • Giuseppe De Luca
    • 2
  • Benedetta Bellandi
    • 1
  • Vincenzo Comito
    • 1
  • Renato Valenti
    • 1
  • Rossella Marcucci
    • 3
  • Nazario Carrabba
    • 1
  • Angela Migliorini
    • 1
  • R. N. Erica Ramazzotti
    • 1
  • Gian Franco Gensini
    • 3
    • 4
  • Rosanna Abbate
    • 3
  • David Antoniucci
    • 1
  1. 1.The Invasive CardiologyCareggi HospitalFlorenceItaly
  2. 2.Division of Cardiology, “Maggiore della Carità” HospitalEastern Piedmont University “A. Avogadro”NovaraItaly
  3. 3.Department of Experimental and Clinical MedicineUniversity of FlorenceFlorenceItaly
  4. 4.Don Carlo Gnocchi FoundationFlorenceItaly