Journal of Thrombosis and Thrombolysis

, Volume 38, Issue 3, pp 395–401 | Cite as

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

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

Prasugrel Stent Switching Bleeding Acute coronary syndromes 

Notes

Acknowledgments

This study was supported by the A.R. CARD Foundation, Florence, Italy.

References

  1. 1.
    Wiviott SD, Trenk D, Frelinger AL, PRINCIPLE-TIMI 44 Investigators et al (2007) Prasugrel compared with high loading- and maintenance-dose clopidogrel in patients with planned percutaneous coronary intervention: the Prasugrel in comparison to clopidogrel for inhibition of platelet activation and aggregation-thrombolysis in myocardial infarction 44 trial. Circulation 116:2923–2932PubMedCrossRefGoogle Scholar
  2. 2.
    Wiviott SD, Antman EM, Winters KJ, JUMBO-TIMI 26 Investigators et al (2005) Randomized comparison of prasugrel (CS-747, LY640315), a novel thienopyridine P2Y12 antagonist, with clopidogrel in percutaneous coronary intervention: results of the joint utilization of medications to block platelets optimally (JUMBO)-TIMI 26 trial. Circulation 111:3366–3373PubMedCrossRefGoogle Scholar
  3. 3.
    Wiviott SD, Braunwald E, McCabe CH (2007) TRITON-TIMI 38 Investigators. Prasugrel versus clopidogrel in patients with acute coronary syndromes. N Engl J Med 357:2001–2015PubMedCrossRefGoogle Scholar
  4. 4.
    Wijns W, Kolh P, Danchin N et al (2010) Guidelines on myocardial revascularization. Eur Heart J 31:2501–2555PubMedCrossRefGoogle Scholar
  5. 5.
    Levine GN, Bates ER, Blankenship JC, ACCF, AHA, SCAI Practice Guidelines et al (2011) ACCF/AHA/SCAI guideline for percutaneous coronary intervention: executive summary (2011). A report of the American college of cardiology foundation/American heart association task force on practice guidelines and the society for cardiovascular angiography and interventions. Circulation 124:2574–2609PubMedCrossRefGoogle Scholar
  6. 6.
    Wiviott SD, Braunwald E, Angiolillo DJ, TRITON-TIMI 38 investigators et al (2008) Greater clinical benefit of more intensive oral antiplatelet therapy with prasugrel in patients with diabetes mellitus in the trial to assess improvement in therapeutic outcomes by optimizing platelet inhibition with prasugrel-thrombolysis in myocardial infarction 38. Circulation 118:1626–1636PubMedCrossRefGoogle Scholar
  7. 7.
    Murphy SA, Antman EM, Wiviott SD et al (2008) Reduction in recurrent cardiovascular events with prasugrel compared with clopidogrel in patients with acute coronary syndromes from the TRITON-TIMI 38 trial. Eur Heart J 29:2473–2479PubMedCentralPubMedCrossRefGoogle Scholar
  8. 8.
    Wiviott SD, Braunwald E, McCabe CH, TRITON-TIMI 38 investigators et al (2008) Intensive oral antiplatelet therapy for reduction of ischaemic events including stent thrombosis in patients with acute coronary syndromes treated with percutaneous coronary intervention and stenting in the TRITON-TIMI 38 trial: a subanalysis of a randomised trial. Lancet 371:1353–1363PubMedCrossRefGoogle Scholar
  9. 9.
    Migliorini A, Valenti R, Marcucci R et al (2009) High residual platelet reactivity after clopidogrel loading and long-term clinical outcome after drug-eluting stenting for unprotected left main coronary disease. Circulation 120:2214–2221PubMedCrossRefGoogle Scholar
  10. 10.
    Parodi G, Bellandi B, Venditti F et al (2012) Residual platelet reactivity, bleedings and adherence to treatment in patients having coronary stent implantation treated with prasugrel. Am J Cardiol 109:214–218PubMedCrossRefGoogle Scholar
  11. 11.
    Parodi G, Marcucci R, Valenti R et al (2011) Association between high residual platelet reactivity after clopidogrel loading and long-term cardiovascular events among patients with acute coronary syndromes undergoing percutaneous coronary intervention. JAMA 306:1215–1223PubMedCrossRefGoogle Scholar
  12. 12.
    Erlinge D, Gurbel PA, James S et al (2013) Prasugrel 5-mg in the very elderly attenuates platelet inhibition but maintains non-inferiority to prasugrel 10-mg in non-elderly patients: the generations trial, a pharmacodynamic and pharmacokinetic study in stable coronary artery disease patients. J Am Coll Cardiol 1097:2161–2162Google Scholar
  13. 13.
    Erlinge D, Ten Berg J, Foley D et al (2012) Reduction in platelet reactivity with prasugrel 5 mg in low-body-weight patients is noninferior to prasugrel 10 mg in higher-body-weight patients: results from the feather trial. J Am Coll Cardiol 60:2032–2040PubMedCrossRefGoogle Scholar
  14. 14.
    The TIMI study group (1985) The thrombolysis in myocardial infarction trial. N Engl J Med 31:932–936CrossRefGoogle Scholar
  15. 15.
    Mehran R, Rao SV, Bhatt DL et al (2011) Standardized bleeding definitions for cardiovascular clinical trials. A consensus report from the bleeding academic research consortium. Circulation 123:2736–2747PubMedCrossRefGoogle Scholar
  16. 16.
    Roe MT, Armstrong PW, Fox KA, TRILOGY ACS Investigators et al (2012) Prasugrel versus clopidogrel for acute coronary syndromes without revascularization. New Engl J Med 367:1297–1309PubMedCrossRefGoogle Scholar
  17. 17.
    Small DS, Farid NA, Payne CD et al (2008) Effects of proton pump inhibitors lansoprazole on the pharmacokinetics and pharmacodynamics of prasugrel and clopidogrel. J Clin Pharmacol 48:475–484PubMedCrossRefGoogle Scholar
  18. 18.
    Azmoon S, Angiolillo D (2012) Switching antiplatelets regimens: alternatives to clopidogrel in patients with acute coronary syndrome undergoing PCI. Cath Cardiovasc Interv 81:232–242CrossRefGoogle Scholar
  19. 19.
    Brandt JT, Payne CD, Wiviott SD et al (2007) A comparison of prasugrel and clopidogrel loading doses on platelet function: magnitude of platelet inhibition is related to active metabolite formation. Am Heart J 153(66):9–16Google Scholar
  20. 20.
    Payne CD, Li YG, Brandt JT et al (2008) Switching directly to prasugrel from clopidogrel results in greater inhibition of platelet aggregation in aspirin-treated subjects. Platelets 19:275–281PubMedCrossRefGoogle Scholar
  21. 21.
    Angiolillo DJ, Saucedo JF, Deraad R, SWAP Investigators et al (2010) Increased platelet inhibition after switching from maintenance clopidogrel to prasugrel in patients with acute coronary syndromes: results of the SWAP (SWitching Anti Platelet) study. J Am Coll Cardiol 56:1017–1023PubMedCrossRefGoogle Scholar
  22. 22.
    Montalescot G, Sideris G, Cohen R et al (2010) Prasugrel compared with high-dose clopidogrel in acute coronary syndrome. The randomised, double-blind ACAPULCO study. Thromb Haemost 103:213–223PubMedCrossRefGoogle Scholar
  23. 23.
    Diodati JD, Fung A, Saucedo JF et al (2012) Transferring from clopidogrel loading dose to prasugrel loading dose in acute coronary syndrome patients: the TRIPLET trial. Can J Cardiol 28:S377 724 AbstractCrossRefGoogle Scholar
  24. 24.
    Loh JP, Pendyala LK, Kitabata H et al (2013) Safety of reloading prasugrel in addition to clopidogrel loading in patients with acute coronary syndrome undergoing percutaneous coronary intervention. Am J Cardiol 111:841–845PubMedCrossRefGoogle Scholar
  25. 25.
    Trenk D, Stone GW, Gawaz M et al (2012) A randomized trial of prasugrel versus clopidogrel in patients with high platelet reactivity on clopidogrel after elective percutaneous coronary intervention with implantation of drug eluting stents. J Am Coll Cardiol 59:2159–2164PubMedCrossRefGoogle Scholar

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

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