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Prasugrel or double-dose clopidogrel to overcome clopidogrel low-response--the TAILOR (Thrombocytes And IndividuaLization of ORal antiplatelet therapy in percutaneous coronary intervention) randomized trial.
- Source :
-
Platelets [Platelets] 2014; Vol. 25 (7), pp. 506-12. Date of Electronic Publication: 2013 Nov 18. - Publication Year :
- 2014
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Abstract
- High on-treatment platelet reactivity (HTPR) is associated with poor prognosis in patients undergoing percutaneous coronary intervention (PCI). The antiplatelet effect and safety of prasugrel was compared to that of double-dose clopidogrel in patients with stable coronary artery disease or acute coronary syndrome (ACS) exhibiting HTPR on clopidogrel and treated with PCI, using multiple electrode aggregometry (MEA) to assess platelet reactivity. Of 923 patients screened, 237 (25.7%) exhibited HTPR. Of these, 106 were eligible for participation in a randomized trial comparing two intensified antiplatelet regimen: 52 were assigned to double maintenance-dose clopidogrel and 54 to standard-dose prasugrel. At 1 month, tailoring antiplatelet therapy improved platelet inhibition to a level considered as therapeutic in 73.1% of patients. Prasugrel entailed greater platelet inhibition (p = 0.02) and a lower rate of persisting HTPR at follow-up compared to double-dose clopidogrel (HTPR persisted in 20.4% and 42% respectively, p = 0.02). Within the 30-day follow-up, no major bleeds were observed and the incidence of major adverse cardiovascular events (MACE) was similar in the two treatment arms. Prasugrel demonstrated superiority to double-dose clopidogrel in overcoming HTPR and reducing platelet activity. Intensifying antiplatelet therapy in both ACS and stable angina pectoris (SAP) patients exhibiting HTPR prior to PCI was well tolerated.
- Subjects :
- Aged
Clopidogrel
Coronary Artery Disease blood
Coronary Artery Disease drug therapy
Coronary Artery Disease surgery
Female
Humans
Male
Piperazines adverse effects
Platelet Aggregation Inhibitors adverse effects
Prasugrel Hydrochloride
Prognosis
Thiophenes adverse effects
Ticlopidine administration & dosage
Ticlopidine adverse effects
Treatment Outcome
Blood Platelets drug effects
Coronary Artery Disease therapy
Percutaneous Coronary Intervention methods
Piperazines administration & dosage
Platelet Aggregation Inhibitors administration & dosage
Thiophenes administration & dosage
Ticlopidine analogs & derivatives
Subjects
Details
- Language :
- English
- ISSN :
- 1369-1635
- Volume :
- 25
- Issue :
- 7
- Database :
- MEDLINE
- Journal :
- Platelets
- Publication Type :
- Academic Journal
- Accession number :
- 24245960
- Full Text :
- https://doi.org/10.3109/09537104.2013.845874