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Prasugrel in Clopidogrel Nonresponders Undergoing Percutaneous Coronary Intervention: The RECLOSE-3 Study (REsponsiveness to CLOpidogrel and StEnt Thrombosis).
- Source :
-
JACC. Cardiovascular interventions [JACC Cardiovasc Interv] 2015 Oct; Vol. 8 (12), pp. 1563-70. Date of Electronic Publication: 2015 Sep 17. - Publication Year :
- 2015
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Abstract
- Objectives: This study sought to investigate the efficacy of prasugrel compared with clopidogrel in clopidogrel nonresponders.<br />Background: Clopidogrel nonresponsiveness is a strong marker of the risk of cardiac death and stent thrombosis after a percutaneous coronary intervention (PCI). It is unknown whether clopidogrel nonresponsiveness is a nonmodifiable risk factor or whether prasugrel with more potent and predictable platelet inhibition as measured by ex vivo techniques is associated with a positive effect on clinical outcome.<br />Methods: The RECLOSE-3 (REsponsiveness to CLOpidogrel and StEnt thrombosis) study screened clopidogrel nonresponders after a 600-mg loading dose of clopidogrel. Clopidogrel nonresponders switched to prasugrel (10 mg/day) the day of the PCI, and an adenosine diphosphate (ADP) test (10 μmol/l of ADP) was performed 6 days after the PCI. The primary endpoint was 2-year cardiac mortality. Patient outcome was compared with the RECLOSE-2-ACS study.<br />Results: We screened 1,550 patients, of whom 302 were clopidogrel nonresponders. The result of the ADP test was 77.6 ± 6.2%. After switching to prasugrel, the ADP test result decreased to 47.1 ± 16.8%. The 2-year cardiac mortality rate was 4% in the RECLOSE-3 study and 9.7% in nonresponders of the RECLOSE-2-ACS study (p = 0.007). The definite and probable stent thrombosis rates were 0.7% and 4.4%, respectively (p = 0.004). On multivariable analysis, prasugrel treatment was related to the risk of 2-year cardiac death (hazard ratio: 0.32, p = 0.036).<br />Conclusions: Clopidogrel nonresponsiveness can be overcome by prasugrel (10 mg/day), and optimal platelet aggregation inhibition on prasugrel treatment is associated with a low rate of long-term cardiac mortality and stent thrombosis.<br /> (Copyright © 2015 American College of Cardiology Foundation. Published by Elsevier Inc. All rights reserved.)
- Subjects :
- Aged
Aged, 80 and over
Chi-Square Distribution
Clopidogrel
Coronary Artery Disease blood
Coronary Artery Disease diagnosis
Coronary Artery Disease mortality
Coronary Thrombosis blood
Coronary Thrombosis diagnosis
Coronary Thrombosis etiology
Drug Resistance
Female
Historically Controlled Study
Humans
Kaplan-Meier Estimate
Male
Middle Aged
Multivariate Analysis
Percutaneous Coronary Intervention adverse effects
Percutaneous Coronary Intervention mortality
Platelet Aggregation Inhibitors adverse effects
Platelet Function Tests
Prasugrel Hydrochloride adverse effects
Predictive Value of Tests
Proportional Hazards Models
Risk Factors
Ticlopidine administration & dosage
Ticlopidine adverse effects
Time Factors
Treatment Outcome
Coronary Artery Disease therapy
Coronary Thrombosis prevention & control
Drug Substitution
Percutaneous Coronary Intervention instrumentation
Platelet Aggregation drug effects
Platelet Aggregation Inhibitors administration & dosage
Prasugrel Hydrochloride administration & dosage
Stents
Ticlopidine analogs & derivatives
Subjects
Details
- Language :
- English
- ISSN :
- 1876-7605
- Volume :
- 8
- Issue :
- 12
- Database :
- MEDLINE
- Journal :
- JACC. Cardiovascular interventions
- Publication Type :
- Academic Journal
- Accession number :
- 26386764
- Full Text :
- https://doi.org/10.1016/j.jcin.2015.07.010