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Prasugrel effectively reduces the platelet reactivity units in patients with genetically metabolic dysfunction of cytochrome P450 2C19 who are treated with long-term dual antiplatelet therapy after undergoing drug-eluting stent implantation
Dual antiplatelet therapy (DAPT) with aspirin and P2Y(12) inhibitor is administered following percutaneous coronary intervention (PCI) with coronary stent implantation. Several studies have reported the effects of switching between P2Y(12) inhibitors on platelet reactivity (P2Y(12) reaction units: P...
Autores principales: | , , , , , , , , , , , , , , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
Springer Japan
2019
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Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7026273/ https://www.ncbi.nlm.nih.gov/pubmed/31549178 http://dx.doi.org/10.1007/s00380-019-01499-7 |
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author | Shimamatsu, Junichiro Sasaki, Ken-ichiro Katsuki, Yoshio Kawasaki, Tomohiro Murasato, Yoshinobu Ajisaka, Hidehiko Yokoi, Hiroyoshi Tashiro, Hideki Harada, Atsushi Hirakawa, Yuji Ishizaki, Yuta Ishimatsu, Takashi Kagiyama, Kotaro Fukumoto, Yoshihiro Kakuma, Tatsuyuki Ueno, Takafumi |
author_facet | Shimamatsu, Junichiro Sasaki, Ken-ichiro Katsuki, Yoshio Kawasaki, Tomohiro Murasato, Yoshinobu Ajisaka, Hidehiko Yokoi, Hiroyoshi Tashiro, Hideki Harada, Atsushi Hirakawa, Yuji Ishizaki, Yuta Ishimatsu, Takashi Kagiyama, Kotaro Fukumoto, Yoshihiro Kakuma, Tatsuyuki Ueno, Takafumi |
author_sort | Shimamatsu, Junichiro |
collection | PubMed |
description | Dual antiplatelet therapy (DAPT) with aspirin and P2Y(12) inhibitor is administered following percutaneous coronary intervention (PCI) with coronary stent implantation. Several studies have reported the effects of switching between P2Y(12) inhibitors on platelet reactivity (P2Y(12) reaction units: PRU), from acute to late phase after PCI. However, the effect of switching at very late phase is unknown. This study examined the effect on PRU in Japanese coronary heart disease patients with long-term DAPT (aspirin + clopidogrel) when switching from clopidogrel to prasugrel. Ninety-six patients were enrolled in this study. The median DAPT duration at enrollment was 1824.0 days. Twenty-three patients with PRU ≥ 208 at enrollment were randomly assigned into either continuing to receive clopidogrel (Continued Group; n = 11) or switching to prasugrel (Switched Group; n = 12). The primary endpoint was the rate of patients who achieved PRU < 208 at the end of 12 weeks of treatment, which was significantly higher in Switched Group relative to Continued Group (90.0% vs. 36.4%; P = 0.024). The secondary endpoint was the PRU at week 12 in groups subdivided according to cytochrome P450 (CYP) 2C19 genotypes. At week 12, extensive metabolizers (EM Group) had 202.3 ± 60.0 and 174.5 ± 22.3 in Continued Group and Switched Group (P = 0.591), respectively; intermediate and poor metabolizers (non-EM Group) had 229.4 ± 36.9 and 148.4 ± 48.4 in Continued Group and Switched Group (P = 0.002), respectively. The PRU for non-EM Group was significantly reduced in Switched Group. Thus, for patients with long-term DAPT (aspirin + clopidogrel) after PCI with coronary stent implantation, switching from clopidogrel to prasugrel resulted in a stable reduction in PRU, regardless of CYP2C19 polymorphism. |
format | Online Article Text |
id | pubmed-7026273 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2019 |
publisher | Springer Japan |
record_format | MEDLINE/PubMed |
spelling | pubmed-70262732020-03-02 Prasugrel effectively reduces the platelet reactivity units in patients with genetically metabolic dysfunction of cytochrome P450 2C19 who are treated with long-term dual antiplatelet therapy after undergoing drug-eluting stent implantation Shimamatsu, Junichiro Sasaki, Ken-ichiro Katsuki, Yoshio Kawasaki, Tomohiro Murasato, Yoshinobu Ajisaka, Hidehiko Yokoi, Hiroyoshi Tashiro, Hideki Harada, Atsushi Hirakawa, Yuji Ishizaki, Yuta Ishimatsu, Takashi Kagiyama, Kotaro Fukumoto, Yoshihiro Kakuma, Tatsuyuki Ueno, Takafumi Heart Vessels Original Article Dual antiplatelet therapy (DAPT) with aspirin and P2Y(12) inhibitor is administered following percutaneous coronary intervention (PCI) with coronary stent implantation. Several studies have reported the effects of switching between P2Y(12) inhibitors on platelet reactivity (P2Y(12) reaction units: PRU), from acute to late phase after PCI. However, the effect of switching at very late phase is unknown. This study examined the effect on PRU in Japanese coronary heart disease patients with long-term DAPT (aspirin + clopidogrel) when switching from clopidogrel to prasugrel. Ninety-six patients were enrolled in this study. The median DAPT duration at enrollment was 1824.0 days. Twenty-three patients with PRU ≥ 208 at enrollment were randomly assigned into either continuing to receive clopidogrel (Continued Group; n = 11) or switching to prasugrel (Switched Group; n = 12). The primary endpoint was the rate of patients who achieved PRU < 208 at the end of 12 weeks of treatment, which was significantly higher in Switched Group relative to Continued Group (90.0% vs. 36.4%; P = 0.024). The secondary endpoint was the PRU at week 12 in groups subdivided according to cytochrome P450 (CYP) 2C19 genotypes. At week 12, extensive metabolizers (EM Group) had 202.3 ± 60.0 and 174.5 ± 22.3 in Continued Group and Switched Group (P = 0.591), respectively; intermediate and poor metabolizers (non-EM Group) had 229.4 ± 36.9 and 148.4 ± 48.4 in Continued Group and Switched Group (P = 0.002), respectively. The PRU for non-EM Group was significantly reduced in Switched Group. Thus, for patients with long-term DAPT (aspirin + clopidogrel) after PCI with coronary stent implantation, switching from clopidogrel to prasugrel resulted in a stable reduction in PRU, regardless of CYP2C19 polymorphism. Springer Japan 2019-09-23 2020 /pmc/articles/PMC7026273/ /pubmed/31549178 http://dx.doi.org/10.1007/s00380-019-01499-7 Text en © The Author(s) 2019 Open AccessThis article is distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. |
spellingShingle | Original Article Shimamatsu, Junichiro Sasaki, Ken-ichiro Katsuki, Yoshio Kawasaki, Tomohiro Murasato, Yoshinobu Ajisaka, Hidehiko Yokoi, Hiroyoshi Tashiro, Hideki Harada, Atsushi Hirakawa, Yuji Ishizaki, Yuta Ishimatsu, Takashi Kagiyama, Kotaro Fukumoto, Yoshihiro Kakuma, Tatsuyuki Ueno, Takafumi Prasugrel effectively reduces the platelet reactivity units in patients with genetically metabolic dysfunction of cytochrome P450 2C19 who are treated with long-term dual antiplatelet therapy after undergoing drug-eluting stent implantation |
title | Prasugrel effectively reduces the platelet reactivity units in patients with genetically metabolic dysfunction of cytochrome P450 2C19 who are treated with long-term dual antiplatelet therapy after undergoing drug-eluting stent implantation |
title_full | Prasugrel effectively reduces the platelet reactivity units in patients with genetically metabolic dysfunction of cytochrome P450 2C19 who are treated with long-term dual antiplatelet therapy after undergoing drug-eluting stent implantation |
title_fullStr | Prasugrel effectively reduces the platelet reactivity units in patients with genetically metabolic dysfunction of cytochrome P450 2C19 who are treated with long-term dual antiplatelet therapy after undergoing drug-eluting stent implantation |
title_full_unstemmed | Prasugrel effectively reduces the platelet reactivity units in patients with genetically metabolic dysfunction of cytochrome P450 2C19 who are treated with long-term dual antiplatelet therapy after undergoing drug-eluting stent implantation |
title_short | Prasugrel effectively reduces the platelet reactivity units in patients with genetically metabolic dysfunction of cytochrome P450 2C19 who are treated with long-term dual antiplatelet therapy after undergoing drug-eluting stent implantation |
title_sort | prasugrel effectively reduces the platelet reactivity units in patients with genetically metabolic dysfunction of cytochrome p450 2c19 who are treated with long-term dual antiplatelet therapy after undergoing drug-eluting stent implantation |
topic | Original Article |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7026273/ https://www.ncbi.nlm.nih.gov/pubmed/31549178 http://dx.doi.org/10.1007/s00380-019-01499-7 |
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