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Shimamatsu J, Sasaki KI, Katsuki Y, Kawasaki T, Murasato Y, Ajisaka H, Yokoi H, Tashiro H, Harada A, Hirakawa Y, Ishizaki Y, Ishimatsu T, Kagiyama K, Fukumoto Y, Kakuma T, Ueno T. 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. Heart Vessels 2020; 35:312-322. [PMID: 31549178 PMCID: PMC7026273 DOI: 10.1007/s00380-019-01499-7] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/17/2019] [Accepted: 09/06/2019] [Indexed: 12/20/2022]
Abstract
Dual antiplatelet therapy (DAPT) with aspirin and P2Y12 inhibitor is administered following percutaneous coronary intervention (PCI) with coronary stent implantation. Several studies have reported the effects of switching between P2Y12 inhibitors on platelet reactivity (P2Y12 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.
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Affiliation(s)
- Junichiro Shimamatsu
- Division of Cardiovascular Medicine, Department of Internal Medicine, Kurume University School of Medicine, 67 Asahimachi, Kurume, 830-0011, Fukuoka, Japan
- Division of Cardiovascular Internal Medicine, Tanushimaru Chuo Hospital, Kurume, Japan
| | - Ken-Ichiro Sasaki
- Division of Cardiovascular Medicine, Department of Internal Medicine, Kurume University School of Medicine, 67 Asahimachi, Kurume, 830-0011, Fukuoka, Japan
| | | | - Tomohiro Kawasaki
- Department of Cardiology, Cardiovascular Center, Shin Koga Hospital, Kurume, Japan
| | - Yoshinobu Murasato
- Department of Cardiology, National Hospital Organization Kyushu Medical Center, Fukuoka, Japan
| | - Hidehiko Ajisaka
- Division of Cardiovascular Internal Medicine, Asakura Medical Association Hospital, Asakura, Japan
| | - Hiroyoshi Yokoi
- Division of Cardiovascular Internal Medicine, Fukuoka Sanno Hospital, Fukuoka, Japan
| | - Hideki Tashiro
- Division of Cardiovascular Internal Medicine, St. Mary's Hospital, Kurume, Japan
| | | | | | - Yuta Ishizaki
- Division of Cardiovascular Medicine, Department of Internal Medicine, Kurume University School of Medicine, 67 Asahimachi, Kurume, 830-0011, Fukuoka, Japan
| | - Takashi Ishimatsu
- Division of Cardiovascular Medicine, Department of Internal Medicine, Kurume University School of Medicine, 67 Asahimachi, Kurume, 830-0011, Fukuoka, Japan
| | - Kotaro Kagiyama
- Division of Cardiovascular Medicine, Department of Internal Medicine, Kurume University School of Medicine, 67 Asahimachi, Kurume, 830-0011, Fukuoka, Japan
| | - Yoshihiro Fukumoto
- Division of Cardiovascular Medicine, Department of Internal Medicine, Kurume University School of Medicine, 67 Asahimachi, Kurume, 830-0011, Fukuoka, Japan
| | | | - Takafumi Ueno
- Division of Cardiovascular Medicine, Department of Internal Medicine, Kurume University School of Medicine, 67 Asahimachi, Kurume, 830-0011, Fukuoka, Japan.
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