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Song K, Jin X, Kim MH, Li JX, Jin CD, Yuan SL, Song ZY, Jin EZ, Lee KM, Lim KH, Cho YR. Differences in Optimal Platelet Reactivity after Potent P2Y12 Inhibitor Treatment in Acute Coronary Syndrome Patients Undergoing Percutaneous Coronary Intervention. J Clin Med 2022; 11:jcm11092480. [PMID: 35566604 PMCID: PMC9100277 DOI: 10.3390/jcm11092480] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2022] [Accepted: 03/29/2022] [Indexed: 01/23/2023] Open
Abstract
Background: East Asian patients receiving treatment with the potent P2Y12 inhibitors prasugrel or ticagrelor experience more potent platelet inhibition than with clopidogrel. Methods: This study investigated differences in OPR rates with reduced doses of prasugrel (n = 38) or ticagrelor (n = 40) for maintenance therapy in 118 Korean ACS patients who had undergone PCI, in comparison to conventional-dose clopidogrel (n = 40). We assessed drug responses at one- and three-months post-PCI with VerifyNow and multiple electrode aggregometry assays. Results: At the one-month period, patients receiving standard-dose prasugrel or ticagrelor had lower platelet reactivity as determined by the three assays than those receiving the conventional dose of clopidogrel (VN: p = 0.000; MEA: p = 0.000; LTA: p = 0.000). At the 3-month point, platelet reactivity was lower in those receiving reduced-dose prasugrel or ticagrelor than the clopidogrel-treated patients (VN: p = 0.000; MEA: p = 0.012; LTA: p = 0.002). Prasugrel resulted in significantly lower platelet inhibition than ticagrelor as determined by VN and LTA (VN: p = 0.000; LTA: p = 0.003). At three months, there was a significant overall difference in OPR among the three groups when measured by VN (p < 0.001), but not when measured by MEA (p = 0.596). OPR in the reduced-dose prasugrel group was not significantly different to the clopidogrel group at three months (VN: p = 0.180; MEA: p = 0.711). OPR in the reduced-dose ticagrelor group was similar to clopidogrel as determined by MEA at three months, but was different when assessed by VN (VN: p = 0.000; MEA: p = 0.540). Compared to standard-dose, the reduced-dose prasugrel OPR rate was significantly increased (VN: p = 0.008; MEA: p = 0.020). Conclusions: OPR values for reduced-dose prasugrel and conventional-dose clopidogrel at three months were similar but higher than for reduced-dose ticagrelor as determined by VN, but no differences were noted by MEA. The MEA assay might have less sensitivity and consistency than the VN assay. Further studies are needed to explore this discrepancy.
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Affiliation(s)
- Kai Song
- Department of Cardiology, Dong-A University Hospital, Busan 49201, Korea; (K.S.); (X.J.); (S.-L.Y.); (Z.-Y.S.); (K.-M.L.); (K.-H.L.); (Y.-R.C.)
- Department of Cardiology, Huizhou Third People’s Hospital, Guangzhou Medical University, Huizhou 516002, China
| | - Xuan Jin
- Department of Cardiology, Dong-A University Hospital, Busan 49201, Korea; (K.S.); (X.J.); (S.-L.Y.); (Z.-Y.S.); (K.-M.L.); (K.-H.L.); (Y.-R.C.)
| | - Moo-Hyun Kim
- Department of Cardiology, Dong-A University Hospital, Busan 49201, Korea; (K.S.); (X.J.); (S.-L.Y.); (Z.-Y.S.); (K.-M.L.); (K.-H.L.); (Y.-R.C.)
- Correspondence: ; Tel.: +82-51-240-2976
| | - Jia-Xin Li
- Department of Cardiology, Fourth Affiliated Hospital of Harbin Medical University, Harbin 150001, China; (J.-X.L.); (E.-Z.J.)
| | - Cai-De Jin
- Department of Cardiology, Affiliated Hospital of Zunyi Medical University, Zunyi 563003, China;
| | - Song-Lin Yuan
- Department of Cardiology, Dong-A University Hospital, Busan 49201, Korea; (K.S.); (X.J.); (S.-L.Y.); (Z.-Y.S.); (K.-M.L.); (K.-H.L.); (Y.-R.C.)
| | - Zhao-Yan Song
- Department of Cardiology, Dong-A University Hospital, Busan 49201, Korea; (K.S.); (X.J.); (S.-L.Y.); (Z.-Y.S.); (K.-M.L.); (K.-H.L.); (Y.-R.C.)
- Department of Cardiology, Fourth Affiliated Hospital of Harbin Medical University, Harbin 150001, China; (J.-X.L.); (E.-Z.J.)
| | - En-Ze Jin
- Department of Cardiology, Fourth Affiliated Hospital of Harbin Medical University, Harbin 150001, China; (J.-X.L.); (E.-Z.J.)
| | - Kwang-Min Lee
- Department of Cardiology, Dong-A University Hospital, Busan 49201, Korea; (K.S.); (X.J.); (S.-L.Y.); (Z.-Y.S.); (K.-M.L.); (K.-H.L.); (Y.-R.C.)
| | - Kyung-Hee Lim
- Department of Cardiology, Dong-A University Hospital, Busan 49201, Korea; (K.S.); (X.J.); (S.-L.Y.); (Z.-Y.S.); (K.-M.L.); (K.-H.L.); (Y.-R.C.)
| | - Young-Rak Cho
- Department of Cardiology, Dong-A University Hospital, Busan 49201, Korea; (K.S.); (X.J.); (S.-L.Y.); (Z.-Y.S.); (K.-M.L.); (K.-H.L.); (Y.-R.C.)
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