A pharmacodynamic comparison of 5 anti-platelet protocols in patients with ST-elevation myocardial infarction undergoing primary PCI

BMC Cardiovascular Disorders

David Erlinge¹  Sven Björnsson²  Eva Norström²  Matthias Götberg¹  Jan Harnek¹  Fredrik Scherstén¹  J Gustav Smith¹  Andreas Martinsson¹  Pontus Andell¹  Sasha Koul¹ 

[1] Department of Cardiology, Lund University, Skåne University Hospital Lund, SE 221 85, Lund, Sweden;Department of Clinical Chemistry, Skåne University Hospital Malmö, Malmö, Sweden

关键词: STEMI;    Upstream;    Clopidogrel;    Ticagrelor;    Prasugrel;   

Others  :  1088403
DOI  :  10.1186/1471-2261-14-189

 received in 2014-06-12, accepted in 2014-12-11,  发布年份 2014

【 摘 要 】

Background

Despite advances in anti-platelet treatments, there still exists an early increase in both ischemic as well as bleeding events following primary PCI in patients with ST-elevation myocardial infarction (STEMI). Platelet inhibition data of different anti-platelet treatments in the acute phase of a myocardial infarction might offer some insight into these problems. The aim of this study was to evaluate the pharmacodynamic profile of 5 different anti-platelet treatments in the acute phase of STEMI in patients undergoing primary PCI.

Methods

A total of 223 STEMI patients undergoing primary PCI were prospectively included. Patients received either pre-hospital clopidogrel only, pre-hospital clopidogrel followed by prasugrel switch in the cath lab, prasugrel treatment only, pre-hospital clopidogrel followed by ticagrelor switch in the cath lab or pre-hospital ticagrelor only. Platelet reactivity was measured serially using vasodilator-stimulated phosphoprotein (VASP).

Results

Patients receiving pre-hospital clopidogrel followed by prasugrel switch showed similar platelet inhibition data as patients receiving prasugrel only, with more than 90% being good responders the day after PCI. Average time from prasugrel administration to a VASP value of <50% was 1.5 hours. In patients receiving pre-hospital ticagrelor, 50% were good responders at completion of PCI and average time to a VASP-value of <50% was 2.3 hours. Only 32% of patients receiving clopidogrel only were responders the day after PCI.

Conclusions

Switching from an upstream bolus dose of clopidogrel to prasugrel at the time of PCI, appeared as a safe and feasible option with no tendency for overshoot or attenuation of platelet inhibition. Pre-hospital administration of ticagrelor was associated with a 50% good responder rate at completion of PCI.

【 授权许可】

   
2014 Koul et al.; licensee BioMed Central Ltd.

【 图 表 】

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