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

BMC Cardiovascular Disorders

Research Article

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

[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: Prasugrel;    Ticagrelor;    Clopidogrel;    Upstream;    STEMI;   

DOI  :  10.1186/1471-2261-14-189

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

来源: Springer

【 摘 要 】

BackgroundDespite 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.MethodsA 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).ResultsPatients 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.ConclusionsSwitching 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】

CC BY   
© Koul et al.; licensee BioMed Central Ltd. 2014