Increased Platelet Inhibition After Switching From Maintenance Clopidogrel to Prasugrel in Japanese Patients With Stable Coronary Artery Disease

• Nishi Takeshi

  Department of Cardiovascular Medicine, Chiba University Graduate School of Medicine

• Ariyoshi Noritaka

  Division of Pharmacy, University Hospital, Chiba University School of Medicine Clinical Research Center, University Hospital, Chiba University School of Medicine

• Nakayama Takashi

  Department of Cardiovascular Medicine, Chiba University Graduate School of Medicine

• Fujimoto Yoshihide

  Department of Cardiovascular Medicine, Chiba University Graduate School of Medicine

• Sugimoto Kazumasa

  Department of Cardiovascular Medicine, Chiba University Graduate School of Medicine

• Takahara Masayuki

  Department of Cardiovascular Medicine, Chiba University Graduate School of Medicine

• Wakabayashi Shinichi

  Department of Cardiovascular Medicine, Chiba University Graduate School of Medicine

• Koshizaka Masaya

  Clinical Research Center, University Hospital, Chiba University School of Medicine

• Hanaoka Hideki

  Clinical Research Center, University Hospital, Chiba University School of Medicine

• Kobayashi Yoshio

  Department of Cardiovascular Medicine, Chiba University Graduate School of Medicine

抄録

Background:The pharmacodynamic effects of changing from standard-dose clopidogrel to low-dose (3.75 mg) prasugrel in Japanese patients are largely unknown.Methods and Results:A total of 53 consecutive Japanese patients with stable coronary artery disease (CAD) who received aspirin and clopidogrel were enrolled. Clopidogrel was switched to 3.75 mg prasugrel. At day 14, prasugrel was switched to 75 mg clopidogrel. Platelet reactivity was measured using the VerifyNow assay at baseline, day 14, and day 28. VerifyNow P2Y12 reaction units (PRU) >208 was defined as high on-treatment platelet reactivity (HPR). The prevalence of HPR (18.9% vs. 41.5% vs. 44.2%, P<0.001) and the PRU level (154.3±54.2 vs. 196.2±55.5 vs. 194.6±55.8, P<0.001) were significantly lower on prasugrel maintenance therapy compared with the clopidogrel therapy before and after switching. The CYP2C19 genotypes that account for the 3 phenotypes (ie, extensive metabolizer, intermediate metabolizer, and poor metabolizer) had a significant impact on platelet reactivity with clopidogrel (174.9±54.0 vs. 193.1±56.5 vs. 240.6±25.4 PRU, P<0.001) but not prasugrel (147.0±51.9 vs. 147.5±58.3 vs. 184.4±38.3 PRU, P=0.15).Conclusions:Low-dose prasugrel achieves stronger platelet inhibition than clopidogrel in Japanese patients with stable CAD. (Circ J 2015; 79: 2439–2444)

収録刊行物

• Circulation Journal

  Circulation Journal 79 (11), 2439-2444, 2015

  一般社団法人 日本循環器学会

キーワード

• Clopidogrel
• Percutaneous coronary intervention
• Platelet resistance
• Prasugrel

詳細情報

• CRID: 1390001205109103104
• NII論文ID: 130005104892
• NII書誌ID: AA11591968
• DOI: 10.1253/circj.cj-15-0546
• ISSN: 13474820
• ISSN: 13469843
• NDL書誌ID: 026815766
• PubMed: 26310876
• Web Site: https://ndlsearch.ndl.go.jp/books/R000000004-I026815766
• Web Site: https://www.jstage.jst.go.jp/article/circj/79/11/79_CJ-15-0546/_pdf
• Web Site: https://search.jamas.or.jp/link/ui/2016232432
• 本文言語コード: en
• データソース種別:
  • JaLC
  • NDL
  • Crossref
  • PubMed
  • CiNii Articles
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