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• W2129125956 abstract "On-clopidogrel treatment platelet reactivity (PR) presents considerable variability over time. In stable coronary artery disease (CAD) and in acute coronary syndrome (ACS) patients the baseline just before PCI or the next day PR decreases when reassessed at 1–3 months later [ 1 Campo G. Parrinello G. Ferraresi P. et al. Prospective evaluation of on-clopidogrel platelet reactivity over time in patients treated with percutaneous coronary intervention relationship with gene polymorphisms and clinical outcome. J Am Coll Cardiol. 2011; 57: 2474-2483 Abstract Full Text Full Text PDF PubMed Scopus (302) Google Scholar , 2 Price M.J. Berger P.B. Teirstein P.S. et al. Standard- vs high-dose clopidogrel based on platelet function testing after percutaneous coronary intervention: the GRAVITAS randomized trial. JAMA. 2011; 305: 1097-1105 Crossref PubMed Scopus (1168) Google Scholar , 3 Trenk D. Stone G.W. Gawaz M. et al. A randomized trial of prasugrel versus clopidogrel in patients with high platelet reactivity on clopidogrel after elective percutaneous coronary intervention with implantation of drug-eluting stents: results of the TRIGGER-PCI (Testing Platelet Reactivity in Patients Undergoing Elective Stent Placement on Clopidogrel to Guide Alternative Therapy With Prasugrel) study. J Am Coll Cardiol. 2012; 59: 2159-2164 Abstract Full Text Full Text PDF PubMed Scopus (535) Google Scholar ]. This has been at least partially attributed to the acuity of the disease and platelet activation induced by PCI itself [ 1 Campo G. Parrinello G. Ferraresi P. et al. Prospective evaluation of on-clopidogrel platelet reactivity over time in patients treated with percutaneous coronary intervention relationship with gene polymorphisms and clinical outcome. J Am Coll Cardiol. 2011; 57: 2474-2483 Abstract Full Text Full Text PDF PubMed Scopus (302) Google Scholar , 4 Gurbel P.A. Cummings C.C. Alford A.B. Meister A.F. Serebruany V.L. Onset and extent of platelet inhibition by clopidogrel loading in patients undergoing elective coronary stenting: the Plavix Reduction of New Thrombus Occurrence (PRONTO) trial. Am Heart J. 2003; 145: 239-247 Abstract Full Text Full Text PDF PubMed Scopus (124) Google Scholar ]. In the setting of ST elevation myocardial infarction (STEMI) and post 600 mg of clopidogrel loading, PR is higher at 2–4 h compared to 24 h – probably as a reflection of a delayed onset of action – and stabilizing thereafter at Day 3–5 [ 5 Heestermans A.A. van Werkum J.W. Taubert D. et al. Impaired bioavailability of clopidogrel in patients with a ST-segment elevation myocardial infarction. Thromb Res. 2008; 122: 776-781 Abstract Full Text Full Text PDF PubMed Scopus (150) Google Scholar , 6 Alexopoulos D. Theodoropoulos K.C. Stavrou E.F. et al. Prasugrel versus high dose clopidogrel to overcome early high on clopidogrel platelet reactivity in patients with ST elevation myocardial infarction. Cardiovasc Drugs Ther. 2012; 26: 393-400 Crossref PubMed Scopus (42) Google Scholar ]. The newer, more potent P2Y12 inhibitors, prasugrel and ticagrelor, provide a faster, stronger and more consistent platelet inhibition than clopidogrel. However, the PR evolution over time in patients while on-prasugrel or on-ticagrelor is not clear. PR stability was reported in prasugrel treated stable CAD patients between 3 and 6 months post PCI [ [3] Trenk D. Stone G.W. Gawaz M. et al. A randomized trial of prasugrel versus clopidogrel in patients with high platelet reactivity on clopidogrel after elective percutaneous coronary intervention with implantation of drug-eluting stents: results of the TRIGGER-PCI (Testing Platelet Reactivity in Patients Undergoing Elective Stent Placement on Clopidogrel to Guide Alternative Therapy With Prasugrel) study. J Am Coll Cardiol. 2012; 59: 2159-2164 Abstract Full Text Full Text PDF PubMed Scopus (535) Google Scholar ], while a high on-prasugrel PR persisted in only a minority of patients at a second assessment [ [7] Alexopoulos D. Plakomyti T.E. Xanthopoulou I. Variability and treatment of high on-prasugrel platelet reactivity in patients with initial high on-clopidogrel platelet reactivity. Int J Cardiol. 2012; 154: 333-334 Abstract Full Text Full Text PDF PubMed Scopus (5) Google Scholar ]. Following ticagrelor loading PR levels achieved at 24 h were similar to those at 6 weeks [ [8] Gurbel P.A. Bliden K.P. Butler K. et al. Randomized double-blind assessment of the ONSET and OFFSET of the antiplatelet effects of ticagrelor versus clopidogrel in patients with stable coronary artery disease: the ONSET/OFFSET Study. Circulation. 2009; 120: 2577-2585 Crossref PubMed Scopus (968) Google Scholar ]. In STEMI patients following either ticagrelor or prasugrel loading we described a strong platelet inhibition as early as within 6 h, with PR remaining very low till Day 5 [ [9] Alexopoulos D. Xanthopoulou I. Gkizas V. et al. Randomized assessment of ticagrelor versus prasugrel antiplatelet effects in patients with ST elevation myocardial infarction. Circ Cardiovasc Interv. 2012; 5: 797-804 Crossref PubMed Scopus (324) Google Scholar ]. In the present study we aimed to identify the variability between PR assessed in the acute phase of STEMI and while on chronic (>3 months) treatment with prasugrel or ticagrelor." @default.
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• W2129125956 title "Evolving pattern of on-prasugrel and on-ticagrelor platelet reactivity over time in ST elevation myocardial infarction patients" @default.
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