Title

Pharmacodynamic assessment of platelet inhibition by prasugrel vs. clopidogrel in the TRITON-TIMI 38 trial

UMMS Affiliation

Department of Pediatrics

Date

7-2009

Document Type

Article

Medical Subject Headings

Acute Coronary Syndrome; Adenosine Diphosphate; Angioplasty, Balloon, Coronary; Cell Adhesion Molecules; Female; Humans; Male; Microfilament Proteins; Middle Aged; Myocardial Infarction; Phosphoproteins; Phosphorylation; Piperazines; Platelet Aggregation Inhibitors; Thiophenes; Ticlopidine

Disciplines

Hematology | Oncology | Pediatrics

Abstract

AIMS: To examine the extent of platelet inhibition by prasugrel vs. clopidogrel in a TRITON-TIMI 38 substudy.

METHODS AND RESULTS: TRITON-TIMI 38 randomized acute coronary syndrome (ACS) patients undergoing percutaneous coronary intervention (PCI) to prasugrel or standard dose clopidogrel. Selected sites prospectively enrolled TRITON-TIMI 38 patients to evaluate adenosine diphosphate (ADP)-attenuated phosphorylation of platelet vasodilator-stimulated phosphoprotein (VASP) (n = 125 patients) and, in a subset (n = 31 patients), ADP-stimulated platelet aggregation. VASP platelet reactivity index (PRI) was lower in prasugrel-treated patients than in clopidogrel-treated patients at 1-2 h post-PCI (>or=1 h after loading dose) (P andlt; 0.001) and at 30 days (P andlt; 0.001). Maximal platelet aggregation to 20 microM ADP was lower in prasugrel-treated patients than in clopidogrel-treated patients at 1-2 h (P = 0.004) and 30 days (P = 0.03). Results were similar with 5 microM ADP. Thienopyridine hyporesponsiveness, prespecified as VASP PRI >50%, was more frequent in clopidogrel-treated patients than in prasugrel-treated patients at 1-2 h (P andlt; 0.001) and 30 days (P = 0.03).

CONCLUSIONS: The TRITON-TIMI 38 platelet substudy shows that prasugrel results in greater inhibition of ADP-mediated platelet function in ACS patients than clopidogrel, supporting the hypothesis that greater platelet inhibition leads to a lower incidence of ischaemic events and more bleeding both early and late following PCI.

Rights and Permissions

Citation: Eur Heart J. 2009 Jul;30(14):1753-63. Epub 2009 May 12. doi 10.1093/eurheartj/ehp159

Related Resources

Link to article in PubMed

PubMed ID

19435740