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    Prasugrel compared with high loading- and maintenance-dose clopidogrel in patients with planned percutaneous coronary intervention: the Prasugrel in Comparison to Clopidogrel for Inhibition of Platelet Activation and Aggregation-Thrombolysis in Myocardial Infarction 44 trial

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    Authors
    Wiviott, Stephen D.
    Trenk, Dietmar
    Frelinger, Andrew L. III
    O'Donoghue, Michelle
    Neumann, Franz-Josef
    Michelson, Alan D.
    Angiolillo, Dominick J.
    Hod, Hanoch
    Montalescot, Gilles
    Miller, Debra L.
    Jakubowski, Joseph A.
    Cairns, Richard
    Murphy, Sabina A.
    McCabe, Carolyn H.
    Antman, Elliott M.
    Braunwald, Eugene
    Show allShow less
    UMass Chan Affiliations
    Department of Pediatrics
    Document Type
    Journal Article
    Publication Date
    2007-12-18
    Keywords
    Aged
    Angioplasty, Balloon, Coronary
    Combined Modality Therapy
    Cross-Over Studies
    Female
    Humans
    Male
    Middle Aged
    Myocardial Infarction
    Piperazines
    Platelet Activation
    Platelet Aggregation Inhibitors
    Thiophenes
    Thrombolytic Therapy
    Ticlopidine
    derivatives
    Treatment Outcome
    Hematology
    Oncology
    Pediatrics
    Show allShow less
    
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    Link to Full Text
    http://dx.doi.org/10.1161/CIRCULATIONAHA.107.740324
    Abstract
    BACKGROUND: The increasing use of higher-than-approved doses of clopidogrel in clinical practice is based in part on the desire for greater levels of inhibition of platelet aggregation (IPA). Prasugrel is a new thienopyridine that is more potent than standard-dose clopidogrel in healthy subjects and patients with stable coronary artery disease. The relative antiplatelet effects of prasugrel versus high-dose clopidogrel in percutaneous coronary intervention patients are unknown. METHODS AND RESULTS: Prasugrel in Comparison to Clopidogrel for Inhibition of Platelet Activation and Aggregation-Thrombolysis in Myocardial Infarction 44 (PRINCIPLE-TIMI 44) was a randomized, double-blind, 2-phase crossover study of prasugrel compared with high-dose clopidogrel in patients undergoing cardiac catheterization for planned percutaneous coronary intervention. The primary end point of the loading-dose phase (prasugrel 60 mg versus clopidogrel 600 mg) was IPA with 20 mumol/L ADP at 6 hours. Patients with percutaneous coronary intervention entered the maintenance-dose phase, a 28-day crossover comparison of prasugrel 10 mg/d versus clopidogrel 150 mg/d with a primary end point of IPA after 14 days of either drug. In this study, 201 subjects were randomized. IPA at 6 hours was significantly higher in subjects receiving prasugrel (mean+/-SD, 74.8+/-13.0%) compared with clopidogrel (31.8+/-21.1%; Pandlt;0.0001). During the maintenance-dose phase, IPA with 20 mumol/L ADP was higher in subjects receiving prasugrel (61.3+/-17.8%) compared with clopidogrel (46.1+/-21.3%; Pandlt;0.0001). Results were consistent across all key secondary end points; significant differences emerged by 30 minutes and persisted across all time points. CONCLUSIONS: Among patients undergoing cardiac catheterization with planned percutaneous coronary intervention, loading with 60 mg prasugrel resulted in greater platelet inhibition than a 600-mg clopidogrel loading dose. Maintenance therapy with prasugrel 10 mg/d resulted in a greater antiplatelet effect than 150 mg/d clopidogrel.
    Source
    Circulation. 2007 Dec 18;116(25):2923-32. Epub 2007 Dec 3. doi: 10.1161/CIRCULATIONAHA.107.740324
    DOI
    10.1161/CIRCULATIONAHA.107.740324
    Permanent Link to this Item
    http://hdl.handle.net/20.500.14038/43413
    PubMed ID
    18056526
    Related Resources
    Link to article in PubMed
    ae974a485f413a2113503eed53cd6c53
    10.1161/CIRCULATIONAHA.107.740324
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