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
dc.contributor.author | Wiviott, Stephen D. | |
dc.contributor.author | Trenk, Dietmar | |
dc.contributor.author | Frelinger, Andrew L. III | |
dc.contributor.author | O'Donoghue, Michelle | |
dc.contributor.author | Neumann, Franz-Josef | |
dc.contributor.author | Michelson, Alan D. | |
dc.contributor.author | Angiolillo, Dominick J. | |
dc.contributor.author | Hod, Hanoch | |
dc.contributor.author | Montalescot, Gilles | |
dc.contributor.author | Miller, Debra L. | |
dc.contributor.author | Jakubowski, Joseph A. | |
dc.contributor.author | Cairns, Richard | |
dc.contributor.author | Murphy, Sabina A. | |
dc.contributor.author | McCabe, Carolyn H. | |
dc.contributor.author | Antman, Elliott M. | |
dc.contributor.author | Braunwald, Eugene | |
dc.date | 2022-08-11T08:10:11.000 | |
dc.date.accessioned | 2022-08-23T16:58:38Z | |
dc.date.available | 2022-08-23T16:58:38Z | |
dc.date.issued | 2007-12-18 | |
dc.date.submitted | 2012-04-25 | |
dc.identifier.citation | Circulation. 2007 Dec 18;116(25):2923-32. Epub 2007 Dec 3. doi: 10.1161/CIRCULATIONAHA.107.740324 | |
dc.identifier.issn | 0009-7322 (Linking) | |
dc.identifier.doi | 10.1161/CIRCULATIONAHA.107.740324 | |
dc.identifier.pmid | 18056526 | |
dc.identifier.uri | http://hdl.handle.net/20.500.14038/43413 | |
dc.description.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. | |
dc.language.iso | en_US | |
dc.relation | <a href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=18056526&dopt=Abstract">Link to article in PubMed</a> | |
dc.relation.url | http://dx.doi.org/10.1161/CIRCULATIONAHA.107.740324 | |
dc.subject | Aged | |
dc.subject | Angioplasty, Balloon, Coronary | |
dc.subject | Combined Modality Therapy | |
dc.subject | Cross-Over Studies | |
dc.subject | Female | |
dc.subject | Humans | |
dc.subject | Male | |
dc.subject | Middle Aged | |
dc.subject | Myocardial Infarction | |
dc.subject | Piperazines | |
dc.subject | Platelet Activation | |
dc.subject | Platelet Aggregation Inhibitors | |
dc.subject | Thiophenes | |
dc.subject | Thrombolytic Therapy | |
dc.subject | Ticlopidine | |
dc.subject | derivatives | |
dc.subject | Treatment Outcome | |
dc.subject | Hematology | |
dc.subject | Oncology | |
dc.subject | Pediatrics | |
dc.title | 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 | |
dc.type | Journal Article | |
dc.source.journaltitle | Circulation | |
dc.source.volume | 116 | |
dc.source.issue | 25 | |
dc.identifier.legacycoverpage | https://escholarship.umassmed.edu/peds_hematology/90 | |
dc.identifier.contextkey | 2796580 | |
html.description.abstract | <p>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.</p> <p>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.</p> <p>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.</p> | |
dc.identifier.submissionpath | peds_hematology/90 | |
dc.contributor.department | Department of Pediatrics | |
dc.source.pages | 2923-32 |