|Piper J et al.|
Akutes Koronarsyndrom: Duale Plättchenhemmung mit Clopidogrel oder Prasugrel?
Ergebnisse einer Patientenerhebung an 178 kardiologischen Rehabilitationspatienten (CLOPRA-Studie) // Acute coronary syndrome: DAPT with Clopidogrel or Prasugrel?
Journal für Kardiologie - Austrian Journal of Cardiology 2016; 23 (7-8): 182-188
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Keywords: akutes Koronarsyndrom, betagter Patient, Clopidogrel, Prasugrel, Thrombozyten-Reagibilität, TRI, VASP-Test, Acute Coronary Syndrome, elderly, PRI, thrombocyte reactivity
Objectives: – To evaluate Clopidogrel low- and non-responders and potential influences of co-medications and co-diseases in elderly patients with acute coronary syndrome (ACS) initially treated with acetylsalicylic acid (ASS) plus Clopidogrel (dual antiplatelet therapy, DAPT); – to clarify how far reduced Clopidogrel response can be improved by switching to Prasugrel (5 or 10 mg per day).
Background: Clopidogrel can be affected with limited response. This phenomenon was evaluated focused on elderly ACS patients. Positive effects induced by drug-switch to Prasugrel were also evaluated.
Methods: Measurements of the thrombocyte/platelet reactivity indices (TRI/PRI) were made by VASP-tests. Clopidogrel low- and non-responders switched to Prasugrel were checked by further VASP-tests. All data were statistically analyzed. Results: In the whole study group of elderly patients (n = 178, mean age: 74.1 ± 0.6 years), 44.4% of patients treated with a dual antiplatelet therapy (DAPT) were affected with a limited Clopidogrel response. The proportion of Clopidogrel low- and non responders was not significantly influenced by age, gender and co-morbidity. In all cases with limited Clopidogrel response TRI values could be lowered by switching to Prasugrel. In patients of 75 years or older, a daily dose of 5 mg Prasugrel led to the same reduction of TRI as 10 mg given to younger patients. After drugswitching circa 12% remained low- or non responders. In patients successfully switched to Prasugrel we found the same reduction of thrombocyte reactivity as in Clopidogrel responders (mean TRI: 19%). Unexpectedly, beta blockers seemed to be significantly associated with reduced Clopidogrel response, whereas proton pump inhibitors showed no interaction.
Conclusions: Based on VASP tests, proportions of low- and non responders are significantly lower in patients treated with Prasugrel when compared with Clopidogrel. Most of patients showing a limited Clopidogrel response can be successfully converted to responders when switched to Prasugrel. In elderly ACS-patients (≥ 75 years), 5 mg Prasugrel are adequate,
Ziele und Fragestellungen: – Anteile
von Clopidpgrel Low- und Non-Respondern,
Effekte von Komedikationen und Begleiterkrankungen
bei älteren Patienten mit akutem Koronarsyndrom,
behandelt mit ASS plus Clopidogrel;
– Verringerung der Thrombozyten-Reagibilität
durch Umstellung auf Prasugrel (5 oder 10 mg).