Prasugrel reduced platelet reactivity units by 24.4 to 42.0 units more than clopidogrel at Day 5 and lowered odds of high platelet reactivity in high-risk subgroups including CKD (OR 8.06, p=0.012) and age ≥75 years (OR 5.02, p=0.025) in patients with acute atherothrombotic stroke or high-risk TIA.
RCT (n=176)
Open-label
Randomized
Yes
Does prasugrel improve early platelet inhibition compared to clopidogrel across different patient background subgroups with acute atherothrombotic stroke or high-risk TIA?
Prasugrel provides more potent early platelet inhibition than clopidogrel in acute stroke patients, particularly in high-risk subgroups such as those with advanced age, chronic kidney disease, or metabolic comorbidities.
Effect estimate: OR 2.73 for non-HPR in ABCD-GENE score ≥10 subgroup favoring prasugrel (p=0.076); OR 8.06 for non-HPR in CKD patients favoring prasugrel (p=0.012); OR 5.02 for age ≥75 years favoring prasugrel (p=0.025); OR 4.61 for BMI <25 kg/m2 favoring prasugrel (p=0.012); OR 4.73 for dyslipidemia favoring prasugrel (p=0.009); OR 3.86 for diabetes favoring prasugrel (p=0.038); OR 3.31 for treatment initiation ≤24 hours favoring prasugrel (p=0.010); OR 2.77 (NIHSS ≤3) and 9.00 (NIHSS ≥4) favoring prasugrel
Aim: To explore whether the antiplatelet effects of prasugrel and clopidogrel vary according to patient background factors in the ACUTE-PRAS study.
Fujimoto et al. (Thu,) conducted a rct in Patients with acute atherothrombotic stroke or high-risk transient ischemic attack initiating antiplatelet therapy within 48 hours of symptom onset (n=176). Prasugrel vs. Clopidogrel 75 mg or 300 mg initial dose followed by 50 mg or 75 mg once daily as maintenance was evaluated on Platelet reaction units (PRU) on Day 5 post-treatment initiation as a measure of platelet inhibition; defined high platelet reactivity (HPR) as PRU ≥ 208 (OR 2.73 for non-HPR in ABCD-GENE score ≥10 subgroup favoring prasugrel (p=0.076); OR 8.06 for non-HPR in CKD patients favoring prasugrel (p=0.012); OR 5.02 for age ≥75 years favoring prasugrel (p=0.025); OR 4.61 for BMI <25 kg/m2 favoring prasugrel (p=0.012); OR 4.73 for dyslipidemia favoring prasugrel (p=0.009); OR 3.86 for diabetes favoring prasugrel (p=0.038); OR 3.31 for treatment initiation ≤24 hours favoring prasugrel (p=0.010); OR 2.77 (NIHSS ≤3) and 9.00 (NIHSS ≥4) favoring prasugrel). Prasugrel reduced platelet reactivity units by 24.4 to 42.0 units more than clopidogrel at Day 5 and lowered odds of high platelet reactivity in high-risk subgroups including CKD (OR 8.06, p=0.012) and age ≥75 years (OR 5.02, p=0.025) in patients with acute atherothrombotic stroke or high-risk TIA.