Switching directly from clopidogrel to prasugrel maintenance dose achieved a new steady state maximal platelet aggregation of approximately 24% (p<0.01 vs clopidogrel), without increasing bleeding.
RCT (n=39)
randomized
Does switching directly from clopidogrel to prasugrel improve platelet inhibition in healthy subjects on aspirin?
Switching directly from clopidogrel to prasugrel without a washout period rapidly increases platelet inhibition without increasing short-term bleeding in healthy subjects.
p-value: p=<0.01
Prasugrel, a novel P2Y(12) antagonist, achieves faster onset and greater inhibition of platelet aggregation than clopidogrel 300 and 600 mg loading doses (LD). We studied the safety, time course, and level of platelet inhibition when switching directly from clopidogrel 75 mg maintenance dose (MD) to a prasugrel 60 mg LD/10 mg MD or 10 mg MD regimen. Healthy subjects (n = 39) on aspirin (81 mg/d) received a clopidogrel 600 mg LD followed by 10 days of clopidogrel MD (75 mg/d). Subjects were then randomized without a washout period to prasugrel 60 mg LD (n = 16) followed by 10 days of prasugrel MD (10 mg/d) or to prasugrel MD (10 mg/d, n = 19) for 11 days. Maximal platelet aggregation (MPA) to 20 microM ADP was measured by turbidimetric aggregometry. In subjects on clopidogrel 75 mg MD, mean MPA decreased from 39 to 12% by 30 minutes, and to 5% by 1 hour after a prasugrel 60 mg LD (p < 0.001 for both) and from 37 to 28% (p < 0.001) by 1 hour after a prasugrel 10 mg MD. During prasugrel MD, a new pharmacodynamic steady state MPA of approximately 24% (p < 0.01 vs. clopidogrel MD) occurred within four to five days of switching from clopidogrel. Changing from clopidogrel to prasugrel did not increase bleeding episodes or other adverse events. Switching directly from clopidogrel MD to either prasugrel LD or MD was well tolerated and resulted in significantly greater levels of platelet inhibition than a clopidogrel 75 mg MD.
Payne et al. (Tue,) conducted a rct in Healthy subjects on aspirin (n=39). Prasugrel vs. Clopidogrel 75 mg maintenance dose (baseline) was evaluated on Maximal platelet aggregation (MPA) to 20 microM ADP at steady state (p=<0.01). Switching directly from clopidogrel to prasugrel maintenance dose achieved a new steady state maximal platelet aggregation of approximately 24% (p<0.01 vs clopidogrel), without increasing bleeding.