Key result
De-escalating prasugrel to 2.5 mg is linked to ~91% lower bleeding risk vs 3.75 mg post-PCI.
Why the study?
Asians often face clopidogrel resistance and the East Asian paradox, prompting evaluation of the effects of P2Y12 inhibitors, including low-dose prasugrel 2.5 mg, on PRU in the chronic phase post-PCI.
Does low-dose prasugrel (2.5 mg) improve platelet reactivity profiles compared to clopidogrel 75 mg or prasugrel 3.75 mg in Asian patients in the chronic phase post-PCI?
Cohort (n=348)
Yes
Does low-dose prasugrel (2.5 mg) improve platelet reactivity profiles compared to clopidogrel 75 mg or prasugrel 3.75 mg in Asian patients in the chronic phase post-PCI?
Effect estimate: OR 0.09 (95% CI 0.01-0.79)
Absolute Event Rate: 3% vs 20%
p-value: p=0.030
Low-dose prasugrel (2.5 mg) provides a more stable platelet reactivity profile with lower ischemic risk than clopidogrel and lower bleeding risk than standard-dose prasugrel in Asian patients during the chronic phase post-PCI.
May reduce bleeding with prasugrel de-escalation post-PCI; hypothesis-generating for Asian chronic-phase dosing, pending randomized trials.
Purpose Asians often face the problems of clopidogrel resistance and East Asian paradox. This study aimed to evaluate the effects of P2Y12 inhibitors, including low-dose prasugrel 2.5 mg, on the P2Y12 reaction unit (PRU) in the chronic phase after percutaneous coronary intervention (PCI). Methods A total of 348 patients were studied. PRU was measured 6-12 months after PCI and subsequently, 6 months later using a P2Y12 assay, respectively. This study evaluated the proportion of bleeding risk (PRU ≤85) and ischemic risk (PRU ≥239) as primary endpoints, and the prediction of bleeding risk and ischemic risk using multivariable logistic regression analysis. Results At baseline, 136 patients (39%) received prasugrel 3.75 mg, 48 patients (14%) received prasugrel 2.5 mg, and 164 patients (47%) received clopidogrel 75 mg. Clopidogrel 75 mg had a significantly higher proportion of ischemic risk within one year after PCI than the other groups, and was an independent predictor for ischemic risk with reference of prasugrel 3.75 mg. In addition, switching from clopidogrel 75 mg to prasugrel 2.5 mg significantly lowered and aggregated the PRU value. Whereas, dose reduction of prasugrel had a significantly lower proportion of bleeding risk over one year after PCI than the continuation of prasugrel 3.75 mg, and was an independent predictor for bleeding risk with reference of continuation of prasugrel 3.75 mg. Conclusions Prasugrel 2.5 mg has a lower ischemic risk and a more stable PRU value compared with clopidogrel treatment. Prasugrel also contributes to a decline in bleeding risk with concomitant dose reduction. Trial registration : University Hospital Medical Information Network (UMIN), ID : UMIN000029541, Date : October 16, 2017 (https://center6.umin.ac.jp/cgi-open-bin/ctr_e/ctr_view.cgi?recptno=R000033395)
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Fukase et al. (2023) conducted a cohort in Coronary artery disease post-percutaneous coronary intervention (n=348). Prasugrel de-escalation vs. Prasugrel 3.75 mg continuation was evaluated on Bleeding risk (PRU ≤ 85) during follow-up (OR 0.09, 95% CI 0.01-0.79, p=0.030). De-escalation to prasugrel 2.5 mg significantly reduced the risk of bleeding compared to continuation of prasugrel 3.75 mg (OR 0.09) in patients in the chronic phase post-percutaneous coronary intervention.
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