Prasugrel achieves greater and faster P2Y12receptor-mediated platelet inhibition than clopidogrel due to more efficient generation of its active metabolite in aspirin-treated patients with coronary artery disease
Key result
Prasugrel 60/10 mg provided greater inhibition of platelet aggregation than clopidogrel 600/75 mg at 2 hours post-loading dose (mean MPA 31% vs 55%, P<0.001).
Why the study?
Does prasugrel improve P2Y12 receptor-mediated platelet inhibition compared to clopidogrel in aspirin-treated patients with stable coronary artery disease?
Population
110 aspirin-treated subjects with stable coronary artery disease
Comparison
Prasugrel 60 mg loading dose and 10 mg… vs Clopidogrel 600 mg loading dose and 75 mg…
Design
RCT, randomized, double-blind
Follow-up
28 days
Authors
Discussion
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Implication
Supports prasugrel loading when rapid platelet inhibition is desired in stable CAD; confirms superior early pharmacodynamics versus clopidogrel.
Study Design
Type
RCT (n=110)
Blinding
double-blind
Randomization
randomized
Structured PICO
Does prasugrel improve P2Y12 receptor-mediated platelet inhibition compared to clopidogrel in aspirin-treated patients with stable coronary artery disease?
P
Population
110 aspirin-treated subjects with stable coronary artery disease
I
Intervention
Prasugrel 60 mg loading dose and 10 mg maintenance dose for 28 days
C
Comparator
Clopidogrel 600 mg loading dose and 75 mg maintenance dose for 28 days
O
Outcome
P2Y12 receptor antagonism and platelet inhibition (assessed by maximal platelet aggregation and platelet reactivity index)surrogate
Main Result
Absolute Event Rate: 31% vs 55%
p-value: p=<0.001
Prasugrel provides faster onset and greater inhibition of P2Y12 receptor-mediated platelet aggregation than clopidogrel due to more efficient generation of its active metabolite.
Cite This Study
Wallentin et al. (2007) conducted an RCT in stable coronary artery disease (n=110). prasugrel vs. clopidogrel 600 mg LD and 75 mg MD was evaluated on maximal platelet aggregation (MPA) at 2 h post-LD (p=<0.001). Prasugrel 60/10 mg provided greater inhibition of platelet aggregation than clopidogrel 600/75 mg at 2 hours post-loading dose (mean MPA 31% vs 55%, P<0.001).