Key result
Prasugrel lowers hs-CRP by ~73% post-PCI, significantly outperforming clopidogrel.
Why the study?
Does prasugrel reduce hs-CRP levels more than clopidogrel in patients undergoing percutaneous coronary intervention?
RCT (n=120)
Double-blind
2:1
No
Does prasugrel reduce hs-CRP levels more than clopidogrel in patients undergoing percutaneous coronary intervention?
Absolute Event Rate: 73% vs 39%
p-value: p=0.002
Prasugrel provides a more potent anti-inflammatory effect than clopidogrel in patients undergoing PCI, as evidenced by a greater reduction in hs-CRP levels.
Prasugrel may be preferred over clopidogrel for greater anti-inflammatory effect in PCI; extends RCT comparisons of P2Y12 inhibitor pleiotropy.
OBJECTIVES: A growing body of clinical and laboratory evidence indicates that inflammation plays a crucial role in atherosclerosis. In the present study, we compared the effects of clopidogrel and prasugrel on high-sensitivity C-reactive protein (hs-CRP) in patients undergoing percutaneous coronary intervention (PCI). METHODS: The present randomized, double-blind clinical trial included 120 patients who underwent PCI. Eligible patients were randomly assigned 2:1 to one of the two groups: 80 patients in the first group received clopidogrel (Plavix(®); loading dose and maintenance dose of 300 and 75 mg daily, respectively) and 40 patients in the second group received prasugrel (Effient(®); loading dose and maintenance dose of 60 and 10 mg, respectively) for 12 weeks. The hs-CRP levels between baseline and 12th week were compared. RESULTS: Of the 120 patients, 69 patients (57.5%) were male. Pretreatment hs-CRP level was statistically comparable in clopidogrel (median, 15.10 mg/dL; interquartile range [IQR], 9.62-23.75 mg/dL) and prasugrel groups (median, 18 mg/dL; IQR, 14.25-22 mg/dL; P = 0.06). Patients taking clopidogrel showed a significant reduction in hs-CRP level compared with the baseline values (P < 0.001). Prasugrel administration also resulted in a significant reduction in hs-CRP level (P < 0.001). A significant 73% overall reduction in the hs-CRP level was seen with prasugrel compared with 39% overall reduction in hs-CRP level with clopidogrel (P = 0.002). CONCLUSION: Prasugrel seems to be superior to clopidogrel in the reduction of hs-CRP in patients undergoing PCI.
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Hajsadeghi et al. (2016) conducted an RCT in Patients undergoing percutaneous coronary intervention (PCI) (n=120). Prasugrel vs. Clopidogrel (300 mg loading dose followed by 75 mg daily maintenance dose) was evaluated on Reduction in high-sensitivity C-reactive protein (hs-CRP) serum level between baseline and 12th week (p=0.002). Prasugrel resulted in a significantly higher 73% overall reduction in hs-CRP levels compared with a 39% reduction with clopidogrel in patients undergoing PCI (P=0.002).
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