June 13, 2026Journal of the American College of Cardiology
Recovery of Platelet Function After Discontinuation of Prasugrel or Clopidogrel Maintenance Dosing in Aspirin-Treated Patients With Stable Coronary Disease
Key result
Prasugrel delays return to baseline platelet reactivity by ~2 days vs clopidogrel.
- n=56
Why the study?
Guidelines recommend discontinuing clopidogrel at least 5 days and prasugrel at least 7 days before surgery, but the pharmacodynamic basis for these recommendations is limited.
Does prasugrel 10 mg daily compared to clopidogrel 75 mg daily delay the recovery of platelet function after discontinuation in aspirin-treated patients with stable coronary disease?
Key Points
- This study aims to evaluate how quickly platelet function returns after stopping prasugrel or clopidogrel in patients receiving aspirin.
- Aspirin-treated patients with coronary artery disease were randomly assigned to either prasugrel 10 mg or clopidogrel 75 mg daily for 7 days.
- Platelet reactivity was measured before and for up to 12 days after discontinuing the study drugs.
- The primary endpoint was the proportion of patients returning to baseline reactivity post-discontinuation.
- After 24 hours, platelet reactivity was lower in patients who took prasugrel compared to those who took clopidogrel.
- ≥75% of patients returned to baseline reactivity by washout day 7 after prasugrel versus day 5 after clopidogrel.
- Recovery time depends on pre-treatment platelet reactivity and inhibition level, not on the drug used.
Study Design
Type
RCT (n=56)
Structured PICO
Does prasugrel 10 mg daily compared to clopidogrel 75 mg daily delay the recovery of platelet function after discontinuation in aspirin-treated patients with stable coronary disease?
P
Population
56 aspirin-treated patients with coronary artery disease randomized to prasugrel or clopidogrel for 7 days, with platelet reactivity measured for up to 12 days during washout.
I
Intervention
Prasugrel 10 mg daily for 7 days
C
Comparator
Clopidogrel 75 mg daily for 7 days
O
Outcome
Cumulative proportion of patients returning to baseline platelet reactivity after study drug discontinuationsurrogate
The offset of prasugrel's antiplatelet effect takes longer than clopidogrel's, confirming current guidelines recommending a 7-day waiting period for prasugrel and 5 days for clopidogrel before surgery.
Discussion
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Key expert perspectives
Captured external expert commentary on this paper, strongest first. Original sources are linked where available.
“Everybody responds to clopidogrel differently. Half the patients fully recover function by 3 days. On the other hand, for some 7 days [off drug] may be better because they are strong responders. Giving a prescription for x number of days [to delay surgery] doesn't really make sense.”
EREric R. BatesCardiologist, University of Michigan Medical Center
“For example, if [testing shows that] a patient is a nonresponder, he can go to surgery right away.”
“People might be tempted to assume that pharmacodynamics equals events, but that's not been proven.”
Implication
Individualized washout based on baseline reactivity may guide pre-surgical timing; extends pharmacodynamic data on P2Y12 discontinuation in aspirin users.
Cite This Study
Price et al. (2012) conducted an RCT in Stable Coronary Disease (n=56). Prasugrel vs. Clopidogrel 75 mg daily was evaluated on Cumulative proportion of patients returning to baseline reactivity after study drug discontinuation. Prasugrel resulted in a more delayed recovery of platelet function compared with clopidogrel, with ≥75% of patients returning to baseline reactivity by washout day 7 versus day 5.