Key result
Loading with 60 mg prasugrel prior to PCI followed by 75 mg daily clopidogrel resulted in 0 deaths, 0 MIs, and 0 major bleeding events at 30 days among 102 patients.
Why the study?
Does a strategy of prasugrel loading followed by clopidogrel maintenance prevent 30-day cardiovascular events and bleeding in patients undergoing PCI?
Observational (n=102)
No
Does a strategy of prasugrel loading followed by clopidogrel maintenance prevent 30-day cardiovascular events and bleeding in patients undergoing PCI?
A strategy of loading with prasugrel followed by clopidogrel maintenance appears safe and effective in patients undergoing PCI, with no deaths or MIs at 30 days in this small pilot study.
Zero events in small cohort; hypothesis-generating for prasugrel loading then clopidogrel maintenance in PCI, needs RCTs before practice change.
BACKGROUND: Dual anti-platelet therapy including clopidogrel or prasugrel is standard of care for patients receiving stents. Prasugrel has quicker onset so it can be loaded later than clopidogrel with greater efficacy. However, prasugrel is much more expensive than clopidogrel. OBJECTIVES: To describe the incidence of 30-day death from cardiovascular causes, myocardial infarction, unstable angina requiring intervention, and minor and major bleeding in patients loaded with 60 mg of prasugrel prior to percutaneous coronary intervention (PCI) and then continued on 75 mg of clopidogrel daily after the procedure. METHODS: We reviewed sequential medical records of 102 patients (Mean age: 67.8, male 68.6%, smokers: 22.6%, BMI: 29.5%, hypertension: 90.2%, DM: 33.3%, average ejection fraction: 49.7%) who underwent PCI (3.9% STEMI, 12.7% NSTEMI, 35.3% unstable angina and 48.1% electively) at Baylor University Medical Center between October 2009 and December 2011 who were loaded with prasugrel 60 mg prior to procedure, and then continued on 75 mg clopidogrel daily. RESULTS: None of the patients died or experienced a myocardial infarction (MI) within 30 days of the procedure. Three patients experienced unstable angina requiring intervention but none had in-stent thrombosis or restenosis on repeat angiography. None of the patients experienced a major bleeding event. One patient developed a gastrointestinal bleed which did not require blood transfusion and the bleeding it resolved on discontinuation of the clopidogrel. CONCLUSION: In this retrospective pilot study, a strategy of loading patients needing PCI with prasugrel 60 mg immediately prior to coronary intervention, then continuation of anti-platelet therapy with 75 mg clopidogrel daily was safe and effective.
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Benjamin et al. (2012) conducted an observational in Percutaneous coronary intervention (n=102). Prasugrel loading followed by clopidogrel maintenance was evaluated on 30-day death from cardiovascular causes, myocardial infarction, unstable angina requiring intervention, and minor and major bleeding. Loading with 60 mg prasugrel prior to PCI followed by 75 mg daily clopidogrel resulted in 0 deaths, 0 MIs, and 0 major bleeding events at 30 days among 102 patients.
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