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Low Rates of High Platelet Reactivity with Prasugrel Treatment

Cardiology   |   Hospital Medicine   |  
 
MONDAY, Jan. 7 (HealthDay News) -- Treatment of patients with acute coronary syndromes (ACS) with percutaneous coronary intervention and a maintenance dose of prasugrel is associated with low rates of high platelet reactivity (HPR), ischemic events, and major bleeding in the first 30 days of treatment, according to research published in the Jan. 1 issue of The American Journal of Cardiology.

Guillaume Cayla, M.D., Ph.D., of the University of Paris, and colleagues studied the platelet reactivity and rate of 30-day bleeding events in patients treated with percutaneous coronary intervention and prasugrel 10 mg/day after ACS. Platelet reactivity was monitored using three different tests: the vasodilator-stimulated phosphoprotein (VASP) index, the VerifyNow P2Y12 assay, and light transmission aggregometry.

The researchers found that HPR was seen in 6.8, 3.4, and 3.2 percent of patients using the VASP, P2Y12, and residual platelet reactivity definitions, respectively. Obesity and multivessel disease were significantly and independently associated with HPR. No major bleeding complications were observed at 30 days, and 1.6 percent of patients had recurrent ischemic events. Overall, 14.2 percent of patients experienced nuisance bleeding and 2.5 percent experienced minor bleeding episodes, neither of which were predicted by VASP index.

"In conclusion, patients with acute coronary syndromes receiving maintenance doses of prasugrel have low rates of HPR and ischemic events within the first month. Minor or minimal bleeding is frequent, but not major bleeding," the authors write. "VASP was poorly correlated with the risk for minor or minimal bleeding."

Several authors disclosed financial ties to the pharmaceutical industry.
 

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Further Reading
For patients who undergo percutaneous coronary intervention, mortality is associated with increases in mean platelet volume over time following the procedure, according to a study published in the Jan. 15 issue of The American Journal of Cardiology.
For patients with ST-segment elevation myocardial infarction, high-sensitivity C-reactive protein measurements at presentation predict subsequent nonfatal myocardial infarction and cardiac death; and for patients with acute coronary syndromes, fetuin-A and C-reactive protein have prognostic value, according to two studies published in the Jan. 1 issue of The American Journal of Cardiology.
Study results presented at ACC.13 show that patients with unprotected left main coronary artery disease treated with double kissing crush stenting experienced fewer cases of restenosis and other major adverse events compared to patients who received culotte stenting.
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