Patients with poor responsiveness to thienopyridine treatment or with diabetes have lower levels of circulating active metabolite, but their platelets respond normally to active metabolite added ex vivo

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Erlinge, DavidLund University,Lunds universitet,Kardiologi,Sektion II,Institutionen för kliniska vetenskaper, Lund,Medicinska fakulteten,Cardiology,Section II,Department of Clinical Sciences, Lund,Faculty of Medicine (author)

Patients with poor responsiveness to thienopyridine treatment or with diabetes have lower levels of circulating active metabolite, but their platelets respond normally to active metabolite added ex vivo

Article/chapterEnglish2008

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Elsevier BV,2008
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LIBRIS-ID:oai:DiVA.org:uu-102860
https://urn.kb.se/resolve?urn=urn:nbn:se:uu:diva-102860URI
https://doi.org/10.1016/j.jacc.2008.07.068DOI
https://lup.lub.lu.se/record/1276453URI

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Language:English
Summary in:English

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Subject category:ref swepub-contenttype
Subject category:art swepub-publicationtype

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OBJECTIVES: We evaluated the prevalence and mechanism of poor responsiveness to clopidogrel and prasugrel in coronary artery disease patients with and without diabetes. BACKGROUND: Low platelet inhibition by clopidogrel is associated with ischemic clinical events. A higher 600-mg loading dose (LD) has been advocated to increase responsiveness to clopidogrel. METHODS: In this study, 110 aspirin-treated patients were randomized to double-blind treatment with clopidogrel 600 mg LD/75 mg maintenance dose (MD) for 28 days or prasugrel 60 mg LD/10 mg MD for 28 days. Pharmacodynamic (PD) response was evaluated by light transmission aggregometry and vasodilator-stimulated phosphoprotein phosphorylation. The PD poor responsiveness was defined with 4 definitions previously associated with worse clinical outcomes. Active metabolites (AM) of clopidogrel and prasugrel were measured. Clopidogrel AM was added ex vivo. RESULTS: The proportion of patients with poor responsiveness was greater in the clopidogrel group for all definitions at all time points from 1 h to 29 days. Poor responders had significantly lower plasma AM levels compared with responders. Patients with diabetes were over-represented in the poor-responder groups and had significantly lower levels of AM. Platelets of both poor responders and diabetic patients responded fully to AM added ex vivo. CONCLUSIONS: Prasugrel treatment results in significantly fewer PD poor responders compared with clopidogrel after a 600-mg clopidogrel LD and during MD. The mechanism of incomplete platelet inhibition in clopidogrel poor-responder groups and in diabetic patients is lower plasma levels of its AM and not differences in platelet P2Y(12) receptor function.

Subject headings and genre

MEDICIN OCH HÄLSOVETENSKAP Klinisk medicin Kardiologi hsv//swe
MEDICAL AND HEALTH SCIENCES Clinical Medicine Cardiac and Cardiovascular Systems hsv//eng
prasugrel
trials
thienopyridine
clopidogrel
platelets
clopidogrel resistance
coronary artery disease
MEDICINE
MEDICIN

Added entries (persons, corporate bodies, meetings, titles ...)

Varenhorst, ChristophUppsala universitet,Institutionen för medicinska vetenskaper,UCR(Swepub:uu)chrva923 (author)
Braun, OscarLund University,Lunds universitet,Kardiologi,Sektion II,Institutionen för kliniska vetenskaper, Lund,Medicinska fakulteten,Cardiology,Section II,Department of Clinical Sciences, Lund,Faculty of Medicine(Swepub:lu)kard-oos (author)
James, Stefan,1964-Uppsala universitet,Institutionen för medicinska vetenskaper,UCR(Swepub:uu)stjam367 (author)
Winters, Kenneth J (author)
Jakubowski, Joseph A (author)
Brandt, John T (author)
Sugidachi, Atsuhiro (author)
Siegbahn, Agneta,1947-Uppsala universitet,Institutionen för medicinska vetenskaper(Swepub:uu)agsie424 (author)
Wallentin, Lars,1943-Uppsala universitet,Institutionen för medicinska vetenskaper,UCR(Swepub:uu)larswall (author)
KardiologiSektion II (creator_code:org_t)

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In:Journal of the American College of Cardiology: Elsevier BV52:24, s. 1968-770735-10971558-3597

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