Korean J Intern Med.  2015 Sep;30(5):620-628. 10.3904/kjim.2015.30.5.620.

A pharmacodynamic study of the optimal P2Y12 inhibitor regimen for East Asian patients with acute coronary syndrome

• Lee JH
• Ahn SG
• Park B
• Park SW
• Kang YS
• Lee JW
• Youn YJ
• Ahn MS
• Kim JY
• Yoo BS
• Lee SH
• Yoon J

• KMID: 2381560
• DOI: http://doi.org/10.3904/kjim.2015.30.5.620

Abstract

BACKGROUND/AIMS
Newer P2Y12 inhibitors, such as prasugrel and ticagrelor, have greater antiplatelet efficacy but may increase the risk of bleeding. In this study, we compared the pharmacodynamic efficacy of prasugrel and ticagrelor in East Asian patients with acute coronary syndrome (ACS).
METHODS
We selected 83 ACS patients undergoing percutaneous coronary intervention who were discharged with 90 mg ticagrelor twice daily (n = 24), 10 mg prasugrel daily (n = 39) or 5 mg prasugrel daily (n = 20). After 2 to 4 weeks, on-treatment platelet reactivity (OPR) was assessed in terms of P2Y12 reaction units (PRUs) using the VerifyNow P2Y12 assay (Accumetrics). We compared East Asian (85 < PRU < or = 275) and Caucasian (85 < PRU < or = 208) criteria for assessing the therapeutic window of OPR.
RESULTS
OPR was lowest in the ticagrelor group, followed by the 10 mg prasugrel and 5 mg prasugrel groups (49.1 ± 29.9 vs. 83.7 ± 57.1 vs. 168.5 ± 60.8, respectively; p < 0.001). The 5 mg prasugrel group had the highest proportion of patients with OPR values within the therapeutic window, followed by the 10 mg prasugrel and ticagrelor groups (90.0% vs. 46.2% vs. 12.5%, respectively; p < 0.001 for East Asian criteria; 60.0% vs. 43.6% vs. 12.5%, respectively; p < 0.001 for Caucasian criteria).
CONCLUSIONS
Short-term administration of 5 mg prasugrel facilitated maintenance within the therapeutic window of OPR compared with the 10 mg prasugrel and ticagrelor groups. Thus, 5 mg prasugrel daily may be the optimal antiplatelet regimen for stabilized East Asian ACS patients.

Keyword

Prasugrel; Ticagrelor; Platelet function test

MeSH Terms

Acute Coronary Syndrome/blood/diagnosis/ethnology/*therapy
Adenosine/administration & dosage/adverse effects/*analogs & derivatives/pharmacology
Aged
*Asian Continental Ancestry Group
Blood Platelets/*drug effects/metabolism
Drug Administration Schedule
Drug Monitoring/methods
European Continental Ancestry Group
Female
Hemorrhage/chemically induced
Humans
Male
Middle Aged
*Percutaneous Coronary Intervention/adverse effects
Pilot Projects
Platelet Aggregation Inhibitors/administration & dosage/adverse effects
Platelet Function Tests
Prasugrel Hydrochloride/administration & dosage/adverse effects/*pharmacology
Purinergic P2Y Receptor Antagonists/administration & dosage/adverse effects/*pharmacology
Receptors, Purinergic P2Y12/blood/*drug effects
Republic of Korea
Retrospective Studies
Risk Factors
Time Factors
Treatment Outcome
Adenosine
Platelet Aggregation Inhibitors
Purinergic P2Y Receptor Antagonists
Prasugrel Hydrochloride
Receptors, Purinergic P2Y12
Ticagrelor