Recovery of platelet function after discontinuation of prasugrel or clopidogrel maintenance dosing in aspirin-treated patients with stable coronary disease
JACC - Journal of the American College of Cardiology, 06/15/2012
Price MJ et al. – Recovery time after thienopyridine discontinuation depends on the magnitude of on–treatment platelet inhibition, resulting, on average, in a more delayed recovery with prasugrel compared with clopidogrel. The offset of prasugrel was consistent with current guidelines regarding the recommended waiting period for surgery after discontinuation.Methods
- 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 study drug administration and for up to 12 days during washout.
- The primary endpoint was the cumulative proportion of patients returning to baseline reactivity after study drug discontinuation.
- A total of 56 patients were randomized; 54 were eligible for analysis.
- Platelet reactivity was lower 24 h after the last dose of prasugrel compared with clopidogrel.
- After prasugrel, ≥75% of patients returned to baseline reactivity by washout day 7 compared with day 5 after clopidogrel.
- Recovery time was dependent on the level of platelet reactivity before study drug exposure and the initial degree of platelet inhibition after study drug discontinuation but not on treatment assignment.