Circulation reports · 2025
Differences in P2Y12 Reaction Units Between Prasugrel and Clopidogrel by Ischemic Cerebrovascular Disease Subtypes - Subanalysis From ACUTE-PRAS.
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Fujimoto Shigeru, Iguchi Yasuyuki, Yamagami Hiroshi, Koga Masatoshi, Itabashi Ryo, Yakushiji Yusuke, Kowata Kazuma, Kimura Naoto, Terasawa Yuka, Shimizu Takahiro, Miyazaki Yuichi, Oki Koichi, Masuo Osamu, Matsuoka Hideki, Arakawa Shuji, Ueda Toshihiro, Tanaka Ryota, Hashimoto Wataru, Abe Satoru, Kato Go, Furugori Taketoshi, Kimura Kazumi, ACUTE-PRAS Investigators
Аннотация
BACKGROUND: We previously reported that prasugrel treatment resulted in stable inhibition of platelet aggregation compared with clopidogrel in patients with acute large artery atherosclerosis (LAA) or high-risk transient ischemic attack (TIA). However, the differences by disease subtypes were not assessed. This subgroup analysis of the open-label ACUTE-PRAS study examined differences in P2Y12 reaction units between prasugrel and clopidogrel by disease subtypes (acute LAA and high-risk TIA).
METHODS AND RESULTS: We measured platelet reaction units (PRU) by disease subtypes for each treatment arm. Eighty-eight patients were included in each treatment arm in the full analysis. In the prasugrel group, there were 61 (69.3%) patients with LAA and 27 (30.7%) patients with high-risk TIA. In the clopidogrel group, there were 64 (72.7%) patients with LAA and 24 (27.3%) patients with high-risk TIA. Among patients with LAA, PRU at Day 5 were numerically lower in the prasugrel group than in the clopidogrel group (arithmetic mean±standard deviation at Day 5: 128.8±49.0 vs. 178.9±60.5). In contrast, PRU at Day 5 were similar between prasugrel and clopidogrel in patients with high-risk TIA.
CONCLUSIONS: Prasugrel may have the potential to elicit stronger platelet aggregation inhibitory effects compared with clopidogrel in patients with acute LAA.
METHODS AND RESULTS: We measured platelet reaction units (PRU) by disease subtypes for each treatment arm. Eighty-eight patients were included in each treatment arm in the full analysis. In the prasugrel group, there were 61 (69.3%) patients with LAA and 27 (30.7%) patients with high-risk TIA. In the clopidogrel group, there were 64 (72.7%) patients with LAA and 24 (27.3%) patients with high-risk TIA. Among patients with LAA, PRU at Day 5 were numerically lower in the prasugrel group than in the clopidogrel group (arithmetic mean±standard deviation at Day 5: 128.8±49.0 vs. 178.9±60.5). In contrast, PRU at Day 5 were similar between prasugrel and clopidogrel in patients with high-risk TIA.
CONCLUSIONS: Prasugrel may have the potential to elicit stronger platelet aggregation inhibitory effects compared with clopidogrel in patients with acute LAA.