Platelet function during extended prasugrel and clopidogrel therapy for patients with ACS treated without revascularization: The TRILOGY ACS platelet function substudy

Paul A. Gurbel, David Erlinge, E. Magnus Ohman, Benjamin Neely, Megan Neely, Shaun G. Goodman, Kurt Huber, Mark Y. Chan, Jan H. Cornel, Eileen Brown, Chunmei Zhou, Joseph A. Jakubowski, Harvey D. White, Keith A A Fox, Dorairaj Prabhakaran, Paul W. Armstrong, Udaya S. Tantry, Matthew T. Roe

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Abstract

Context: The relationship of platelet function testing measurements with outcomes in patients with acute coronary syndromes (ACS) initially managed medically without revascularization is unknown. Objective: To characterize the differences and evaluate clinical outcomes associated with platelet reactivity among patients with ACS treated with clopidogrel or prasugrel. Design, Setting, and Patients: Patients with medically managed unstable angina or non-ST-segment elevationmyocardial infarction were enrolled in the TRILOGY ACS trial (2008 to 2011) comparing clopidogrel vs prasugrel. Of 9326 participants, 27.5% were included in a platelet function substudy: 1286 treated with prasugrel and 1278 treated with clopidogrel. Interventions: Aspirin with either prasugrel (10 or 5 mg/d) or clopidogrel (75 mg/d); those 75 years or older and younger than 75 years but who weighed less than 60 kg received a 5-mg prasugrel maintenance dose. Main Outcome Measures: Platelet reactivity, measured in P2Y12 reaction units (PRUs), was performed at baseline, at 2 hours, and at 1, 3, 6, 12, 18, 24, and 30 months after randomization. The primary efficacy end point was a composite of cardiovascular death, myocardial infarction, or stroke through 30 months. Results: Among participants younger than 75 years and weighing 60 kg or more, the median PRU values at 30 days were 64 (interquartile range [IQR], 33-128) in the prasugrel group vs 200 (IQR, 141-260) in the clopidogrel group (P

Original languageEnglish (US)
Pages (from-to)1785-1794
Number of pages10
JournalJournal of the American Medical Association
Volume308
Issue number17
DOIs
StatePublished - Nov 7 2012

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ASJC Scopus subject areas

  • Medicine(all)

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Gurbel, P. A., Erlinge, D., Ohman, E. M., Neely, B., Neely, M., Goodman, S. G., Huber, K., Chan, M. Y., Cornel, J. H., Brown, E., Zhou, C., Jakubowski, J. A., White, H. D., Fox, K. A. A., Prabhakaran, D., Armstrong, P. W., Tantry, U. S., & Roe, M. T. (2012). Platelet function during extended prasugrel and clopidogrel therapy for patients with ACS treated without revascularization: The TRILOGY ACS platelet function substudy. Journal of the American Medical Association, 308(17), 1785-1794. https://doi.org/10.1001/jama.2012.17312