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

Ji Hyun Lee, Sung Gyun Ahn, Bonil Park, Sang Wook Park, Yong Seok Kang, Jun Won Lee, Young Jin Youn, Min Soo Ahn, Jang Young Kim, Byung Su Yoo, Seung Hwan Lee, Junghan Yoon

Research output: Contribution to journalArticle

8 Citations (Scopus)

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, ontreatment platelet reactivity (OPR) was assessed in terms of P2Y12 reaction units (PRUs) using the VerifyNow P2Y12 assay (Accumetrics). We compared East Asian (85 < PRU ≤ 275) and Caucasian (85 < PRU ≤ 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.

Original languageEnglish
Pages (from-to)620-628
Number of pages9
JournalKorean Journal of Internal Medicine
Volume30
Issue number5
DOIs
Publication statusPublished - 2015 Sep 1

Fingerprint

Acute Coronary Syndrome
Blood Platelets
Prasugrel Hydrochloride
Percutaneous Coronary Intervention
Ticagrelor
Therapeutics
Maintenance
Hemorrhage

All Science Journal Classification (ASJC) codes

  • Internal Medicine

Cite this

@article{2244620049c44de99bad73e7c21ced09,
title = "A pharmacodynamic study of the optimal P2Y12 inhibitor regimen for East Asian patients with acute coronary syndrome",
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, ontreatment platelet reactivity (OPR) was assessed in terms of P2Y12 reaction units (PRUs) using the VerifyNow P2Y12 assay (Accumetrics). We compared East Asian (85 < PRU ≤ 275) and Caucasian (85 < PRU ≤ 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.",
author = "Lee, {Ji Hyun} and Ahn, {Sung Gyun} and Bonil Park and Park, {Sang Wook} and Kang, {Yong Seok} and Lee, {Jun Won} and Youn, {Young Jin} and Ahn, {Min Soo} and Kim, {Jang Young} and Yoo, {Byung Su} and Lee, {Seung Hwan} and Junghan Yoon",
year = "2015",
month = "9",
day = "1",
doi = "10.3904/kjim.2015.30.5.620",
language = "English",
volume = "30",
pages = "620--628",
journal = "Korean Journal of Internal Medicine",
issn = "1226-3303",
publisher = "Korean Association of Internal Medicine",
number = "5",

}

A pharmacodynamic study of the optimal P2Y12 inhibitor regimen for East Asian patients with acute coronary syndrome. / Lee, Ji Hyun; Ahn, Sung Gyun; Park, Bonil; Park, Sang Wook; Kang, Yong Seok; Lee, Jun Won; Youn, Young Jin; Ahn, Min Soo; Kim, Jang Young; Yoo, Byung Su; Lee, Seung Hwan; Yoon, Junghan.

In: Korean Journal of Internal Medicine, Vol. 30, No. 5, 01.09.2015, p. 620-628.

Research output: Contribution to journalArticle

TY - JOUR

T1 - A pharmacodynamic study of the optimal P2Y12 inhibitor regimen for East Asian patients with acute coronary syndrome

AU - Lee, Ji Hyun

AU - Ahn, Sung Gyun

AU - Park, Bonil

AU - Park, Sang Wook

AU - Kang, Yong Seok

AU - Lee, Jun Won

AU - Youn, Young Jin

AU - Ahn, Min Soo

AU - Kim, Jang Young

AU - Yoo, Byung Su

AU - Lee, Seung Hwan

AU - Yoon, Junghan

PY - 2015/9/1

Y1 - 2015/9/1

N2 - 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, ontreatment platelet reactivity (OPR) was assessed in terms of P2Y12 reaction units (PRUs) using the VerifyNow P2Y12 assay (Accumetrics). We compared East Asian (85 < PRU ≤ 275) and Caucasian (85 < PRU ≤ 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.

AB - 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, ontreatment platelet reactivity (OPR) was assessed in terms of P2Y12 reaction units (PRUs) using the VerifyNow P2Y12 assay (Accumetrics). We compared East Asian (85 < PRU ≤ 275) and Caucasian (85 < PRU ≤ 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.

UR - http://www.scopus.com/inward/record.url?scp=84942090097&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=84942090097&partnerID=8YFLogxK

U2 - 10.3904/kjim.2015.30.5.620

DO - 10.3904/kjim.2015.30.5.620

M3 - Article

C2 - 26354056

AN - SCOPUS:84942090097

VL - 30

SP - 620

EP - 628

JO - Korean Journal of Internal Medicine

JF - Korean Journal of Internal Medicine

SN - 1226-3303

IS - 5

ER -