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Thromb Haemost 2011; 106(06): 1149-1157
DOI: 10.1160/TH11-05-0346
Wound Healing and Inflammation/Infection
Schattauer GmbH

Platelet function profiles in the elderly: Results of a pharmacodynamic study in patients on clopidogrel therapy and effects of switching to prasugrel 5 mg in patients with high platelet reactivity

Piera Capranzano
1   Cardiovascular Department, Ferrarotto Hospital, University of Catania, Italy
2   ETNA Foundation, Catania, Italy
,
Claudia Tamburino
1   Cardiovascular Department, Ferrarotto Hospital, University of Catania, Italy
2   ETNA Foundation, Catania, Italy
,
Davide Capodanno
1   Cardiovascular Department, Ferrarotto Hospital, University of Catania, Italy
2   ETNA Foundation, Catania, Italy
,
Eligio Miccichè
1   Cardiovascular Department, Ferrarotto Hospital, University of Catania, Italy
,
Lucia D’Urso
1   Cardiovascular Department, Ferrarotto Hospital, University of Catania, Italy
,
Valeria Calvi
1   Cardiovascular Department, Ferrarotto Hospital, University of Catania, Italy
,
Dominick J. Angiolillo
2   ETNA Foundation, Catania, Italy
3   Division of Cardiology, University of Florida College of Medicine-Jacksonville, Jacksonville, Florida, USA
,
Corrado Tamburino
1   Cardiovascular Department, Ferrarotto Hospital, University of Catania, Italy
2   ETNA Foundation, Catania, Italy
› Author Affiliations Financial support: This study was supported by internal institutional funding from ETNA Foundation, Catania, Italy.
Further Information

Publication History

Received: 23 May 2011

Accepted after major revision: 23 September 2011

Publication Date:
27 November 2017 (online)

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Summary

Studies specifically designed to assess clopidogrel response in the elderly as well as treatment alternatives to improve platelet inhibition in this highrisk population are lacking. This study aimed to define phar-macodynamic (PD) profiles, including high platelet reactivity (HPR) rates, among elderly patients on maintenance clopidogrel therapy and to assess the PD effects of prasugrel 5 mg/day in elderly with HPR. This was a prospective observational PD study enrolling consecutive ≥75-year-old patients on maintenance clopidogrel therapy (75 mg/day) who were tested for clopidogrel response by the VerifyNow P2Y12 assay and light transmittance aggregometry (LTA). HPR rates were estimated using multiple definitions. HPR patients identified by the VerifyNow P2Y12 assay [P2Y12 reaction unit (PRU) ≥230] were switched to prasugrel 5 mg/day, and platelet function testing was performed after 15 days of treatment. PD testing was completed in 100 patients. The HPR prevalence varied between 25% and 32%, depending on the definition used. A PRU ≥230 was observed in 25 patients; of these, 20 switched to prasugrel 5 mg/day. This resulted in significant reduction in PRU mean values (279.8 ± 45.1 vs. 171.7 ± 65.2, p=0.0002) with an absolute between-treatment difference of 108.1 (95% confidence intervals 75.2–140.9). Accordingly, switching to prasugrel 5 mg/day overcame HPR in most (80%) patients. Consistently, all LTA measures were significantly lower after prasugrel compared with clopidogrel. In conclusion, a considerable proportion of elderly patients exhibit HPR while on standard clopidogrel therapy. Switching to 5 mg/day prasugrel in elderly patients with HPR is associated with enhanced platelet inhibition and overcomes HPR in the majority of these patients.

Keywords

Clopidogrel non-responsiveness - elderly patients - prasugrel
 

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