JACC March 12, 2013
Volume 61, Issue 10
TCT@ACC-i2: Invasive and Interventional Cardiology
safeTy of reloading prasugrel in addiTion To clopidogrel loading in paTienTs wiTh acuTe
coronary syndrome undergoing pci
Poster Sessions, Expo North
Monday, March 11, 2013, 9:45 a.m.-10:30 a.m.
Session Title: Acute Coronary Syndrome and Acute Myocardial Infarction
Abstract Category: 40. TCT@ACC-i2: ACS/AMI/Hemodynamic Support
Presentation Number: 2113-260
Authors: Joshua Loh, Lakshmana Pendyala, Hironori Kitabata, Salem Badr, Danny Dvir, Israel Barbash, Sa’ar Minha, Rebecca Torguson, Kenneth
Kent, Lowell Satler, William Suddath, Augusto Pichard, Ron Waksman, Washington Hospital Center, Washington, DC, USA
Background: Patients with acute coronary syndrome (ACS) undergoing percutaneous coronary intervention (PCI) are commonly loaded with
either clopidogrel or prasugrel in addition to aspirin. This study aimed to assess the safety of reloading prasugrel in patients initially loaded with
clopidogrel, when compared to prasugrel loading alone.
methods: The study included a cohort of 606 consecutive ACS patients who received a prasugrel 60-mg loading dose before PCI. These patients
were categorized into clopidogrel preloading (300- or 600-mg) followed by prasugrel reloading (CP-load group, n=90) and prasugrel loading only
(P-load group, n=516). Both groups received prasugrel 10 mg as maintenance dose following PCI. The primary end point was in-hospital Thrombolysis
In Myocardial Infarction (TIMI)-defined major bleeding; secondary end points were other in-hospital bleeding and vascular complications.
results: Patients in the CP-load were younger, with lower rates of cardiovascular risk factors. Significantly more patients in the CP-load group
presented with biomarker positive myocardial infarction (80.0 vs. 30.6%, p=<0.001) and cardiogenic shock (5.6 vs. 1.4%, p=0.022). There were no
significant differences (p=NS) in TIMI major bleeding (2.6 vs. 2.8%), TIMI major or minor bleeding (12.2 vs. 7.0%), need for blood transfusion (2.6
vs. 2.1%) and vascular complications (1.3 vs. 2.0%) between the CP-load and P-load groups. The C-P load group experienced more in-hospital major
adverse cardiac events (5.6 vs. 1.6%, p=0.031), urgent coronary artery bypass grafting (3.3 vs. 0.2%, p=0.011) and longer hospital (3.2 vs. 2.4 days,
p=0.014) and intensive care unit (0.8 vs. 0.3 days, p <0.001) stays.
conclusions: For patients with ACS who are subjected to PCI and were loaded with clopidogrel prior to arrival to the catheterization laboratory, it is
safe to reload with prasugrel in the catheterization laboratory with respect to in-hospital bleeding and vascular complications.