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Oscar Braun

Physician

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Assessment of P2Y(12) inhibition with the point-of-care device VerifyNow P2Y12 in patients treated with prasugrel or clopidogrel coadministered with aspirin

Author

  • Christoph Varenhorst
  • Stefan James
  • David Erlinge
  • Oscar Braun
  • John T. Brandt
  • Kenneth J. Winters
  • Joseph A. Jakubowski
  • Sylvia Olofsson
  • Lars Wallentin
  • Agneta Slegbahn

Summary, in English

Background Variability in response to thienopyridines has led to the development of point-of-care devices to assess adenosine diphosphate (ADP)-induced platelet aggregation. These tests need to be evaluated in comparison to reference measurements of P2Y(12) function during different thienopyridine treatments. Methods After a run-in on 75 mg aspirin, I 10 subjects were randomized to double-blind treatment with clopidogrel 600 mg loading dose (LD)/75 mg maintenance dose (MD) or prasugrel 60 mg LD/10 mg MD. Antiplatelet effects were evaluated by VerifyNow P2Y12 (VN-P2Y12) device (Accumetrics, San Diego, CA), vasodilator-stimulated phosphoprotein (VASP) phosphorylation assay, and light transmission aggregometry (LTA). Prasugrel's and clopidogrel's active metabolite concentration were also determined. Results Dose- and time-dependent inhibition of P2Y(12) was evident with VN-P2Y12. There was strong correlation with VN-P2Y12 and VASP or LTA for all treatments through a wide range of P2Y(12) function. At high levels of P2Y(12) inhibition, platelet function measured by VN-P2Y12 was maximally inhibited and could not reflect further changes seen with VASP or LTA methods. Correlation was also observed between exposure to clopidogrel's active metabolite and VN-F`2Y12 during MD and LD, whereas it was observed only with prasugrel MD. Conclusion The VN-P2Y12 correlated strongly with inhibition of P2Y(12) function, as measured with either VASP or LTA. VN-P2Y12 also correlated to exposure to the active metabolite of prasugrel and clopidogrel up to levels associated with assumed saturation of the P2Y(12) receptor. (Am Heart J 2009; 1 57:562.e1-562.e9.)

Department/s

  • Cardiology

Publishing year

2009

Language

English

Publication/Series

American Heart Journal

Volume

157

Issue

3

Document type

Journal article

Publisher

Mosby-Elsevier

Topic

  • Cardiac and Cardiovascular Systems

Status

Published

ISBN/ISSN/Other

  • ISSN: 1097-6744