Produção Nacional
Revisado por pares
P2Y12 receptor inhibition with prasugrel and ticagrelor in STEMI patients after fibrinolytic therapy: Analysis from the SAMPA randomized trial
2016; Elsevier BV; Volume: 230; Linguagem: Inglês
10.1016/j.ijcard.2016.12.173
ISSN1874-1754
AutoresLeonardo Guimarães, Philippe Généreux, Diego Augusto O. da Silveira, Antônio Eduardo Pereira Pesaro, Felipe Falcão, B R C Barbosa, Cristiano Freitas de Souza, Francisco Antônio Helfenstein Fonseca, Cláudia Maria Rodrigues Alves, Antônio Carlos Carvalho, Gregg W. Stone, Adriano Caixeta,
Tópico(s)Coronary Interventions and Diagnostics
ResumoBackground A pharmacodynamic comparison between ticagrelor and prasugrel after fibrinolytic therapy has not yet been performed. Methods In the single-center SAMPA trial, 50 consecutive STEMI patients previously treated with clopidogrel and undergoing a pharmacoinvasive strategy were randomized to either a ticagrelor (n = 25) 180 mg loading dose followed by 90 mg bid, or a prasugrel (n = 25) 60 mg loading dose followed by 10 mg/day, initiated after fibrinolytic therapy but before angiography. Platelet reactivity was assessed with the VerifyNow P2Y12 assay at 0, 2, 6, and 24 h after randomization. Results Mean times from fibrinolysis to prasugrel or ticagrelor administration were 11.1 ± 6.9 and 13.3 ± 6.3 h, respectively (p = 0.24). The values of PRU decreased significantly from baseline to 2 h (all p < 0.001) and from 2 h to 6 h (all p < 0.001) in both groups. There was no difference in PRU values between 6 h and 24 h. The mean PRU values at 0, 2, 6, and 24 h were 234.9, 127.8, 45.4, and 48.0 in the prasugrel group and 233.1, 135.1, 67.7, and 56.9 in the ticagrelor group, respectively. PRU values did not significantly differ between groups at any time period of the study. Conclusions In patients with STEMI treated with fibrinolytic therapy, platelet inhibition after clopidogrel is suboptimal and can be further increased with more potent agents. Ticagrelor and prasugrel demonstrated a similar extent of P2Y12 receptor inhibition within 24 h, although maximal platelet inhibition after these potent agents was not achieved for 6 h.
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