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Prasugrel versus clopidogrel for residual thrombus burden in patients with ST-segment elevation myocardial infarction

an optical coherence tomography study

Yokota, Takashia,b; Higuma, Takumib; Endo, Tomohidea; Nishizaki, Fumiea; Hanada, Kenjia; Yokoyama, Hiroakia; Yamada, Masahiroa; Okumura, Kenc; Tomita, Hirofumia,b

doi: 10.1097/MCA.0000000000000663
Anti-platelet therapy in CAD
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Background Prasugrel was shown to inhibit platelet activity more rapidly and consistently than clopidogrel. We compared the effects of prasugrel and clopidogrel on residual thrombus burden assessed by optical coherence tomography after stent implantation in patients with ST-segment elevation myocardial infarction (STEMI).

Patients and methods A total of 76 patients with STEMI undergoing percutaneous coronary intervention (PCI) within 12 h after the onset were retrospectively enrolled. Of them, 34 patients were treated with prasugrel (loading dose, 20 mg) and the remaining 42 with clopidogrel (loading dose, 300 mg). Stent volume and in-stent thrombus volume were assessed by post-PCI optical coherence tomography.

Results Baseline clinical characteristics, angiographic findings, and PCI procedure did not differ between the two groups. There was no difference in in-stent volume between patients with prasugrel and clopidogrel [169 (134–214) versus 166 (128–210) mm3, P=0.83]. Patients with prasugrel had a significantly reduced in-stent thrombus volume compared with those with clopidogrel [0.59 (0.16–1.09) vs. 1.08 (0.32–2.30) mm3, P=0.03]. The mean area and maximum area of in-stent thrombus were also significantly smaller in prasugrel than in clopidogrel group [0.03 (0.01–0.05) vs. 0.05 (0.01–0.10) mm2, P=0.04, and 0.45 (0.27–0.75) vs. 0.77 (0.34–1.23) mm2, P=0.03, respectively].

Conclusion Prasugrel more effectively reduced residual thrombus burden after stent implantation in patients with STEMI, indicating a faster and more potent platelet inhibitory effect of prasugrel compared with clopidogrel.

aDepartment of Cardiology

bDepartment of Advanced Cardiovascular Therapeutics, Hirosaki University Graduate School of Medicine, Hirosaki

cDivision of Cardiology, Saiseikai Kumamoto Hospital, Kumamoto, Japan

Correspondence to Hirofumi Tomita, MD, PhD, Department of Cardiology, Hirosaki University Graduate School of Medicine, 5 Zaifu-cho, Hirosaki 036-8092, Japan Tel: +81 172 395 057; fax: +81 172 359 190; e-mail: tomitah@hirosaki-u.ac.jp

Received May 23, 2018

Accepted September 2, 2018

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