Prasugrel 5 mg inhibits platelet P-selectin and GPIIb–IIIa expression in very elderly and non elderly : results from the GENERATIONS trial, a pharmacodynamic study in stable CAD patients

Summary, in English

Platelet P-selectin and activated glycoprotein IIb–IIIa (GPIIb–IIIa) are markers of platelet activation and mediates platelet aggregation. Prasugrel (Pras) 5 mg may be used in very elderly (VE) acute coronary syndrome (ACS) patients undergoing PCI, but its effect on platelet P-selectin and activated GPIIb–IIIa in those patients is not known. Stable ACS patients, VE (78 ± 5 years, n = 23) and non-elderly (NE) (55 ± 5 years, n = 22) were randomized to Pras (5 or 10 mg) or clopidogrel (Clop) 75 mg during three 12-day periods. Platelet activation markers were measured by flow cytometry on unstimulated or stimulated (adenosine diphosphate (ADP) 20 μM) platelets, before and after each dosing period.Results: At baseline there was no difference in platelet activation markers, either unstimulated or ADP-stimulated, between NE and VE. Pras 5 mg reduced both ADP-stimulated platelet P-selectin and activated GPIIb–IIIa in VE (p <0.01 for both analyses) and NE (p <0.001 and p <0.05, respectively). Clop 75 mg had a similar effect as Pras 5 mg but did not significantly reduce activated GPIIb–IIIa in VE. Prasugrel 10 mg resulted in decreased platelet activation in both age groups compared to Clop 75 mg (p <0.01).Conclusions: In VE and NE-patients, Pras 5 mg inhibited platelet P-selectin expression similar to Clop 75 mg and Pras 10 mg. Prasugrel 10 mg inhibited platelet P-selectin expression better than Clop 75 mg. Prasugrel 10 mg and 5 mg, but not Clop 75 mg, significantly inhibited activated GPIIb–IIIa in VE. This platelet reactivity data support the use of Pras 5 mg for VE patients.

• Författare: Henrik Wagner; Christian Lood; Catharina Borna; Olof Gidlöf; Lennart Truedsson; Patricia Brown; Chunmei Zhou; Kenneth Winters; Joseph A. Jakubowski; David Erlinge
• Avdelning/ar: Kardiologi; Reumatologi och molekylär skelettbiologi; Avdelningen för mikrobiologi, immunologi och glykobiologi - MIG
• Publiceringsår: 2016-10
• Språk: Engelska
• Sidor: 369-375
• Publikation/Tidskrift/Serie: Journal of Thrombosis and Thrombolysis
• Volym: 42
• Issue: 3
• Länkar: http://dx.doi.org/10.1007/s11239-016-1372-1
• Dokumenttyp: Artikel i tidskrift
• Förlag: Springer
• Ämne: Microbiology in the medical area
• Nyckelord: Activated GPIIb–IIIa; Platelets; Prasugrel; Surface P-selectin
• Status: Published
• Projekt: Helsingborg Resuscitation and Cardiovascular Research Group
• ISBN/ISSN/Övrigt: ISSN: 0929-5305