Antiplatelet Effect of Low-Dose Prasugrel in Elderly Patients Undergoing Percutaneous Coronary Interventions.

IF 2.8 3区医学 Q2 PERIPHERAL VASCULAR DISEASE

Current vascular pharmacology Pub Date : 2024-01-01 DOI:10.2174/0115701611280276240529105022

Monica Verdoia, Matteo Nardin, Rocco Gioscia, Andrea Rognoni, Giuseppe De Luca

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引用次数: 0

Abstract

Background: Low-dose prasugrel (5 mg) has been proposed for patients with Acute Coronary Syndrome (ACS) and advanced age or low body weight. However, the routine use of dose-adjusted prasugrel in this high-risk subset of patients is still debated.

Aim: This study aimed to assess the prevalence and predictors of HRPR among elderly patients treated with low-dose (5 mg) prasugrel to evaluate the routine use of dose-adjusted prasugrel in this high-risk subset of patients.

Methods: We included 59 elderly patients (≥75 years) treated with Dual Antiplatelet Therapy (DAPT: acetylsalicylic acid (ASA) 100-160 mg + prasugrel 5 mg) after Percutaneous Coronary Interventions (PCI) and undergoing platelet function assessment (by whole blood impedance aggregometry) 30-90 days post-discharge.

Results: At a median follow-up of 43 days (interquartile range-IQR: 32-54), high-on treatment residual platelet reactivity (HRPR) occurred in 25 patients (42.4%), who displayed a greater body mass index (BMI) (p=0.02), lower levels of vitamin D (p=0.05) and were more frequently treated with nitrates (p=0.03). After multivariate analysis, BMI was the only independent predictor of prasugrel HRPR, and a BMI >26 was the best cut-off for predicting HRPR (adjusted Odds Ratio - OR=8.6, 95%CI: 2.2-33.9, p=0.002).

Conclusion: Among elderly patients receiving DAPT after PCI, HRPR is common with low-dose prasugrel. A greater BMI, especially for values ≥26, is the only independent predictor of HRPR with prasugrel 5 mg.

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小剂量普拉格雷对接受经皮冠状动脉介入治疗的老年患者的抗血小板作用

背景：低剂量普拉格雷（5 毫克）已被推荐用于急性冠状动脉综合征（ACS）、高龄或低体重患者。目的：本研究旨在评估接受低剂量（5 毫克）普拉格雷治疗的老年患者中 HRPR 的发生率和预测因素，以评估在这一高风险亚群患者中常规使用剂量调整后的普拉格雷的情况：我们纳入了59例经皮冠状动脉介入治疗（PCI）后接受双重抗血小板疗法（DAPT：乙酰水杨酸（ASA）100-160毫克+普拉格雷5毫克）治疗并在出院后30-90天接受血小板功能评估（通过全血阻抗聚集测定法）的老年患者（≥75岁）：在中位随访43天（四分位间范围-IQR：32-54）时，25名患者（42.4%）出现了治疗后高残留血小板反应性（HRPR），这些患者的体重指数（BMI）较高（P=0.02），维生素D水平较低（P=0.05），且更常接受硝酸盐治疗（P=0.03）。经过多变量分析，BMI是普拉格雷HRPR的唯一独立预测因子，BMI>26是预测HRPR的最佳临界值（调整后的比值比-OR=8.6，95%CI：2.2-33.9，p=0.002）：结论：在PCI术后接受DAPT治疗的老年患者中，使用低剂量普拉格雷时，HRPR很常见。结论：在接受 PCI 后 DAPT 的老年患者中，使用低剂量普拉格雷会出现 HRPR。体重指数越大，尤其是数值≥26 时，是普拉格雷 5 毫克使用时 HRPR 的唯一独立预测因素。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Current vascular pharmacology 医学-外周血管病

CiteScore

9.20

自引率

4.40%

发文量

审稿时长

6-12 weeks

期刊介绍： Current Vascular Pharmacology publishes clinical and research-based reviews/mini-reviews, original research articles, letters, debates, drug clinical trial studies and guest edited issues to update all those concerned with the treatment of vascular disease, bridging the gap between clinical practice and ongoing research. Vascular disease is the commonest cause of death in Westernized countries and its incidence is on the increase in developing countries. It follows that considerable research is directed at establishing effective treatment for acute vascular events. Long-term treatment has also received considerable attention (e.g. for symptomatic relief). Furthermore, effective prevention, whether primary or secondary, is backed by the findings of several landmark trials. Vascular disease is a complex field with primary care physicians and nurse practitioners as well as several specialties involved. The latter include cardiology, vascular and cardio thoracic surgery, general medicine, radiology, clinical pharmacology and neurology (stroke units).