P2Y₁₂ Inhibitor Response By Patient Background Factors: An Exploratory Post Hoc Subgroup Analysis of the ACUTE-PRAS Study.

IF 3.4 2区医学 Q2 PERIPHERAL VASCULAR DISEASE

Journal of atherosclerosis and thrombosis Pub Date : 2026-06-01 Epub Date: 2026-03-03 DOI:10.5551/jat.66056

Shigeru Fujimoto, Yasuyuki Iguchi, Hiroshi Yamagami, Masatoshi Koga, Ryo Itabashi, Yusuke Yakushiji, Kazuma Kowata, Naoto Kimura, Yuka Terasawa, Takahiro Shimizu, Yuichi Miyazaki, Koichi Oki, Osamu Masuo, Hideki Matsuoka, Shuji Arakawa, Toshihiro Ueda, Ryota Tanaka, Wataru Hashimoto, Satoru Abe, Go Kato, Taketoshi Furugori, Kazumi Kimura

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引用次数: 0

Abstract

Aim: To explore whether the antiplatelet effects of prasugrel and clopidogrel vary according to patient background factors in the ACUTE-PRAS study.

Methods: This was a post hoc, hypothesis-generating, exploratory analysis of the multicenter, open-label, randomized controlled ACUTE-PRAS study, in which 176 patients with acute atherothrombotic stroke or high-risk TIA received prasugrel or clopidogrel within 48 h of symptom onset. High platelet reactivity (HPR; platelet reaction units [PRU] ＞208) and absolute PRU were assessed on Day 5 in subgroups stratified by ABCD-GENE score, age, body mass index (BMI), chronic kidney disease (CKD), diabetes mellitus (DM), hypertension, dyslipidemia, time from stroke onset to treatment, National Institutes of Health Stroke Scale (NIHSS) score, and prior ischemic stroke.

Results: Patients with prasugrel had numerically lower rates of HPR than those with clopidogrel in the high-risk stratum of ABCD-GENE score ≥ 10 (OR 2.73, p = 0.076), and favorable trends in prasugrel were also observed for CKD (8.06, p = 0.012), age ＞75 years (5.02, p = 0.025), BMI ＜25 kg/m² (4.61, p = 0.012), dyslipidemia (4.73, p = 0.009), DM (3.86, p = 0.038), treatment initiation ≤ 24 h (3.31, p = 0.010), and NIHSS ≤ 3 (2.77, p = 0.036) or ≥ 4 (9.00, p = 0.025). Prasugrel also reduced PRU numerically more than clopidogrel across most subgroups, except in patients with BMI ≥ 25 kg/m², treatment initiation ＞24 hours, or prior ischemic stroke, where only numerical differences were observed.

Conclusions: Prasugrel provided favorable early platelet inhibition, particularly in subgroups characterized by advanced age, CKD, low BMI, metabolic comorbidities, or very early treatment start.

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患者背景因素对P2Y12抑制剂的反应：急性pras研究的探索性事后亚组分析

目的：探讨普拉格雷和氯吡格雷的抗血小板作用是否因患者背景因素而异。方法：这是一项多中心、开放标签、随机对照的急性- pras研究的事后、假设生成、探索性分析，其中176例急性动脉粥样硬化性卒中或高风险TIA患者在症状出现48小时内接受普拉格雷或氯吡格雷治疗。在第5天，以ABCD-GENE评分、年龄、体重指数（BMI）、慢性肾病（CKD）、糖尿病（DM）、高血压、血脂异常、卒中发病至治疗时间、美国国立卫生研究院卒中量表（NIHSS）评分和既往缺血性卒中进行分组，评估高血小板反应性（HPR；血小板反应单位[PRU] >208）和绝对PRU。结果:患者普拉格雷与氯吡格雷HPR的数值更低的利率比ABCD-GENE高危层的分数≥10(或2.73,p = 0.076),普拉格雷和有利的趋势也观察慢性肾病(8.06,p = 0.012),年龄> 75岁(5.02,p = 0.025),体重指数< 25公斤/ m²(4.61,p = 0.012),血脂异常(4.73,p = 0.009), DM (3.86, p = 0.038),治疗起始≤24小时(3.31,p = 0.010),和署≤3 (2.77,p = 0.036)或≥4 (9.00,p = 0.025)。在大多数亚组中，除了BMI≥25kg /m2、开始治疗bbb24小时或既往缺血性卒中患者外，普拉格雷在数值上也比氯吡格雷更能降低PRU，其中只有数值差异。结论：普拉格雷提供了良好的早期血小板抑制，特别是在高龄、CKD、低BMI、代谢合并症或很早开始治疗的亚组中。

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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