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Pharmacodynamic profile in East Asian patients with ACS treated with prasugrel standard-dose v de-escalation strategy: a randomized A-MATCH trial.

Abstract：

:Compared with Caucasian patients, East Asian patients have the unique risk-benefit trade-off and different responsiveness to antithrombotic regimens. The aim of this study was to compare pharmacodynamic profile in East Asian patients with acute coronary syndromes (ACS) treated with prasugrel standard-dose vs. de-escalation strategy. Before discharge, ACS patients with age <75 year or weight ≥60 kg (n=250) were randomly assigned to the standard-dose (10-mg group) or de-escalation strategy (5-mg group or platelet function test [PFT]-guided group). After 1 month, VerifyNow P2Y12 assay-based platelet reactivity (P2Y12 Reaction Units [PRU]) and bleeding episodes were evaluated. Primary endpoint was the percentage of patients with the therapeutic window (85≤PRU≤208). The percentage of patients within the therapeutic window was significantly lower in the 10-mg group compared to the 5-mg and PFT-guided groups (35.3% vs. 67.5% vs. 65.9%) (Odds ratio [OR], 3.80 and 3.54; 95% confidence interval [CI], 2.01-7.21 and 1.87-6.69, respectively). Compared with the 10-mg group, the bleeding rate was tended to be lower with de-escalation strategies (35.3% vs. 24.1% vs. 23.2%) (Hazard ratio [HR], 0.58 and 0.55; 95% CI, 0.30-1.14 and 0.28-1.09, respectively). 'PRU<127' was the optimal cut-off for predicting one-month bleeding events (area under curve, 0.616; 95% CI, 0.543-0.689; p= 0.005), which criteria was significantly associated with early discontinuation of prasugrel treatment (HR, 2.00; 95% CI, 1.28-3.03; p= 0.001). In conclusion, compared with the standard-dose prasugrel, prasugrel de-escalation strategy in East Asian patients presented with ACS showed a higher chance within the therapeutic window and a lower tendency toward bleeding episodes.

journal_name

Thromb Haemost

journal_title

Thrombosis and haemostasis

authors

Jeong YH,Oh JH,Yoon HJ,Park Y,Suh J,Lee SW,Lee K,Kim JS,Chun WJ,Park YH,Nam CW,Kim JH,Ahn JH,Hwang SJ,Hwang JY,Tantry US,Gurbel P,Shin ES

doi

10.1055/a-1346-3300

subject

Has Abstract

pub_date

2021-01-05 00:00:00

eissn

0340-6245

issn

2567-689X

pub_type

临床试验

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