Background
Thienopyridine platelet inhibition (TPI) on the day of drug eluting stent (DES) implantation must be practical and effective. We hypothesized that optimal TPI is achievable in all patients (pts) on maintenance TPI and all receiving initial loading doses for TPI on the day of DES if effectiveness is confirmed using VerifyNow P2Y12 assays and if suboptimal responses (PRU > 230) are treated by loading with another agent.
Methods
Pts undergoing DES implantation ( n = 387) for ACS (250), MI (6), or chronic coronary artery disease (131) were recruited to an IRB approved protocol. Pts receiving maintenance clopidogrel with VerifyNow PRU > 230 were loaded with prasugrel (60 mg) and re-assayed in 1.5 h. Pts receiving maintenance prasugrel with PRU > 230 received clopidogrel, 600 mg with re-assay in 4 h. Untreated pts ( n = 161) were randomized to loading with clopidogrel (600 mg, n = 81) or prasugrel (60 mg, n = 80). If PRU remained > 230, loading with the alternative agent was performed and TPI reassayed to confirm PRU < 230. MACE and bleeding events were tracked for 30 days.
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