Mini-Focus Issue: Stent Thrombosis and Platelet Reactivity
Clinical Research
Prasugrel Versus Tirofiban Bolus With or Without Short Post-Bolus Infusion With or Without Concomitant Prasugrel Administration in Patients With Myocardial Infarction Undergoing Coronary Stenting: The FABOLUS PRO (Facilitation through Aggrastat By drOpping or shortening Infusion Line in patients with ST-segment elevation myocardial infarction compared to or on top of PRasugrel given at loading dOse) Trial
The authors sought to compare the effect on inhibition of platelet aggregation (IPA) of prasugrel therapy versus tirofiban bolus with or without a post-bolus short drug infusion in ST-segment elevation myocardial infarction (STEMI) patients.
Background
The degree and rapidity of IPA after prasugrel alone with or without concomitant glycoprotein IIb/IIIa inhibition in STEMI patients is unknown.
Methods
A total of 100 STEMI patients randomly received prasugrel 60 mg versus 25 μg/kg tirofiban bolus with or without post-bolus 2-h infusion of tirofiban, with or without concomitant prasugrel. IPA at light transmission aggregometry was performed throughout 24 h. The primary endpoint was IPA stimulated with 20 μmol/l adenosine diphosphate (ADP) at 30 min.
Results
At 30 min, patients in the prasugrel group showed a significantly lower IPA to 20 μmol/l ADP stimulation as compared with tirofiban-treated patients (36 ± 35 vs. 87 ± 31, p < 0.0001). Similarly, patients taking prasugrel showed a suboptimal degree of platelet inhibition for at least 2 h compared with tirofiban patients. Post-bolus tirofiban infusion was necessary to maintain a high level of IPA beyond 1 h after bolus administration if concomitant clopidogrel was given, whereas the bolus-only tirofiban and concomitant prasugrel led to the higher and more consistent IPA levels after both ADP and thrombin receptor-activating peptide stimuli than either therapy alone.
Conclusions
Our study shows that prasugrel administration leads to a suboptimal IPA for at least 2 h in STEMI patients. Yet, prasugrel, given in association with a bolus only of glycoprotein IIb/IIIa inhibitor, obviates the need of post-bolus infusion and almost completely abolishes residual variability of IPA after treatment. (Facilitation through Aggrastat By drOpping or shortening Infusion Line in patients with ST-segment elevation myocardial infarction compared to or on top of PRasugrel given at loading dOse [The FABOLUS PRO trial]; NCT01336348)
Key Words
aggregometry
bolus
clopidogrel
prasugrel
tirofiban
Abbreviations and Acronyms
ADP
adenosine diphosphate
CI
confidence interval
GPI
glycoprotein IIb/IIIa inhibitors
IPA
inhibition of platelet aggregation
PA
platelet aggregation
PCI
percutaneous coronary intervention
STEMI
ST-segment elevation myocardial infarction
TRAP
thrombin receptor-activating peptide
Cited by (0)
This study was supported by a research grant from Iroko Cardio. Dr. Valgimigli has received honoraria for lectures/Advisory Board and research grants from Merck, Iroko Cardio, Eli Lilly, and Medtronic; honoraria for Advisory Board and lectures from The Medicines Company and Eli Lilly Co, Daiichi Sankyo, Inc., St. Jude Medical, and Abbott Vascular; and lectures from Cordis, CID, and Terumo. Dr. Ferrari is on the Speaker's Bureau for Servier, Bayer, Roche, Boehringer Ingelheim; received research grants from Servier, Novartis, Roche, Boehringer Ingelheim; and is on the Advisory Board for Servier, Bayer, Roche, Boehringer Ingelheim. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose.
