Title:Antiplatelet Effect of Low-Dose Prasugrel in Elderly Patients Undergoing Percutaneous Coronary Interventions
Volume: 22
Issue: 5
Author(s): Monica Verdoia*, Matteo Nardin, Rocco Gioscia, Andrea Rognoni and Giuseppe De Luca
Affiliation:
- Division of Cardiology, Ospedale Degli Infermi, ASL Biella, Italy
Keywords:
Elderly patients, platelet aggregation, major bleeding, prasugrel, coronary artery disease, dual antiplatelet therapy, body mass index.
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.
