TOPLINE:

Prasugrel provided a more rapid reduction in platelet aggregation than clopidogrel in patients with stable coronary artery disease on dual antiplatelet therapy and an impaired renal function, specifically within initial days of treatment initiation.

METHODOLOGY:

• Chronic kidney disease often coexists with coronary artery disease and is known to impair drug metabolism. Whether renal function affects platelet aggregation induced by commonly used antiplatelet drugs remains unclear.
• Researchers conducted a substudy of a previous prospective trial involving 164 patients with stable coronary artery disease (median age, 67 years; 82.9% men) who were receiving dual antiplatelet therapy with aspirin and clopidogrel.
• Patients were randomly assigned to either continue 75 mg of clopidogrel daily or switch to 3.75 mg of prasugrel daily.
• The analysis stratified the patients into two groups: those with an estimated glomerular filtration rate (eGFR) < 45 mL/min/1.73 m² (n = 20) and those with an eGFR ≥ 45 mL/min/1.73 m² (n = 144).
• The primary endpoint was inhibition of platelet aggregation, measured as P2Y₁₂ reaction units (PRU), at days 5 and 30 post-randomization.

TAKEAWAY:

• In patients with an eGFR < 45 mL/min/1.73 m²prasugrel induced a faster decline in platelet aggregation than clopidogrel at both days 5 and 30; however, the difference in mean PRU values was statistically significant only on day 5 (mean PRU, 157.9 vs 214.2;