Diurnal Variability of On-Treatment Platelet Reactivity in Clopidogrel versus Prasugrel Treated Acute Coronary Syndrome Patients: A Pre-Specified TROPICAL-ACS Sub-Study.

Long-term evidence supports a clustering of cardiovascular events in the early morning and smaller mechanistic studies in aspirin-treated patients have shown increased platelet reactivity at the end of the dosing interval. Comparative pharmacodynamic analyses for different adenosine diphosphate (ADP) receptor inhibitors in percutaneous coronary intervention-treated acute coronary syndrome (ACS) patients are lacking and this pre-specified analysis from the randomized Testing Responsiveness To Platelet Inhibition On Chronic Antiplatelet Treatment For Acute Coronary Syndromes (TROPICAL-ACS) trial aimed for the first time at investigating diurnal variability of on-treatment platelet reactivity in clopidogrel versus prasugrel treated patients. TROPICAL-ACS randomized 2,610 ACS patients to either treatment with prasugrel (control group) or to a platelet function testing-guided de-escalation of anti-platelet treatment with a switch to clopidogrel (guided de-escalation group). This study design enabled a diurnal comparison of on-prasugrel versus on-clopidogrel treatment platelet reactivity under steady-state conditions. For 2,526 patients (97%), both the exact time of blood sampling and the ADP-induced platelet aggregation value (in units, Multiplate analyser) were available. Platelet reactivity in patients on clopidogrel (

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Georg Thieme Verlag KG Stuttgart · New York.

Déclaration de conflit d'intérêts

D.S. reports grants from Roche Diagnostics and Daiichi Sankyo during the conduct of the study; and personal fees from Bayer AG, Daiichi Sankyo, Eli Lilly, Roche Diagnostics, MSD, Pfizer and AstraZeneca outside of the submitted work. D.A. reports personal fees from Roche Diagnostics, DSI/Lilly, AstraZeneca, Pfizer, Bayer AG and MSD Pharma outside of the submitted work. D.T. reports personal fees from AstraZeneca, Bayer, Boehringer Ingelheim, Bristol-Myers Squibb, Daiichi Sankyo, Eli Lilly and Sanofi; and personal fees from Otsuka outside of the submitted work. T.G. reports personal fees from AstraZeneca, grants and personal fees from Bayer Healthcare, personal fees from Boehringer Ingelheim, grants and personal fees from Bristol-Myers Squibb, personal fees from Pfizer, grants and personal fees from Daiichi Sankyo, grants and personal fees from Eli Lilly, grants and personal fees from The Medicines Company, personal fees from MSD, grants from Siemens Healthcare and grants from Spartan Bioscience outside of the submitted work. Z.H. reports personal fees from AstraZeneca, Bayer, Aspen, Polpharma and Abbott, and personal fees from Medtronic outside of the submitted work. All other authors declare no competing interests. G.T. reports consultancy fees from Biotronik and Abbott, as well as institutional grants from Astra-Zeneca and Medtronic.