[Comparative antiplatelet efficacy of prasugrel and high-dose clopidogrel in patients with coronary heart disease including acute coronary syndrome].

A number of randomized double-blind studies have been conducted for comparative assessment of the pharmacodynamic properties of high loading and maintenance doses of clopidogrel (600-900 mg loading dose and 150 mg maintenance dose) and standard dose of prasugrel (60 mg loading dose and 10 mg maintenance dose) in patients with coronary heart disease, including those with acute coronary syndrome. This review briefly discusses the trials ACAPULCO and PRINCIPLE-TIMI 44. Compared with high dose clopidogrel, prasugrel inhibited P2Y12-mediated platelet aggregation faster and to a greater extent. A difference between effects of clopidogrel and prasugrel emerged as soon as at 30 minutes after the loading dose. Antiplatelet effects of prasugrel were greater than those of clopidogrel both during first 2-4 hours after administration of loading dose, and during maintenance dosing. This may have important clinical implications.