{"id":"b879216c18a6","type":"article","url":"https://hartvaat.nl/2026/03/03/prasugrel-vs-clopidogrel-invloed-van-patientkenmerken-op-trombocytenremming-bij-/","title":"Prasugrel vs. clopidogrel: invloed van patiëntkenmerken op trombocytenremming bij acute beroerte","title_en":"","category":"chronische nierziekte","category_label":"Nierziekte","professions":["cardioloog","internist"],"tags":["dubbele-trombocytenremming","trombocytenaggregatieremmers"],"journal":"Journal of atherosclerosis and thrombosis","doi":"10.5551/jat.66056","source_url":"https://doi.org/10.5551/jat.66056","authors":["Shigeru Fujimoto","Yasuyuki Iguchi","Hiroshi Yamagami","Masatoshi Koga","Ryo Itabashi","Yusuke Yakushiji","Kazuma Kowata","Naoto Kimura","Yuka Terasawa","Takahiro Shimizu","Yuichi Miyazaki","Koichi Oki","Osamu Masuo","Hideki Matsuoka","Shuji Arakawa","Toshihiro Ueda","Ryota Tanaka","Wataru Hashimoto","Satoru Abe","Go Kato","Taketoshi Furugori","Kazumi Kimura"],"significance":4,"published":"2026-04-12","source_date":"2026-03-03","image":"","kennis":[],"congress":"","summary_en":"In a post-hoc analysis of the ACUTE-PRAS trial, this study examined whether the antiplatelet effects of prasugrel and clopidogrel differ by patient characteristics in acute atherothrombotic stroke or TIA. The results identify subgroups at higher risk of high on-treatment platelet reactivity under clopidogrel.","created":"2026-07-03T10:32:44Z","updated":"2026-07-03T13:31:40Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (de url van het record). Samenvattingen zijn redactioneel werk van HartVaat; de oorspronkelijke publicaties blijven van hun uitgevers (doi). Geen medisch advies.","body_markdown":"In een posthocanalyse van de ACUTE-PRAS trial werd onderzocht of het antiplaatjeseffect van prasugrel en clopidogrel verschilt naar gelang patiëntkenmerken bij acuut atherothrombotisch herseninfarct of TIA. De resultaten geven inzicht in welke patiëntsubgroepen een hoger risico lopen op hoge restplaatjesreactiviteit onder clopidogrel.","abstract_original":"AIM: To explore whether the antiplatelet effects of prasugrel and clopidogrel vary according to patient background factors in the ACUTE-PRAS study. METHODS: This was a post hoc, hypothesis-generating, exploratory analysis of the multicenter, open-label, randomized controlled ACUTE-PRAS study, in which 176 patients with acute atherothrombotic stroke or high-risk TIA received prasugrel or clopidogrel within 48 h of symptom onset. High platelet reactivity (HPR; platelet reaction units [PRU] ＞208) and absolute PRU were assessed on Day 5 in subgroups stratified by ABCD-GENE score, age, body mass index (BMI), chronic kidney disease (CKD), diabetes mellitus (DM), hypertension, dyslipidemia, time from stroke onset to treatment, National Institutes of Health Stroke Scale (NIHSS) score, and prior ischemic stroke. RESULTS: Patients with prasugrel had numerically lower rates of HPR than those with clopidogrel in the high-risk stratum of ABCD-GENE score ≥ 10 (OR 2.73, p = 0.076), and favorable trends in prasugrel were also observed for CKD (8.06, p = 0.012), age ＞75 years (5.02, p = 0.025), BMI ＜25 kg/m² (4.61, p = 0.012), dyslipidemia (4.73, p = 0.009), DM (3.86, p = 0.038), treatment initiation ≤ 24 h (3.31, p = 0.010), and NIHSS ≤ 3 (2.77, p = 0.036) or ≥ 4 (9.00, p = 0.025). Prasugrel also reduced PRU numerically more than clopidogrel across most subgroups, except in patients with BMI ≥ 25 kg/m2, treatment initiation ＞24 hours, or prior ischemic stroke, where only numerical differences were observed. CONCLUSIONS: Prasugrel provided favorable early platelet inhibition, particularly in subgroups characterized by advanced age, CKD, low BMI, metabolic comorbidities, or very early treatment start."}