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Several studies have reported the effects of switching between P2Y<jats:sub>12<\/jats:sub> inhibitors on platelet reactivity (P2Y<jats:sub>12<\/jats:sub> reaction units: PRU), from acute to late phase after PCI. However, the effect of switching at very late phase is unknown. This study examined the effect on PRU in Japanese coronary heart disease patients with long-term DAPT (aspirin\u2009+\u2009clopidogrel) when switching from clopidogrel to prasugrel. Ninety-six patients were enrolled in this study. The median DAPT duration at enrollment was 1824.0\u00a0days. Twenty-three patients with PRU\u2009\u2265\u2009208 at enrollment were randomly assigned into either continuing to receive clopidogrel (Continued Group; <jats:italic>n<\/jats:italic>\u2009=\u200911) or switching to prasugrel (Switched Group; <jats:italic>n<\/jats:italic>\u2009=\u200912). The primary endpoint was the rate of patients who achieved PRU\u2009&lt;\u2009208 at the end of 12\u00a0weeks of treatment, which was significantly higher in Switched Group relative to Continued Group (90.0% vs. 36.4%; <jats:italic>P<\/jats:italic>\u2009=\u20090.024). The secondary endpoint was the PRU at week 12 in groups subdivided according to cytochrome P450 (CYP) 2C19 genotypes. At week 12, extensive metabolizers (EM Group) had 202.3\u2009\u00b1\u200960.0 and 174.5\u2009\u00b1\u200922.3 in Continued Group and Switched Group (<jats:italic>P<\/jats:italic>\u2009=\u20090.591), respectively; intermediate and poor metabolizers (non-EM Group) had 229.4\u2009\u00b1\u200936.9 and 148.4\u2009\u00b1\u200948.4 in Continued Group and Switched Group (<jats:italic>P<\/jats:italic>\u2009=\u20090.002), respectively. The PRU for non-EM Group was significantly reduced in Switched Group. Thus, for patients with long-term DAPT (aspirin\u2009+\u2009clopidogrel) after PCI with coronary stent implantation, switching from clopidogrel to prasugrel resulted in a stable reduction in PRU, regardless of CYP2C19 polymorphism.<\/jats:p>","DOI":"10.1007\/s00380-019-01499-7","type":"journal-article","created":{"date-parts":[[2019,9,23]],"date-time":"2019-09-23T18:02:57Z","timestamp":1569261777000},"page":"312-322","update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":9,"title":["Prasugrel effectively reduces the platelet reactivity units in patients with genetically metabolic dysfunction of cytochrome P450 2C19 who are treated with long-term dual antiplatelet therapy after undergoing drug-eluting stent implantation"],"prefix":"10.1007","volume":"35","author":[{"given":"Junichiro","family":"Shimamatsu","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ken-ichiro","family":"Sasaki","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Yoshio","family":"Katsuki","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Tomohiro","family":"Kawasaki","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Yoshinobu","family":"Murasato","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Hidehiko","family":"Ajisaka","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Hiroyoshi","family":"Yokoi","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Hideki","family":"Tashiro","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Atsushi","family":"Harada","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Yuji","family":"Hirakawa","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Yuta","family":"Ishizaki","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Takashi","family":"Ishimatsu","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Kotaro","family":"Kagiyama","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Yoshihiro","family":"Fukumoto","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Tatsuyuki","family":"Kakuma","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7222-9128","authenticated-orcid":false,"given":"Takafumi","family":"Ueno","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"297","published-online":{"date-parts":[[2019,9,23]]},"reference":[{"issue":"10","key":"1499_CR1","doi-asserted-by":"publisher","first-page":"1082","DOI":"10.1016\/j.jacc.2016.03.513","volume":"68","author":"GN Levine","year":"2016","unstructured":"Levine GN, Bates ER, Bittl JA, Brindis RG, Fihn SD, Fleisher LA, Granger CB, Lange RA, Mack MJ, Mauri L, Mehran R, Mukherjee D, Newby LK, O'Gara PT, Sabatine MS, Smith PK, Smith SC Jr (2016) 2016 ACC\/AHA guideline focused update on duration of dual antiplatelet therapy in patients with coronary artery disease: a report of the American College of Cardiology\/American Heart Association Task Force on clinical practice guidelines. 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Yoshihiro Fukumoto has received a speaker honorarium from Daiichi Sankyo Co., Ltd. Takafumi Ueno has received a speaker honorarium from Daiichi Sankyo Co., Ltd. The other authors have nothing to disclose regarding the current study.","order":2,"name":"Ethics","group":{"name":"EthicsHeading","label":"Conflict of interest"}},{"value":"All the procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and\/or national research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards.","order":3,"name":"Ethics","group":{"name":"EthicsHeading","label":"Ethical approval"}}]}}