{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,11,6]],"date-time":"2026-11-06T06:05:06Z","timestamp":1793945106819,"version":"4.8.0"},"reference-count":34,"publisher":"Japanese Circulation Society","issue":"12","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Circ J"],"published-print":{"date-parts":[[2025,11,25]]},"DOI":"10.1253\/circj.cj-24-0949","type":"journal-article","created":{"date-parts":[[2025,5,15]],"date-time":"2025-05-15T18:07:25Z","timestamp":1747332445000},"page":"1922-1930","source":"Crossref","is-referenced-by-count":9,"title":["P2Y&lt;sub&gt;12&lt;\/sub&gt; Reaction Units With Prasugrel in Acute Large Artery Atherosclerosis and Transient Ischemic Attack: An Open-Label Randomized Controlled Study, ACUTE-PRAS"],"prefix":"10.1253","volume":"89","author":[{"given":"Shigeru","family":"Fujimoto","sequence":"first","affiliation":[{"name":"Division of Neurology, Department of Medicine, Jichi Medical University"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yasuyuki","family":"Iguchi","sequence":"additional","affiliation":[{"name":"Department of Neurology, The Jikei University School of Medicine"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hiroshi","family":"Yamagami","sequence":"additional","affiliation":[{"name":"Department of Stroke Neurology, NHO Osaka National Hospital"},{"name":"Division of Stroke Prevention and Treatment, Institute of Medicine, University of Tsukuba"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Masatoshi","family":"Koga","sequence":"additional","affiliation":[{"name":"Department of Cerebrovascular Medicine, National Cerebral and Cardiovascular Center"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ryo","family":"Itabashi","sequence":"additional","affiliation":[{"name":"Stroke Center, Division of Neurology and Gerontology, Department of Internal Medicine, School of Medicine, Iwate Medical University"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yusuke","family":"Yakushiji","sequence":"additional","affiliation":[{"name":"Department of Neurology, Kansai Medical University"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kazuma","family":"Kowata","sequence":"additional","affiliation":[{"name":"Institute of Brain and Blood Vessels Mihara Memorial Hospital"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Naoto","family":"Kimura","sequence":"additional","affiliation":[{"name":"Iwate Prefectural Central Hospital"},{"name":"Nansho Hospital"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yuka","family":"Terasawa","sequence":"additional","affiliation":[{"name":"Department of Neurology, Brain Attack Center Ota Memorial Hospital"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Takahiro","family":"Shimizu","sequence":"additional","affiliation":[{"name":"Department of Neurology, St. Marianna University School of Medicine"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yuichi","family":"Miyazaki","sequence":"additional","affiliation":[{"name":"Shonan Kamakura General Hospital"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Koichi","family":"Oki","sequence":"additional","affiliation":[{"name":"Tokyo Saiseikai Central Hospital"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Osamu","family":"Masuo","sequence":"additional","affiliation":[{"name":"Yokohama Municipal Citizen\u2019s Hospital"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hideki","family":"Matsuoka","sequence":"additional","affiliation":[{"name":"National Hospital Organization Kagoshima Medical Center"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Shuji","family":"Arakawa","sequence":"additional","affiliation":[{"name":"Steel Memorial Yawata Hospital"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Toshihiro","family":"Ueda","sequence":"additional","affiliation":[{"name":"St. Marianna University Toyoko Hospital"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ryota","family":"Tanaka","sequence":"additional","affiliation":[{"name":"Division of Neurology, Department of Medicine, Jichi Medical University"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Wataru","family":"Hashimoto","sequence":"additional","affiliation":[{"name":"Data Intelligence Department, Daiichi Sankyo Co., Ltd."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Satoru","family":"Abe","sequence":"additional","affiliation":[{"name":"Primary Medical Science Department, Medical Affairs Division, Daiichi Sankyo Co., Ltd."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Go","family":"Kato","sequence":"additional","affiliation":[{"name":"Primary Medical Science Department, Medical Affairs Division, Daiichi Sankyo Co., Ltd."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Taketoshi","family":"Furugori","sequence":"additional","affiliation":[{"name":"Primary Medical Science Department, Medical Affairs Division, Daiichi Sankyo Co., Ltd."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kazumi","family":"Kimura","sequence":"additional","affiliation":[{"name":"Department of Neurology, Graduate School of Medicine, Nippon Medical School"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"name":"on behalf of the ACUTE-PRAS Investigators","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"330","reference":[{"key":"1","unstructured":"1. Committee for Stroke Guideline 2021, the Japan Stroke Society. The Japan Stroke Society guideline 2021 for the treatment of stroke (revised version 2023) [in Japanese]. Kyowa Kikaku Ltd, 2023."},{"key":"2","doi-asserted-by":"crossref","unstructured":"2. Prasad K, Siemieniuk R, Hao Q, Guyatt G, O\u2019Donnell M, Lytvyn L, et al. Dual antiplatelet therapy with aspirin and clopidogrel for acute high risk transient ischaemic attack and minor ischaemic stroke: A clinical practice guideline. <i>BMJ<\/i> 2018; 363: k5130.","DOI":"10.1136\/bmj.k5130"},{"key":"3","doi-asserted-by":"crossref","unstructured":"3. Miyamoto S, Ogasawara K, Kuroda S, Itabashi R, Toyoda K, Itoh Y, et al. Japan Stroke Society guideline 2021 for the treatment of stroke. <i>Int J Stroke<\/i> 2022; 17: 1039\u20131049.","DOI":"10.1177\/17474930221090347"},{"key":"4","doi-asserted-by":"crossref","unstructured":"4. Han Y, Lv HH, Liu X, Dong Q, Yang XL, Li SX, et al. Influence of genetic polymorphisms on clopidogrel response and clinical outcomes in patients with acute ischemic stroke <i>CYP2C19<\/i> genotype on clopidogrel response. <i>CNS Neurosci Ther<\/i> 2015; 21: 692\u2013697.","DOI":"10.1111\/cns.12426"},{"key":"5","doi-asserted-by":"crossref","unstructured":"5. Mirabbasi SA, Khalighi K, Wu Y, Walker S, Khalighi B, Fan W, et al. <i>CYP2C19<\/i> genetic variation and individualized clopidogrel prescription in a cardiology clinic. <i>J Community Hosp Intern Med Perspect<\/i> 2017; 7: 151\u2013156.","DOI":"10.1080\/20009666.2017.1347475"},{"key":"6","doi-asserted-by":"crossref","unstructured":"6. Ishizaki T, Horai Y. Review article: Cytochrome P450 and the metabolism of proton pump inhibitors \u2013 emphasis on rabeprazole. <i>Aliment Pharmacol Ther<\/i> 1999; 13(Suppl 3): 27\u201336.","DOI":"10.1046\/j.1365-2036.1999.00022.x"},{"key":"7","doi-asserted-by":"crossref","unstructured":"7. Wang Y, Zhao X, Lin J, Li H, Johnston SC, Lin Y, et al. Association between <i>CYP2C19<\/i> loss-of-function allele status and efficacy of clopidogrel for risk reduction among patients with minor stroke or transient ischemic attack. <i>JAMA<\/i> 2016; 316: 70\u201378.","DOI":"10.1001\/jama.2016.8662"},{"key":"8","unstructured":"8. Pharmaceuticals and Medical Development Agency. Efient<sup>\u00ae<\/sup> tablets [in Japanese]. https:\/\/www.info.pmda.go.jp\/go\/pdf\/430574_3399009F1020_1_21 (accessed June 25, 2024)."},{"key":"9","doi-asserted-by":"crossref","unstructured":"9. Isshiki T, Kimura T, Ogawa H, Yokoi H, Nanto S, Takayama M, et al. Prasugrel, a third-generation P2Y<sub>12<\/sub> receptor antagonist, in patients with coronary artery disease undergoing elective percutaneous coronary intervention. <i>Circ J<\/i> 2014; 78: 2926\u20132934.","DOI":"10.1253\/circj.CJ-14-0266"},{"key":"10","doi-asserted-by":"crossref","unstructured":"10. Ogawa A, Toyoda K, Kitagawa K, Kitazono T, Nagao T, Yamagami H, et al. Comparison of prasugrel and clopidogrel in patients with non-cardioembolic ischaemic stroke: A Phase 3, randomised, non-inferiority trial (PRASTRO-I). <i>Lancet Neurol<\/i> 2019; 18: 238\u2013247.","DOI":"10.1016\/S1474-4422(18)30449-6"},{"key":"11","doi-asserted-by":"crossref","unstructured":"11. Kitagawa K, Toyoda K, Kitazono T, Nishikawa M, Nanto S, Ikeda Y, et al. Safety and efficacy of prasugrel in elderly\/low body weight Japanese patients with ischemic stroke: Randomized PRASTRO-II. <i>Cerebrovasc Dis<\/i> 2020; 49: 152\u2013159.","DOI":"10.1159\/000506825"},{"key":"12","doi-asserted-by":"crossref","unstructured":"12. Kitazono T, Kamouchi M, Matsumaru Y, Nakamura M, Umemura K, Matsuo H, et al. Efficacy and safety of prasugrel vs. clopidogrel in thrombotic stroke patients with risk factors for ischemic stroke recurrence: A double-blind, Phase III study (PRASTRO-III). <i>J Atheroscler Thromb<\/i> 2023; 30: 222\u2013236.","DOI":"10.5551\/jat.63473"},{"key":"13","doi-asserted-by":"crossref","unstructured":"13. Adams HP Jr, Bendixen BH, Kappelle LJ, Biller J, Love BB, Gordon DL, et al. Classification of subtype of acute ischemic stroke. Definitions for use in a multicenter clinical trial. TOAST. Trial of Org 10172 in Acute Stroke Treatment. <i>Stroke<\/i> 1993; 24: 35\u201341.","DOI":"10.1161\/01.STR.24.1.35"},{"key":"14","doi-asserted-by":"crossref","unstructured":"14. Brott T, Adams HP Jr, Olinger CP, Marler JR, Barsan WG, Biller J, et al. Measurements of acute cerebral infarction: A clinical examination scale. <i>Stroke<\/i> 1989; 20: 864\u2013870.","DOI":"10.1161\/01.STR.20.7.864"},{"key":"15","doi-asserted-by":"crossref","unstructured":"15. Johnston SC, Rothwell PM, Nguyen-Huynh MN, Giles MF, Elkins JS, Bernstein AL, et al. Validation and refinement of scores to predict very early stroke risk after transient ischaemic attack. <i>Lancet<\/i> 2007; 369: 283\u2013292.","DOI":"10.1016\/S0140-6736(07)60150-0"},{"key":"16","doi-asserted-by":"crossref","unstructured":"16. Rankin J. Cerebral vascular accidents in patients over the age of 60. III. Diagnosis and treatment. <i>Scott Med J<\/i> 1957; 2: 254\u2013268.","DOI":"10.1177\/003693305700200604"},{"key":"17","doi-asserted-by":"crossref","unstructured":"17. van Swieten JC, Koudstaal PJ, Visser MC, Schouten HJ, van Gijn J. Interobserver agreement for the assessment of handicap in stroke patients. <i>Stroke<\/i> 1988; 19: 604\u2013607.","DOI":"10.1161\/01.STR.19.5.604"},{"key":"18","doi-asserted-by":"crossref","unstructured":"18. Price MJ. Bedside evaluation of thienopyridine antiplatelet therapy. <i>Circulation<\/i> 2009; 119: 2625\u20132632.","DOI":"10.1161\/CIRCULATIONAHA.107.696732"},{"key":"19","doi-asserted-by":"crossref","unstructured":"19. Stone GW, Witzenbichler B, Weisz G, Rinaldi MJ, Neumann FJ, Metzger DC, et al. Platelet reactivity and clinical outcomes after coronary artery implantation of drug-eluting stents (ADAPT-DES): A prospective multicentre registry study. <i>Lancet<\/i> 2013; 382: 614\u2013623.","DOI":"10.1016\/S0140-6736(13)61170-8"},{"key":"20","doi-asserted-by":"crossref","unstructured":"20. Diener HC, Bogousslavsky J, Brass LM, Cimminiello C, Csiba L, Kaste M, et al. Aspirin and clopidogrel compared with clopidogrel alone after recent ischaemic stroke or transient ischaemic attack in high-risk patients (MATCH): Randomised, double-blind, placebo-controlled trial. <i>Lancet<\/i> 2004; 364: 331\u2013337.","DOI":"10.1016\/S0140-6736(04)16721-4"},{"key":"21","doi-asserted-by":"crossref","unstructured":"21. Song BL, Wan M, Tang D, Sun C, Zhu YB, Linda N, et al. Effects of <i>CYP2C19<\/i> genetic polymorphisms on the pharmacokinetic and pharmacodynamic properties of clopidogrel and its active metabolite in healthy Chinese subjects. <i>Clin Ther<\/i> 2018; 40: 1170\u20131178.","DOI":"10.1016\/j.clinthera.2018.06.001"},{"key":"22","doi-asserted-by":"crossref","unstructured":"22. Kobayashi M, Kajiwara M, Hasegawa S. A randomized study of the safety, tolerability, pharmacodynamics, and pharmacokinetics of clopidogrel in three different <i>CYP2C19<\/i> genotype groups of healthy Japanese subjects. <i>J Atheroscler Thromb<\/i> 2015; 22: 1186\u20131196.","DOI":"10.5551\/jat.28639"},{"key":"23","doi-asserted-by":"crossref","unstructured":"23. Mega JL, Close SL, Wiviott SD, Shen L, Hockett RD, Brandt JT, et al. Cytochrome p-450 polymorphisms and response to clopidogrel. <i>N Engl J Med<\/i> 2009; 360: 354\u2013362.","DOI":"10.1056\/NEJMoa0809171"},{"key":"24","doi-asserted-by":"crossref","unstructured":"24. Wang Y, Meng X, Wang A, Xie X, Pan Y, Johnston SC, et al. Ticagrelor versus clopidogrel in <i>CYP2C19<\/i> loss-of-function carriers with stroke or TIA. <i>N Engl J Med<\/i> 2021; 385: 2520\u20132530.","DOI":"10.1056\/NEJMoa2111749"},{"key":"25","doi-asserted-by":"crossref","unstructured":"25. Enomoto Y, Shoda K, Mizutani D, Matsubara H, Egashira Y, Iwama T. Platelet reactivity after clopidogrel loading in patients with acute ischemic stroke. <i>Front Neurol<\/i> 2022; 13: 887243.","DOI":"10.3389\/fneur.2022.887243"},{"key":"26","doi-asserted-by":"crossref","unstructured":"26. Kitazono T, Toyoda K, Kitagawa K, Nagao T, Yamagami H, Uchiyama S, et al. Efficacy and safety of prasugrel by stroke subtype: A sub-analysis of the PRASTRO-I randomized controlled trial. <i>J Atheroscler Thromb<\/i> 2021; 28: 169\u2013180.","DOI":"10.5551\/jat.56093"},{"key":"27","doi-asserted-by":"crossref","unstructured":"27. Jia DM, Chen ZB, Zhang MJ, Yang WJ, Jin JL, Xia YQ, et al. <i>CYP2C19<\/i> polymorphisms and antiplatelet effects of clopidogrel in acute ischemic stroke in China. <i>Stroke<\/i> 2013; 44: 1717\u20131719.","DOI":"10.1161\/STROKEAHA.113.000823"},{"key":"28","doi-asserted-by":"crossref","unstructured":"28. Fukuma K, Yamagami H, Ihara M, Tanaka T, Miyata T, Miyata S, et al. P2Y<sub>12<\/sub> reaction units and clinical outcomes in acute large artery atherosclerotic stroke: A multicenter prospective study. <i>J Atheroscler Thromb<\/i> 2023; 30: 39\u201355.","DOI":"10.5551\/jat.63369"},{"key":"29","doi-asserted-by":"crossref","unstructured":"29. Wang Y, Wang Y, Zhao X, Liu L, Wang D, Wang C, et al. Clopidogrel with aspirin in acute minor stroke or transient ischemic attack. <i>N Engl J Med<\/i> 2013; 369: 11\u201319.","DOI":"10.1056\/NEJMoa1215340"},{"key":"30","doi-asserted-by":"crossref","unstructured":"30. Johnston SC, Easton JD, Farrant M, Barsan W, Conwit RA, Elm JJ, et al. Clopidogrel and aspirin in acute ischemic stroke and high-risk TIA. <i>N Engl J Med<\/i> 2018; 379: 215\u2013225.","DOI":"10.1056\/NEJMoa1800410"},{"key":"31","doi-asserted-by":"crossref","unstructured":"31. Gao Y, Chen W, Pan Y, Jing J, Wang C, Johnston SC, et al. Dual antiplatelet treatment up to 72 hours after ischemic stroke. <i>N Engl J Med<\/i> 2023; 389: 2413\u20132424.","DOI":"10.1056\/NEJMoa2309137"},{"key":"32","doi-asserted-by":"crossref","unstructured":"32. Chen HS, Cui Y, Wang XH, Ma YT, Han J, Duan YJ, et al. Clopidogrel plus aspirin vs. aspirin alone in patients with acute mild to moderate stroke: The ATAMIS randomized clinical trial. <i>JAMA Neurol<\/i> 2024; 81: 450\u2013460.","DOI":"10.1001\/jamaneurol.2024.0146"},{"key":"33","doi-asserted-by":"publisher","unstructured":"33. Han JK, Lee SD, Hwang D, Park SH, Kang J, Yang HM, et al. Renal function-stratified comparison of short- and long-term dual antiplatelet therapy in patients undergoing percutaneous coronary intervention with third-generation drug-eluting stents: Post hoc analysis from the HOST-IDEA randomized clinical trial. <i>Circ J<\/i> 2025; 89: 281\u2013291, doi:10.1253\/circj.CJ-24-0481.","DOI":"10.1253\/circj.CJ-24-0481"},{"key":"34","doi-asserted-by":"crossref","unstructured":"34. Ishida M, Shimada R, Takahashi F, Niiyama M, Ishisone T, Matsumoto Y, et al. One-month dual antiplatelet therapy followed by P2Y<sub>12<\/sub> inhibitor monotherapy after biodegradable polymer drug-eluting stent implantation: The REIWA region-wide registry. <i>Circ J<\/i> 2024; 88: 876\u2013884.","DOI":"10.1253\/circj.CJ-24-0091"}],"container-title":["Circulation Journal"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.jstage.jst.go.jp\/article\/circj\/89\/12\/89_CJ-24-0949\/_pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,12,27]],"date-time":"2025-12-27T03:18:31Z","timestamp":1766805511000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.jstage.jst.go.jp\/article\/circj\/89\/12\/89_CJ-24-0949\/_article"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,11,25]]},"references-count":34,"journal-issue":{"issue":"12","published-print":{"date-parts":[[2025]]}},"URL":"https:\/\/doi.org\/10.1253\/circj.cj-24-0949","relation":{},"ISSN":["1346-9843","1347-4820"],"issn-type":[{"value":"1346-9843","type":"print"},{"value":"1347-4820","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,11,25]]},"article-number":"CJ-24-0949"}}