Prasugrel 5mg Versus High Dose Clopidogrel in Clopidogrel Resistant Patients Aged ≥75 Years and/or Weighing <60 kg Post Percutaneous Coronary Intervention (PCI)

Inclusion criteria

• Age ≥18 years old
• Patients having PCI with stenting 24 hours prior randomization, meeting the following criteria :

• Acute coronary syndrome (unstable angina or myocardial infarction)
• TIMI risk score>2
• Platelet reactivity in PRU ≥235 24 hours post-PCI
• Age≥75 years and/or weight<60 Kg

• Informed consent obtained in writing

Exclusion criteria

• A history of bleeding diathesis
• Chronic oral anticoagulation treatment
• Contraindications to antiplatelet therapy
• Known platelet function disorders
• PCI or coronary artery bypass surgery < 3 months
• Unsuccessful PCI (residual stenosis > 30% or flow < Thrombolysis in myocardial infarction flow 3)
• Planned staged PCI in the next 30 days
• Hemodynamic instability
• hemodialysis
• Creatinine clearance <25 ml/min
• inability to give informed consent
• High likelihood of being unavailable for the Day 30
• History of gastrointestinal bleeding, genitourinary bleeding or other site abnormal bleeding within the previous 6 months.
• Other bleeding diathesis, or considered by investigator to be at high risk for bleeding on longterm antiplatelet therapy.
• Any previous history of ischemic stroke, transient ischemic attack, intracranial hemorrhage or disease (neoplasm, arteriovenous malformation, aneurysm).
• Thrombocytopenia (<100.000 / μL) at randomization
• Anaemia (Hct <30%) at randomization
• Polycythaemia (Hct > 52%) at randomization
• Periprocedural IIb/IIIa inhibitor administration