Implication of plat elet-derived growth factor in sunitinib-induced hypothyroidism

Introduction: Prasugrel has been approved for the reduction of thrombotic cardiovascular events (including stent thrombosis) in patients with acute coronary syndrome who are to be managed with percutaneous coronary interventions. It has been described as an alternative to clopidogrel when a stent thrombosis appears. However, little evidence of prasugrel use exists in a ≥75 years and <60 kg population, which seem to be at increased risk of bleeding with prasugrel. There are several factors that can determine the non-response to clopidogrel treatment, but the most prevalent are drug-drug interactions and genetic polymorphisms. Case report: We report a case of an elderly woman diagnosed with ST-segment elevation myocardial infarction and low body weight. Poor response to clopidogrel evidenced by a stent thrombosis and low rates of ADP platelet aggregation test led to the initiation of prasugrel 5 mg. We describe patient management and review related literature. Discussion: Stent thrombosis is a serious complication after percutaneous coronary interventions with stent implantation. Antithrombotic regimen after stent implantation includes aspirin given indefinitely and clopidogrel given for a variable time depending in part upon stent type. Prasugrel is a novel third-generation thienopyridine with a more potent and consistent blockage and a faster onset of action than clopidogrel. Moreover, it has shown itself to be less vulnerable to drug interactions and is not affected by genetic polymorphisms. Although some international guidelines do not approve use of prasugrel in frail patients because of lack of evidence, certain patients not responding to standard therapy may take benefit of this novel agent. Conclusion: Despite few studies of prasugrel therapy in frail low body weight elderly, we report a successfully treated patient. However, more investigation about this new drug may be useful and even necessary for special groups of populations