Efficacy and safety of prasugrel compared with clopidogrel in patients with acute coronary syndromes: results of TRITON-TIMI 38 trials.
Current guidelines recommend dual antiplatelet therapy using aspirin and clopidogrel for non-ST elevation acute coronary syndromes (ACS). Despite the established benefits of this approach, many patients continue to have recurrent atherothrombotic events. Moreover, it is often difficult to achieve an adequate inhibition of platelet aggregation with clopidogrel in clinical practice. Prasugrel is an orally administered P2Y12 receptor antagonist that is more potent, more rapid in onset and more consistent in its inhibition of platelet aggregation than currently approved doses of clopidogrel. The trial to Assess Improvement in Therapeutic Outcomes by Optimizing Platelet Inhibition with Prasugrel - Thrombolysis in Myocardial Infarction 38 (TRITON-TIMI 38) randomized 13,608 moderate-to-high-risk patients with ACS (with or without ST-segment elevation) undergoing percutaneus coronary intervention to compare prasugrel with clopidogrel for a median of follow-up time of 14.5 months. The TRITON-TIMI 38 trial demonstrated a significant reduction in ischemic events in patients randomized to prasugrel compared with those treated with clopidogrel. This beneficial effect, however, was associated with a significant increase in major bleeding.
Mariani
Matteo
M
Dipartimento Cardiovascolare, Ospedale Civile di Legnano, Milan Italy. mat.mariani@tiscali.it
Mariani
Giuseppe
G
De Servi
Stefano
S
D054058:Acute Coronary Syndrome / Q000188:drug therapy* / Q000601:surgery; D000284:Administration, Oral; D000368:Aged; D015906:Angioplasty, Balloon, Coronary; D017326:Clinical Trials, Phase III as Topic; D000077144:Clopidogrel; D005260:Female; D005500:Follow-Up Studies; D006470:Hemorrhage / Q000139:chemically induced; D006801:Humans; D008297:Male; D008875:Middle Aged; D010879:Piperazines / Q000009:adverse effects / Q000627:therapeutic use*; D010975:Platelet Aggregation Inhibitors / Q000009:adverse effects / Q000627:therapeutic use*; D017410:Practice Guidelines as Topic; D000068799:Prasugrel Hydrochloride; D058919:Purinergic P2 Receptor Antagonists; D016032:Randomized Controlled Trials as Topic; D013876:Thiophenes / Q000009:adverse effects / Q000627:therapeutic use*; D013988:Ticlopidine / Q000009:adverse effects / Q000031:analogs & derivatives* / Q000627:therapeutic use
D010879:Piperazines; D010975:Platelet Aggregation Inhibitors; D058919:Purinergic P2 Receptor Antagonists; D013876:Thiophenes; D000077144:Clopidogrel; D000068799:Prasugrel Hydrochloride; D013988:Ticlopidine