title: Prasugrel: a review of its use in patients with acute coronary syndromes undergoing percutaneous coronary intervention.
abstract: Prasugrel (Efient) is a potent, selective and irreversible inhibitor of adenosine diphosphate (ADP)-mediated platelet aggregation that is indicated for the prevention of atherothrombotic events in patients with acute coronary syndromes (ACS) [comprising unstable angina pectoris/non-ST-segment-elevation myocardial infarction (unstable angina/NSTEMI) and ST-segment-elevation myocardial infarction (STEMI)] undergoing percutaneous coronary intervention (PCI). Oral prasugrel provides rapid, potent inhibition of platelet aggregation and is an effective antiplatelet agent for the management of patients with ACS who are undergoing PCI. In these patients, prasugrel was associated with a significantly lower incidence of ischaemic events than clopidogrel, and was particularly effective in specific subgroups of patients, such as those with diabetes mellitus. However, the efficacy of prasugrel was offset by a higher risk of bleeding than clopidogrel, with patients aged > or =75 years, those weighing <60 kg and those with a history of stroke or transient ischaemic attack at the greatest risk. A lower dose of prasugrel in patients aged > or =75 years and those weighing <60 kg may help to minimize the bleeding risk, although more data are needed to establish this; prasugrel is contraindicated in patients with a history of stroke or transient ischaemic attack. Thus, prasugrel provides a new option for the management of patients with ACS who are undergoing PCI; the risk-benefit ratio should be carefully assessed before intensive antiplatelet therapy with prasugrel is initiated.
authors.affiliation: Wolters Kluwer Health/Adis, 41 Centorian Drive, Mairangi Bay, North Shore 0754, Auckland, New Zealand. demail@adis.co.nz
authors.forename: Sean T
authors.initials: ST
authors.lastname: Duggan
authors.forename: Gillian M
authors.initials: GM
authors.lastname: Keating
mesh_terms: D054058:Acute Coronary Syndrome / Q000188:drug therapy* / Q000601:surgery*; D000328:Adult; D000368:Aged; D015906:Angioplasty, Balloon, Coronary; D016063:Blood Loss, Surgical / Q000503:physiopathology; D000077144:Clopidogrel; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010879:Piperazines / Q000008:administration & dosage / Q000009:adverse effects / Q000493:pharmacokinetics / Q000494:pharmacology / Q000627:therapeutic use*; D010975:Platelet Aggregation Inhibitors / Q000008:administration & dosage / Q000009:adverse effects / Q000493:pharmacokinetics / Q000494:pharmacology / Q000627:therapeutic use*; D000068799:Prasugrel Hydrochloride; D016032:Randomized Controlled Trials as Topic; D013876:Thiophenes / Q000008:administration & dosage / Q000009:adverse effects / Q000493:pharmacokinetics / Q000494:pharmacology / Q000627:therapeutic use*; D013988:Ticlopidine / Q000031:analogs & derivatives / Q000627:therapeutic use; D014018:Tissue Distribution; D055815:Young Adult
chemical_list: D010879:Piperazines; D010975:Platelet Aggregation Inhibitors; D013876:Thiophenes; D000077144:Clopidogrel; D000068799:Prasugrel Hydrochloride; D013988:Ticlopidine
references.citation: J Am Coll Cardiol. 2007 Apr 10;49(14):1505-16
references.pmid: 17418288
references.citation: Platelets. 2006 Jun;17(4):209-17
references.pmid: 16769598
references.citation: J Clin Pharmacol. 2008 Apr;48(4):475-84
references.pmid: 18303127
references.citation: J Cardiovasc Pharmacol. 2007 Mar;49(3):167-73
references.pmid: 17414229
references.citation: Circulation. 2008 Jan 15;117(2):261-95
references.pmid: 18079354
references.citation: Am Heart J. 2006 Oct;152(4):627-35
references.pmid: 16996826
references.citation: Circulation. 2009 May 19;119(19):2553-60
references.pmid: 19414633
references.citation: J Am Coll Cardiol. 2001 Dec;38(7):2114-30
references.pmid: 11738323
references.citation: Lancet. 2008 Apr 19;371(9621):1353-63
references.pmid: 18377975
references.citation: Med J Aust. 2008 Apr 7;188(7):381-2
references.pmid: 18393737
references.citation: Lancet. 2009 Feb 28;373(9665):723-31
references.pmid: 19249633
references.citation: Semin Thromb Hemost. 2005 Apr;31(2):184-94
references.pmid: 15852222
references.citation: Am J Cardiol. 2009 Feb 2;103(3 Suppl):4A-10A
references.pmid: 19166707
references.citation: Am J Med. 2009 May;122(5):407-8
references.pmid: 19375544
references.citation: Clin Cardiol. 1999 Nov;22(11):687-98
references.pmid: 10554682
references.citation: Circulation. 2005 May 24;111(20):2557-9
references.pmid: 15911717
references.citation: Eur Heart J. 2008 Oct;29(20):2473-9
references.pmid: 18682445
references.citation: N Engl J Med. 2007 Nov 15;357(20):2078-81
references.pmid: 17982183
references.citation: Br J Clin Pharmacol. 2007 Apr;63(4):421-30
references.pmid: 17076696
references.citation: Am J Cardiovasc Drugs. 2005;5(6):399-408
references.pmid: 16259528
references.citation: JAMA. 2007 Aug 15;298(7):765-75
references.pmid: 17699010
references.citation: Eur Heart J. 2008 Jan;29(1):21-30
references.pmid: 18055486
references.citation: Eur Heart J. 2007 Jul;28(13):1598-660
references.pmid: 17569677
references.citation: Eur Heart J. 2005 Apr;26(8):804-47
references.pmid: 15769784
references.citation: Am J Cardiovasc Drugs. 2007;7(6):423-32
references.pmid: 18076209
references.citation: N Engl J Med. 2009 Jan 22;360(4):354-62
references.pmid: 19106084
references.citation: Clin Pharmacol Ther. 2007 May;81(5):735-41
references.pmid: 17361128
references.citation: Drug Metab Dispos. 2008 Jul;36(7):1227-32
references.pmid: 18372401
references.citation: J Cardiovasc Pharmacol. 2007 Nov;50(5):555-62
references.pmid: 18030066
references.citation: Circ Res. 2007 May 11;100(9):1261-75
references.pmid: 17495233
references.citation: J Thromb Haemost. 2008 Nov;6(11):1908-14
references.pmid: 18752581
references.citation: Circulation. 2008 Jan 15;117(2):296-329
references.pmid: 18071078
references.citation: Circulation. 2007 Aug 14;116(7):e148-304
references.pmid: 17679616
references.citation: N Engl J Med. 2007 Nov 15;357(20):2001-15
references.pmid: 17982182
references.citation: Circulation. 2009 Jun 2;119(21):2758-64
references.pmid: 19451347
references.citation: Drugs. 2007;67(4):613-46
references.pmid: 17352522
references.citation: Eur J Pharmacol. 2008 Jan 28;579(1-3):276-82
references.pmid: 17996866
references.citation: Curr Med Res Opin. 2008 Aug;24(8):2251-7
references.pmid: 18786302
references.citation: Thromb Haemost. 2005 Sep;94(3):593-8
references.pmid: 16268477
references.citation: Am J Cardiol. 2009 Feb 2;103(3 Suppl):40A-51A
references.pmid: 19166712
references.citation: Circulation. 2008 Oct 14;118(16):1626-36
references.pmid: 18757948
references.citation: Eur Heart J. 2007 Oct;28(20):2525-38
references.pmid: 17951287
references.citation: Thromb Haemost. 2009 Jan;101(1):14-22
references.pmid: 19132184
references.citation: Drug Metab Dispos. 2007 Jul;35(7):1096-104
references.pmid: 17403916
references.citation: J Am Coll Cardiol. 2008 May 27;51(21):2028-33
references.pmid: 18498956
references.citation: J Thromb Haemost. 2007 Dec;5(12):2429-36
references.pmid: 17900275
references.citation: Am Heart J. 2007 Jan;153(1):66.e9-16
references.pmid: 17174640
references.citation: Eur Heart J. 2006 May;27(10):1166-73
references.pmid: 16621870
references.citation: Am Heart J. 2008 Aug;156(2 Suppl):S3-9
references.pmid: 18657680
references.citation: Circulation. 2007 Dec 18;116(25):2923-32
references.pmid: 18056526
references.citation: Drug Metab Dispos. 2006 Apr;34(4):600-7
references.pmid: 16415119
references.citation: J Thromb Haemost. 2007 Jul;5(7):1545-51
references.pmid: 17456192
references.citation: Lancet. 2004 Jul 24-30;364(9431):331-7
references.pmid: 15276392
references.citation: Circulation. 2005 Jun 28;111(25):3366-73
references.pmid: 15967851
references.citation: J Am Coll Cardiol. 2008 Dec 9;52(24):1968-77
references.pmid: 19055987
references.citation: Am Heart J. 2008 Aug;156(2 Suppl):S16-22
references.pmid: 18657682
references.citation: Circulation. 2008 Oct 14;118(16):1607-8
references.pmid: 18852375
references.citation: Am J Cardiol. 2009 Feb 2;103(3 Suppl):27A-34A
references.pmid: 19166710