Thienopyridine antiplatelet agents: focus on prasugrel.
OBJECTIVE
To assess the potential role of prasugrel in the management of acute coronary syndrome (ACS) in older adults.


METHODS
PubMed and International Pharmaceutical Abstracts searches (1966 to 2009) were conducted to identify pertinent English-language studies on the use of prasugrel.


METHODS
All human studies evaluating pharmacokinetic/pharmacodynamic or clinical efficacy of prasugrel were evaluated.


RESULTS
Prasugrel is a third-generation thienopyridine antiplatelet agent. Other thienopyridine antiplatelet agents (e.g., clopidogrel, ticlopidine) have been associated with interindividual variability, drug-drug interactions, and unfavorable adverse effect profile. Prasugrel therapy is associated with more profound platelet inhibition and improved cardiovascular (CV) outcomes compared with clopidogrel; however, prasugrel therapy is associated with an increased bleeding risk. Prasugrel should not be used in adults older than 75 years of age, those who have had a recent transient ischemic attack (TIA) or stroke, those who have a low body weight < 60 kg, and those receiving medications or having conditions associated with a bleeding risk unless they are at a high risk for a CV event.


CONCLUSIONS
Prasugrel therapy does not appear to be associated with interindividual variability in platelet aggregation and has superior CV outcomes compared with clopidogrel. No dosage adjustments need to be made for renal or hepatic impairment. Prasugrel shows promise for the treatment of ACS patients with clopidogrel resistance or those who have an increased risk of CV events (e.g., patients with diabetes); head-to-head trials evaluating these uses have not been conducted. Geriatric patients have an increased risk of bleeding with this agent. Additional studies need to be conducted to determine the appropriate population for prasugrel.
Samford University Global Drug Information Service, Birmingham, AL, USA. mkelly@samford.edu
Maisha Kelly
MK
Freeman
D054058:Acute Coronary Syndrome / Q000097:blood / Q000188:drug therapy*; D000368:Aged; D015906:Angioplasty, Balloon, Coronary / Q000009:adverse effects*; D002986:Clinical Trials as Topic; D004347:Drug Interactions; D004351:Drug Resistance; D019317:Evidence-Based Medicine; D005260:Female; D006470:Hemorrhage / Q000139:chemically induced; D006801:Humans; D008297:Male; D008875:Middle Aged; D018579:Patient Selection; D010879:Piperazines / Q000008:administration & dosage / Q000009:adverse effects / Q000493:pharmacokinetics / Q000627:therapeutic use*; D010974:Platelet Aggregation / Q000187:drug effects*; D010975:Platelet Aggregation Inhibitors / Q000008:administration & dosage / Q000009:adverse effects / Q000493:pharmacokinetics / Q000627:therapeutic use*; D000068799:Prasugrel Hydrochloride; D018570:Risk Assessment; D012307:Risk Factors; D013876:Thiophenes / Q000008:administration & dosage / Q000009:adverse effects / Q000493:pharmacokinetics / Q000627:therapeutic use*; D013927:Thrombosis / Q000209:etiology / Q000517:prevention & control*; D016896:Treatment Outcome
D010879:Piperazines; D010975:Platelet Aggregation Inhibitors; D013876:Thiophenes; D000068799:Prasugrel Hydrochloride