title: Prasugrel for the treatment of coronary thrombosis: a review of pharmacological properties, indications for use and future development.
abstract: BACKGROUND
  Dual antiplatelet therapy with aspirin and the P2Y(12) receptor antagonist clopidogrel is the cornerstone of treatment for prevention of recurrent ischemic events in high-risk patients. Despite the benefits of this strategy, a number of patients experience recurrent atherothrombotic events. Investigations have shown that this may be in part related to the broad range in pharmacodynamic response to clopidogrel, which includes patients with poor platelet inhibitory effects who have an increased risk of events.
  
  
  METHODS
  Prasugrel (CS-747; LY-640315) is a novel, third-generation oral thienopyridine that is a specific, irreversible antagonist of the platelet P2Y(12) receptor. Laboratory results with prasugrel support more potent antiplatelet effects, a lower incidence of interpatient variability in antiplatelet response, and a reduced time to onset of antiplatelet activity compared with clopidogrel.
  
  
  RESULTS
  This manuscript reviews the pharmacological properties, safety and efficacy of prasugrel and provides current indications for its use and future development.
  
  
  CONCLUSIONS
  Prasugrel exerts more prompt, potent and predictable antiplatelet effects than clopidogrel. These translate into a greater reduction in ischemic events, including stent thrombosis, in acute coronary syndrome patients undergoing percutaneous coronary intervention albeit at the expense of an increased risk of bleeding.
authors.affiliation: University of Florida College of Medicine-Jacksonville, 655 West 8th Street, Jacksonville, Florida 32209, USA. dominick.angiolillo@jax.ufl.edu
authors.forename: Salvatore D
authors.initials: SD
authors.lastname: Tomasello
authors.forename: Antonio
authors.initials: A
authors.lastname: Tello-Montoliu
authors.forename: Dominick J
authors.initials: DJ
authors.lastname: Angiolillo
mesh_terms: D000818:Animals; D000077144:Clopidogrel; D003328:Coronary Thrombosis / Q000188:drug therapy* / Q000503:physiopathology; D006801:Humans; D010879:Piperazines / Q000009:adverse effects / Q000494:pharmacology / Q000627:therapeutic use*; D010975:Platelet Aggregation Inhibitors / Q000009:adverse effects / Q000494:pharmacology / Q000627:therapeutic use; D000068799:Prasugrel Hydrochloride; D058921:Purinergic P2Y Receptor Antagonists / Q000009:adverse effects / Q000494:pharmacology / Q000627:therapeutic use*; D013876:Thiophenes / Q000009:adverse effects / Q000494:pharmacology / Q000627:therapeutic use*; D013988:Ticlopidine / Q000009:adverse effects / Q000031:analogs & derivatives / Q000494:pharmacology / Q000627:therapeutic use
chemical_list: D010879:Piperazines; D010975:Platelet Aggregation Inhibitors; D058921:Purinergic P2Y Receptor Antagonists; D013876:Thiophenes; D000077144:Clopidogrel; D000068799:Prasugrel Hydrochloride; D013988:Ticlopidine