title: Contemporary use of prasugrel in clinical practice: insights from the Blue Cross Blue Shield of Michigan Cardiovascular Consortium.
abstract: BACKGROUND
  Prasugrel is a recently approved thienopyridine for use in patients with acute coronary syndromes undergoing percutaneous coronary intervention. There are no data on contemporary use of prasugrel in routine clinical practice.
  
  
  RESULTS
  We assessed the patterns of prasugrel use among 55 821 patients who underwent percutaneous coronary intervention and were discharged alive from January 2010 to December 2011 at 44 hospitals participating in the Blue Cross Blue Shield of Michigan Cardiovascular Consortium. Potential inappropriate therapy was defined as use in patients who had a history of cerebrovascular disease, weighed <60 kg, or were aged ≥75 years old. Clopidogrel was prescribed to 83% (n=46 574) and 17% (n=9247) of patients received prasugrel on hospital discharge. A steady, linear increase in prasugrel use was seen during the study period, with discharge prescription increasing from 8.4% in quarter 1 of 2010 to 22.3% in quarter 4 of 2011. Of the total cohort, 69.1% of patients presented with acute coronary syndrome, and in this group, 17.2% received prasugrel. Among patients prescribed prasugrel, 28.3% (n=2614) received the medication for indications outside of acute coronary syndromes. One or more known contraindications to the drug were present in 6% to 10% of patients discharged on this agent.
  
  
  CONCLUSIONS
  There has been a steady increase in the use of prasugrel with the drug being used in ≈22% of patients undergoing percutaneous coronary intervention by study end. Prasugrel use in patients with known contraindications is not uncommon and may be a suitable target for focused quality improvement efforts.
authors.affiliation: Department of Internal Medicine, Division of Cardiovascular Medicine, The University of Michigan, Ann Arbor, MI 48109, USA.
authors.forename: Amneet
authors.initials: A
authors.lastname: Sandhu
authors.forename: Milan
authors.initials: M
authors.lastname: Seth
authors.forename: Simon
authors.initials: S
authors.lastname: Dixon
authors.forename: David
authors.initials: D
authors.lastname: Share
authors.forename: David
authors.initials: D
authors.lastname: Wohns
authors.forename: Thomas
authors.initials: T
authors.lastname: Lalonde
authors.forename: Mauro
authors.initials: M
authors.lastname: Moscucci
authors.forename: Arthur L
authors.initials: AL
authors.lastname: Riba
authors.forename: Michael
authors.initials: M
authors.lastname: Grossman
authors.forename: Hitinder S
authors.initials: HS
authors.lastname: Gurm
mesh_terms: D054058:Acute Coronary Syndrome / Q000188:drug therapy / Q000628:therapy*; D000368:Aged; D054598:Blue Cross Blue Shield Insurance Plans / Q000639:trends*; D000075202:Contraindications; D004363:Drug Utilization / Q000639:trends; D017723:Drug Utilization Review; D005260:Female; D019983:Guideline Adherence / Q000639:trends; D006801:Humans; D007356:Insurance, Pharmaceutical Services / Q000639:trends; D008297:Male; D008824:Michigan; D008875:Middle Aged; D062645:Percutaneous Coronary Intervention / Q000009:adverse effects / Q000639:trends*; D010879:Piperazines / Q000627:therapeutic use*; D010975:Platelet Aggregation Inhibitors / Q000627:therapeutic use*; D017410:Practice Guidelines as Topic; D010818:Practice Patterns, Physicians' / Q000639:trends*; D000068799:Prasugrel Hydrochloride; D011446:Prospective Studies; D058996:Quality Improvement / Q000639:trends; D019984:Quality Indicators, Health Care / Q000639:trends; D012042:Registries; D012307:Risk Factors; D013876:Thiophenes / Q000627:therapeutic use*; D013997:Time Factors; D016896:Treatment Outcome
chemical_list: D010879:Piperazines; D010975:Platelet Aggregation Inhibitors; D013876:Thiophenes; D000068799:Prasugrel Hydrochloride
keywords: acute coronary syndromes; coronary revascularization; stents