title: Efficacy and Safety of Prasugrel Compared With Clopidogrel for Patients With Acute Coronary Syndrome Undergoing Percutaneous Coronary Intervention.
abstract: Dual antiplatelet therapy comprising aspirin and a P2Y12 inhibitor (clopidogrel, prasugrel, or ticagrelor) is essential to prevent thrombotic complications after percutaneous coronary intervention (PCI). The comparative efficacy between clopidogrel at a higher loading dose (600 mg) and prasugrel is uncertain. The aim of this study was to compare efficacy and safety of clopidogrel (higher loading dose) with prasugrel (loading dose of 60 mg) along with their respective maintenance doses in patients with acute coronary syndrome (ACS) undergoing PCI at 1 year. This is a retrospective, observational, pilot study. Patients with ACS who underwent PCI and received clopidogrel 600 mg or prasugrel 60 mg loading dose followed by maintenance doses of 75 mg and 10 mg, respectively, daily between July 1, 2009 and June 30, 2011 were enrolled. For patients who have died during the study period, investigators attempted to identify the cause of deaths through medical records or death certificates. Two hundred twenty-one patients were enrolled in the study. Primary efficacy end point, composite of death from cardiovascular causes, nonfatal myocardial infarction, or nonfatal stroke occurring through 1 year were not significantly different between the 2 treatment groups. Bleeding events were also not significant between the clopidogrel (N = 136) and prasugrel (N = 85) groups: 9.6% versus 8.2%, P = 0.85. Prasugrel is at least as effective and safe as clopidogrel in patients with ACS undergoing early invasive management.
authors.affiliation: 1Department of Pharmacy Practice, Arnold and Marie Schwartz College of Pharmacy and Health Sciences, Brooklyn, NY; 2Department of Pharmacy, Lenox Hill Hospital, New York, NY; 3Department of Cardiology, New York Methodist Hospital, Brooklyn, NY; and 4Department of Medicine, Weill Cornell Medical College, New York, NY.
authors.forename: Amy
authors.initials: A
authors.lastname: Wang
authors.forename: Leela K
authors.initials: LK
authors.lastname: Lella
authors.forename: Sorin J
authors.initials: SJ
authors.lastname: Brener
mesh_terms: D054058:Acute Coronary Syndrome / Q000188:drug therapy* / Q000601:surgery*; D000368:Aged; D002318:Cardiovascular Diseases / Q000453:epidemiology; D000077144:Clopidogrel; D004305:Dose-Response Relationship, Drug; D005260:Female; D006470:Hemorrhage / Q000453:epidemiology; D006801:Humans; D008297:Male; D008875:Middle Aged; D062645:Percutaneous Coronary Intervention / Q000379:methods*; D010865:Pilot Projects; D010975:Platelet Aggregation Inhibitors / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use*; D000068799:Prasugrel Hydrochloride / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use*; D012189:Retrospective Studies; D013988:Ticlopidine / Q000008:administration & dosage / Q000009:adverse effects / Q000031:analogs & derivatives* / Q000627:therapeutic use
chemical_list: D010975:Platelet Aggregation Inhibitors; D000077144:Clopidogrel; D000068799:Prasugrel Hydrochloride; D013988:Ticlopidine