title: Safety and efficacy of in-hospital clopidogrel-to-prasugrel switching in patients with acute coronary syndrome. An analysis from the 'real world'.
abstract: Antiplatelet switching in the management of acute coronary syndrome (ACS) seems to be safe, but prospective data are limited. This retrospective study assessed the safety and efficacy of in-hospital clopidogrel-to-prasugrel switching in patients with ACS. We analysed 525 consecutive patients with ACS admitted to our coronary care unit. We assessed the prevalence and the short-term outcomes of in-hospital clopidogrel-to-prasugrel switching. Bleeding and thrombotic events were assessed using propensity score matching analysis. A total of 468 patients received acetylsalicylic acid and a P2Y12 ADP receptor inhibitor. Medication switching occurred in 117 patients (25 %). Compared with the clopidogrel group, the switching group consisted preferentially of younger males with STEMI, exhibited fewer comorbidities, and had lower ischaemic risk. We found no differences between the switching group and the clopidogrel group in the bleeding rate [3.6 vs. 2.3 %, odds ratio (OR):1.59 95 % confidence interval (CI): 0.26-9.7, p NS], and in adverse cardiac or cerebrovascular events (MACCE) (5 vs. 8.4 %, OR: 0.57 95 % CI 0.16-2, p NS). In-hospital switching from clopidogrel to prasugrel in a selected high-risk ACS population resulted in a similar incidence of in-hospital haemorrhagic and thrombotic events. This strategy should be clarified in further randomised studies.
authors.affiliation: Coronary Care Unit, Cardiology Department, Virgen Macarena University Hospital, Avd Dr. Fedriani 3, 41071, Seville, Spain, almendrode@secardiologia.es.
authors.forename: Manuel
authors.initials: M
authors.lastname: Almendro-Delia
authors.forename: Emilia
authors.initials: E
authors.lastname: Blanco Ponce
authors.forename: Rocío
authors.initials: R
authors.lastname: Gomez-Domínguez
authors.forename: Carlos
authors.initials: C
authors.lastname: Gonzalez-Matos
authors.forename: Manuel
authors.initials: M
authors.lastname: Lobo-Gonzalez
authors.forename: Auxiliadora
authors.initials: A
authors.lastname: Caballero-Garcia
authors.forename: Rafael
authors.initials: R
authors.lastname: Hidalgo-Urbano
authors.forename: Maria Jose
authors.initials: MJ
authors.lastname: Cruz-Fernandez
authors.forename: Juan C
authors.initials: JC
authors.lastname: Garcia-Rubira
mesh_terms: D054058:Acute Coronary Syndrome / Q000097:blood / Q000188:drug therapy*; D000368:Aged; D000369:Aged, 80 and over; D001241:Aspirin / Q000008:administration & dosage / Q000009:adverse effects; D000077144:Clopidogrel; D057915:Drug Substitution; D005260:Female; D006470:Hemorrhage / Q000097:blood / Q000139:chemically induced; D006801:Humans; D008297:Male; D008875:Middle Aged; D000068799:Prasugrel Hydrochloride / Q000008:administration & dosage* / Q000009:adverse effects; D058925:Receptors, Purinergic P2Y12 / Q000097:blood; D012737:Sex Factors; D013927:Thrombosis / Q000097:blood / Q000139:chemically induced; D013988:Ticlopidine / Q000008:administration & dosage / Q000009:adverse effects / Q000031:analogs & derivatives*
chemical_list: C548576:P2RY12 protein, human; D058925:Receptors, Purinergic P2Y12; D000077144:Clopidogrel; D000068799:Prasugrel Hydrochloride; D013988:Ticlopidine; D001241:Aspirin