Compared to clopidogrel, a reduced dose of prasugrel was not associated with a significant difference in the risk of total ischemic events (HR 0.955) or total bleeding events (HR 0.972).
Observational (n=534)
No
Does reduced-dose prasugrel-based DAPT improve ischemic events or reduce bleeding events compared to clopidogrel-based DAPT in AMI patients undergoing primary PCI?
In Japanese patients with AMI undergoing primary PCI, reduced-dose prasugrel was not associated with an excess risk of bleeding or ischemic events compared to clopidogrel, supporting its safety and efficacy in this population.
Hazard Ratio: 0.955 (95% CI 0.499–1.829)
Absolute Event Rate: 8.3% vs 10.6%
p-value: p=0.890
The rapid introduction of dual antiplatelet therapy (DAPT) is important for patients with acute myocardial infarction (AMI). The risks and benefits of reduced-dose prasugrel (20 mg loading and 3.75 mg maintenance) over clopidogrel have not been fully discussed. The purpose of this study was to compare the 90-days clinical outcomes of AMI between prasugrel-based DAPT and clopidogrel-based DAPT. We included 534 AMI patients and divided them into the clopidogrel group (n = 330) and the prasugrel group (n = 204). The primary endpoint was the total ischemic events and total bleeding events. In all, 52 ischemic events and 35 bleeding events were observed during the study period. The total ischemic events were similar between the clopidogrel and the prasugrel groups (P = 0.385). The total bleeding events were similar between the clopidogrel and the prasugrel groups (P = 0.125). The multivariate Cox hazard analysis showed that prasugrel was not associated with the total ischemic events (hazard ratio (HR) 0.955, 95% confidence interval (CI) 0.499-1.829, P = 0.890) and was not associated with the total bleeding events after controlling confounding factors (HR 0.972, 95% CI 0.528-1.790, P = 0.927). In conclusion, as compared to clopidogrel, the reduced dose of prasugrel was not associated with the excess risk of bleeding or the excess risk of ischemic events. Our real-world data support the current regimen of prasugrel for AMI patients who underwent primary percutaneous coronary intervention.
Shibata et al. (Fri,) conducted a observational in Acute Myocardial Infarction (n=534). Prasugrel vs. Clopidogrel was evaluated on Total ischemic events (HR 0.955, 95% CI 0.499-1.829, p=0.890). Compared to clopidogrel, a reduced dose of prasugrel was not associated with a significant difference in the risk of total ischemic events (HR 0.955) or total bleeding events (HR 0.972).