Does reduced-dose prasugrel (5 mg once daily) reduce the composite of mortality, myocardial infarction, disabling stroke, and rehospitalization for cardiovascular causes or bleeding compared to standard-dose clopidogrel (75 mg) in patients >74 years of age with acute coronary syndrome undergoing percutaneous coronary intervention?
In elderly patients (>74 years) with acute coronary syndromes undergoing PCI, reduced-dose prasugrel (5 mg) did not demonstrate superiority over standard-dose clopidogrel (75 mg) for the composite of ischemic and bleeding events, though the trial was terminated prematurely.
BACKGROUND: Elderly patients are at elevated risk of both ischemic and bleeding complications after an acute coronary syndrome and display higher on-clopidogrel platelet reactivity compared with younger patients. Prasugrel 5 mg provides more predictable platelet inhibition compared with clopidogrel in the elderly, suggesting the possibility of reducing ischemic events without increasing bleeding. METHODS: In a multicenter, randomized, open-label, blinded end point trial, we compared a once-daily maintenance dose of prasugrel 5 mg with the standard clopidogrel 75 mg in patients >74 years of age with acute coronary syndrome undergoing percutaneous coronary intervention. The primary end point was the composite of mortality, myocardial infarction, disabling stroke, and rehospitalization for cardiovascular causes or bleeding within 1 year. The study was designed to demonstrate superiority of prasugrel 5 mg over clopidogrel 75 mg. RESULTS: =0.18). CONCLUSIONS: The present study in elderly patients with acute coronary syndromes showed no difference in the primary end point between reduced-dose prasugrel and standard-dose clopidogrel. However, the study should be interpreted in light of the premature termination of the trial. CLINICAL TRIAL REGISTRATION: URL: https://www.clinicaltrials.gov. Unique identifier: NCT01777503.
Savonitto et al. (Mon,) studied this question.