Benefits for specific subpopulations in TRITON-TIMI 38

Dual-antiplatelet therapy with aspirin and thienopyridines can prevent ischaemic events associated with acute coronary syndromes and percutaneous coronary intervention. The Trial to Assess Improvement in Therapeutic Outcomes by Optimizing Platelet Inhibition with Prasugrel–Thrombolysis in Myocardial Infarction (TRITON-TIMI) 38 trial demonstrated that prasugrel, a novel and potent thienopyridine, can reduce ischaemic events compared with clopidogrel therapy, but at the cost of increased bleeding events in some high-risk patients. This review aims to highlight the driving force behind the reductions in ischaemic events in the overall TRITON-TIMI 38 population, and present the efficacy and safety profiles of prasugrel in important TRITON-TIMI 38 sub-populations [patients with ST-elevation myocardial infarction (STEMI) at inclusion, diabetes, and stent placement], compared with clopidogrel. In the overall TRITON-TIMI 38 population, the reduction in the combined primary efficacy endpoint of cardiovascular death, non-fatal myocardial infarction (MI), or non-fatal stroke with prasugrel, compared with clopidogrel, was driven by a reduction in the rate of MI. In the sub-population analyses, prasugrel significantly reduced the rate of the primary endpoint compared with clopidogrel, again primarily through a reduction in MI. Of note, prasugrel did not increase TIMI major non-coronary artery bypass graft bleeding in patients with STEMI or diabetes, relative to clopidogrel. These data suggest that in high-risk patients, the safety of prasugrel is comparable to that of clopidogrel.