Retrospective observational analysis of prasugrel dosage after percutaneous coronary intervention using the Clinical Deep Data Accumulation System database

Prasugrel reduces the recurrence of atherosclerotic cardiovascular disease and restenosis after percutaneous coronary intervention (PCI). However, its actual dosage in Japan has not been well studied. This study aimed to compare different prasugrel doses after PCI using retrospective data from the Clinical Deep Data Accumulation System (CLIDAS) database. A retrospective observational study was conducted using the CLIDAS-PCI database with a 2-year follow-up after PCI. There were 2,869 and 52 patients in the 3.75- and 2.5 mg groups, respectively. The 2.5 mg group was comprised of significantly more female, older, shorter, and lower-body-weight patients and included more patients with a history of coronary artery bypass grafting, stroke, peripheral arterial disease, or active malignancy than the 3.75 mg group. Concomitant medications included antiplatelets, anticoagulants, and statins. Laboratory data showed substantially lower hemoglobin and platelet counts in the 2.5 mg group. Most patients weighed < 50 kg; however, fewer had an estimated glomerular filtration rate < 30 mL/min/1.73 m². Major adverse cardio- and cerebrovascular events were similar between groups. The 2.5 mg group had more non-fatal strokes and major bleeding associated with antithrombotic therapy. In Japan, prasugrel 2.5 mg should be considered to reduce major bleeding in patients with low body weight, older adults, women, those receiving concomitant antithrombotic therapy, and those with low platelet counts.