Why the study?
Prasugrel was discontinued by its distributor in Canada, creating a therapy gap for patients with moderate- to high-risk acute coronary syndromes recommended to receive ticagrelor or prasugrel over clopidogrel.
Provides guidance on alternative antiplatelet strategies for Canadian clinicians managing ACS patients following the discontinuation of prasugrel.
Prasugrel discontinuation creates an antiplatelet therapy gap in Canadian ACS care; leaves open optimal ticagrelor selection pending updated guidelines.
BACKGROUND: The current Canadian Cardiovascular Society antiplatelet therapy guidelines recommend the use of ticagrelor or prasugrel over clopidogrel as first-line platelet P2Y12 receptor antagonists for treatment of moderate- to high-risk acute coronary syndromes. Recently, Effient (prasugrel [Eli Lilly Canada Inc, Toronto, Canada]) was discontinued by its distributor in Canada. METHODS: Five members of the Canadian Cardiovascular Society antiplatelet therapy 2018 guidelines committee undertook an independent, evidence-based review to outline patients for whom prasugrel should be the optimal P2Y12 agent and discuss alternative strategies to consider without prasugrel. RESULTS: Several clinical scenarios where prasugrel should be indicated are identified and discussed. Considerations to be undertaken for alternative therapies are summarized, including a review of national and international guidelines for de-escalation of P2Y12 receptor antagonists. CONCLUSIONS: The discontinuation of prasugrel poses a challenge for clinicians. Clinicians must consider key factors in determining the best alternate therapy.
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Lordkipanidzé et al. (2020) studied this question.
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