Prasugrel for the treatment of coronary thrombosis: a review of pharmacological properties, indications for use and future development

IMPORTANCE OF THE FIELD: Dual antiplatelet therapy with aspirin and the P2Y(12) receptor antagonist clopidogrel is the cornerstone of treatment for prevention of recurrent ischemic events in high-risk patients. Despite the benefits of this strategy, a number of patients experience recurrent atherothrombotic events. Investigations have shown that this may be in part related to the broad range in pharmacodynamic response to clopidogrel, which includes patients with poor platelet inhibitory effects who have an increased risk of events. AREAS COVERED IN THIS REVIEW: Prasugrel (CS-747; LY-640315) is a novel, third-generation oral thienopyridine that is a specific, irreversible antagonist of the platelet P2Y(12) receptor. Laboratory results with prasugrel support more potent antiplatelet effects, a lower incidence of interpatient variability in antiplatelet response, and a reduced time to onset of antiplatelet activity compared with clopidogrel. WHAT THE READER WILL GAIN: This manuscript reviews the pharmacological properties, safety and efficacy of prasugrel and provides current indications for its use and future development. TAKE HOME MESSAGE: Prasugrel exerts more prompt, potent and predictable antiplatelet effects than clopidogrel. These translate into a greater reduction in ischemic events, including stent thrombosis, in acute coronary syndrome patients undergoing percutaneous coronary intervention albeit at the expense of an increased risk of bleeding.