Key result
Prasugrel significantly reduced ischemic events compared to clopidogrel in patients with ACS undergoing PCI, but was associated with a significant increase in major bleeding.
Why the study?
Does prasugrel reduce ischemic events compared with clopidogrel in moderate-to-high-risk patients with acute coronary syndromes undergoing percutaneous coronary intervention?
RCT (n=13,608)
Does prasugrel reduce ischemic events compared with clopidogrel in moderate-to-high-risk patients with acute coronary syndromes undergoing percutaneous coronary intervention?
In moderate-to-high-risk ACS patients undergoing PCI, prasugrel provides superior reduction in ischemic events compared to clopidogrel, though at the cost of increased major bleeding.
May inform DAPT selection in ACS-PCI despite bleeding trade-off; leaves open optimal patient stratification in real-world settings.
Current guidelines recommend dual antiplatelet therapy using aspirin and clopidogrel for non-ST elevation acute coronary syndromes (ACS). Despite the established benefits of this approach, many patients continue to have recurrent atherothrombotic events. Moreover, it is often difficult to achieve an adequate inhibition of platelet aggregation with clopidogrel in clinical practice. Prasugrel is an orally administered P2Y12 receptor antagonist that is more potent, more rapid in onset and more consistent in its inhibition of platelet aggregation than currently approved doses of clopidogrel. The trial to Assess Improvement in Therapeutic Outcomes by Optimizing Platelet Inhibition with Prasugrel - Thrombolysis in Myocardial Infarction 38 (TRITON-TIMI 38) randomized 13,608 moderate-to-high-risk patients with ACS (with or without ST-segment elevation) undergoing percutaneus coronary intervention to compare prasugrel with clopidogrel for a median of follow-up time of 14.5 months. The TRITON-TIMI 38 trial demonstrated a significant reduction in ischemic events in patients randomized to prasugrel compared with those treated with clopidogrel. This beneficial effect, however, was associated with a significant increase in major bleeding.
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Mariani et al. (2008) conducted an RCT in Acute coronary syndromes (ACS) (n=13,608). Prasugrel vs. Clopidogrel was evaluated on Ischemic events. Prasugrel significantly reduced ischemic events compared to clopidogrel in patients with ACS undergoing PCI, but was associated with a significant increase in major bleeding.
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