Key result
Prasugrel dose de-escalation (5 mg daily) reduced net adverse clinical events compared to conventional 10 mg therapy in diabetic patients with ACS (7.6% vs 11.3%; HR 0.66; 95% CI 0.43-0.99; P=0.049).
Why the study?
The study evaluated the efficacy and safety of prasugrel dose de-escalation therapy in patients with diabetes mellitus and acute coronary syndrome undergoing percutaneous coronary intervention.
Does prasugrel dose de-escalation reduce net adverse clinical events in diabetic patients with acute coronary syndrome undergoing percutaneous coronary intervention?
RCT (n=990)
Does prasugrel dose de-escalation reduce net adverse clinical events in diabetic patients with acute coronary syndrome undergoing percutaneous coronary intervention?
Hazard Ratio: 0.66 (95% CI 0.43–0.99)
Absolute Event Rate: 7.6% vs 11.3%
p-value: p=0.049
In diabetic patients with acute coronary syndrome undergoing percutaneous coronary intervention, de-escalating the prasugrel dose to 5 mg daily reduces net adverse clinical events, driven primarily by a reduction in bleeding without an increase in ischemic risk.
Authors
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Supports prasugrel de-escalation to 5 mg in diabetic ACS-PCI patients; extends tailored P2Y12 strategies to this high-bleeding-risk subgroup.
Lee et al. (2023) conducted an RCT in Diabetes mellitus and acute coronary syndrome undergoing percutaneous coronary intervention (n=990). Prasugrel dose de-escalation vs. Conventional therapy (prasugrel 10 mg daily) was evaluated on Net adverse clinical events (NACE), defined as a composite of all-cause death, non-fatal myocardial infarction (MI), stent thrombosis (ST), clinically driven revascularization, stroke, and BARC class ≥2 bleeding events (HR 0.66, 95% CI 0.43-0.99, p=0.049). Prasugrel dose de-escalation (5 mg daily) reduced net adverse clinical events compared to conventional 10 mg therapy in diabetic patients with ACS (7.6% vs 11.3%; HR 0.66; 95% CI 0.43-0.99; P=0.049).
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