Prasugrel, a third-generation thienopyridine antiplatelet agent, demonstrated superior efficacy to clopidogrel but with an increased risk of bleeding in the phase III pivotal registration Trial to Assess Improvement in Therapeutic Outcomes by Optimizing Platelet Inhibition with Prasugrel-Thrombolysis in Myocardial Infarction (TRITON-TIMI 38). This article reviews and discusses select components...

Assays monitoring P2Y12 platelet reactivity can accurately predict which patients will have a poor response to clopidogrel. We sought to determine the cost-effectiveness of using platelet reactivity assays (PRAs) to select a dual-antiplatelet regimen for patients with acute coronary syndrome. A hybrid decision tree Markov model was developed to determine the cost-effectiveness of universal clop...

Vol. 33 No. 1 • January 2008 • P&T® 51 a combination of death from cardiovascular disease, MI, and stroke. Safety endpoints were TIMI major bleeding episodes and life-threatening bleeding. The clopidogrel group reached the primary endpoint more frequently (12.1% of the time) than the prasugrel group (9.3%); the hazard ratio (HR) was 0.81 (P = 0.004). The benefit was significant in both loading ...

In most countries, the antithrombotic armamentarium for treating acute coronary syndrome (ACS) patients currently consists of aspirin, clopidogrel, heparin, enoxaparin, bivalirudin, and fondaparinux. A large number of new antithrombotic agents for treating ACS patients are about to enter the market or are under development: new P2Y12 inhibitors (prasugrel, ticagrelor, cangrelor), thrombin recep...

BACKGROUND The pharmacodynamic effects of changing from standard-dose clopidogrel to low-dose (3.75 mg) prasugrel in Japanese patients are largely unknown. METHODSANDRESULTS A total of 53 consecutive Japanese patients with stable coronary artery disease (CAD) who received aspirin and clopidogrel were enrolled. Clopidogrel was switched to 3.75 mg prasugrel. At day 14, prasugrel was switched to...

BACKGROUND Platelet activation has been implicated in the pathogenesis of sickle cell disease (SCD) suggesting antiplatelet agents may be therapeutic. To evaluate the safety of prasugrel, a thienopyridine antiplatelet agent, in adult patients with SCD, we conducted a double-blind, randomized, placebo-controlled study. METHODS The primary endpoint, safety, was measured by hemorrhagic events re...

BACKGROUND Ticagrelor and prasugrel provide stronger platelet inhibition compared with clopidogrel. Direct pharmacodynamic comparison between them has not yet been reported in ST-segment-elevation myocardial infarction patients. METHODS AND RESULTS In a prospective, single-center, single-blind study, 55 out of 117 (47%) screened consecutive ST-segment-elevation myocardial infarction patients ...

Background Thromboembolic complications are the main problem in stent-assisted coil embolization of unruptured intracranial aneurysms. The combination of aspirin and clopidogrel is generally used to decrease these complications, but some patients do not respond to clopidogrel and have a higher risk of stent thrombosis. In cardiology, clinical trials have shown that prasugrel reduced the inciden...

BACKGROUND Prasugrel is more effective than clopidogrel in reducing platelet aggregation in acute coronary syndromes. Data available on prasugrel reloading in clopidogrel treated patients with high residual platelet reactivity (HRPR) i.e. poor responders, is limited. OBJECTIVES To determine the effects of prasugrel loading on platelet function in patients on clopidogrel and high platelet reac...

OBJECTIVES This study sought to compare the action of prasugrel and ticagrelor in ST-segment elevation myocardial infarction (STEMI) patients undergoing primary percutaneous coronary intervention (PPCI). BACKGROUND It has been documented that prasugrel and ticagrelor are able to provide effective platelet inhibition 2 h after a loading dose (LD). However, the pharmacodynamic measurements afte...