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Patient variables affected outcomes between prasugrel, clopidogrel
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ACS patients treated with prasugrel experience fewer ischemic complications but more bleeding than those receiving clopidogrel, and individualized thienopyridine selection could maximize the benefits and safety of these drugs, results from a recent study suggest.
Researchers sought to develop models to support targeting prasugrel (Effient, Eli Lilly/Daiichi Sankyo) to those who benefit most from treatment and maximize the drug’s benefits and safety. The study examined 12,579 patients from the TRITON-TIMI 38 trial using risk models for ischemic events, such as CV death, spontaneous MI and stroke, or major/minor TIMI bleeding during a 14.8-month follow-up period.
Prasugrel’s mean absolute reduction in ischemia risk compared with clopidogrel was 1.5 ± 3%, ranging from an 8.4% increased risk to a 31.2% reduction in risk. Prasugrel’s mean absolute increase in bleeding risk compared with clopidogrel was 1.3 ± 1.4% and ranged from a 7.9% lower risk to an 11.2% higher risk.
Each individual’s net benefit in TRITON-TIMI 38 was calculated using these risk models, and the researchers found that 42% of the study participants would have experienced net benefit with prasugrel, a rate that increased if patients more strongly preferred avoiding ischemic events than bleeding.
However, the expected benefits and risks of prasugrel vs. clopidogrel depend highly on patient characteristics, researchers noted.
“This approach can allow clinicians to consider patients’ risks for what they identify as the most clinically relevant outcomes for each treatment decision,” researchers wrote. “… This method could enable providers to consider those outcomes (eg, including TIMI major but not TIMI minor bleeding or spontaneous but not periprocedural MI) that they deem most important when generating risk estimates and discussing treatment options with patients.”
Disclosure: Salisbury receives funds from an American Heart Association–Pharmaceutical Roundtable Spina Outcomes Research Center Grant.
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