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Prasugrel use steadily increased in recent years
Since FDA approval in July 2009, use of prasugrel has steadily increased among patients with ACS undergoing PCI. However, use of this drug in patients with known contraindications is not uncommon, according to data published in Circulation: Cardiovascular Quality and Outcomes.
Researchers used data from the Blue Cross Blue Shield of Michigan Cardiovascular Consortium to assess patterns in the use of prasugrel (Effient, Eli Lilly). The study included 55,821 patients who underwent PCI at 44 hospitals and were discharged in 2010 or 2011. Researchers defined potential inappropriate therapy as prasugrel use in patients with a history of cerebrovascular disease, weight <60 kg and aged at least 75 years.
Results showed a steady increase in the prescribing of prasugrel at hospital discharge, with 8.4% of patients receiving a prescription in the beginning of the study to about 22% of patients by study end.
More than 69% of the total cohort presented with ACS; 17.2% of this group received prasugrel. Among those prescribed prasugrel, 28.3% received the drug for indications other than ACS.
In addition, one or more known contraindications to the drug were present in 6% to 10% of patients discharged on prasugrel.
“Our study provides an analysis of contemporary use of prasugrel and trends in its clinical prescribing practices since drug approval. There has been a steady increase in the overall use of this medication during the study period, with a significant portion of patients receiving the medication for off-label indications,” the researchers wrote.
“More importantly, this agent is used in a substantial number of patients with known contraindications. Further work is warranted to understand and reduce the use of this drug in this subset of patients who are at higher risk of complications,” they wrote.
Disclosure: See the full study for a list of the researchers’ relevant financial disclosures.