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November 5, 2012JAMA

Platelet Function During Extended Prasugrel and Clopidogrel Therapy for Patients With ACS Treated Without Revascularization

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Why the study?

Does aspirin with prasugrel reduce the composite of cardiovascular death, myocardial infarction, or stroke compared to aspirin with clopidogrel in patients with medically managed unstable angina or non-ST-segment elevation myocardial infarction?

Population

2,564 patients with medically managed unstable angina or non-ST-segment elevation myocardial infarction…

Comparison

Aspirin with prasugrel vs Aspirin with clopidogrel (75 mg/d)

Design

RCT, randomized

Follow-up

30 months

Authors

PGPaul A. Gurbel

Discussion

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Overview

Prasugrel confers no ischemic benefit over clopidogrel in medically managed ACS; challenges potency-based platelet inhibition as a driver of outcomes.

Structured PICO

Does aspirin with prasugrel reduce the composite of cardiovascular death, myocardial infarction, or stroke compared to aspirin with clopidogrel in patients with medically managed unstable angina or non-ST-segment elevation myocardial infarction?

P
Population
2,564 patients with medically managed unstable angina or non-ST-segment elevation myocardial infarction (NSTEMI) enrolled in a platelet function substudy of the TRILOGY ACS trial
I
Intervention
Aspirin with prasugrel (10 mg/d, or 5 mg/d for patients ≥75 years or <75 years weighing <60 kg)
C
Comparator
Aspirin with clopidogrel (75 mg/d)
O
Outcome
Composite of cardiovascular death, myocardial infarction, or stroke through 30 monthscomposite

In patients with medically managed ACS, prasugrel provides greater platelet inhibition than clopidogrel, but this lower platelet reactivity is not associated with a significant reduction in ischemic events.

Cite This Study

Paul A. Gurbel (2012) studied this question.

synapsesocial.com/papers/69f29c8f1b51e2fbf018711dhttps://doi.org/10.1001/jama.2012.17312
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