The Pharmaceutical Journal
Vol 280 No 7498 p462
19 April 2008

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Prasugrel cuts ischaemic events with stents more than clopidogrel

Intensive therapy with a new antiplatelet agent — prasugrel — results in fewer ischaemic events than with clopidogrel in patients with intracoronary stents, irrespective of the type of stent used, according to a study published online in The Lancet (29 March 2008).

Researchers analysed data from the TRITON-TIMI 38 trial (PJ, 17 November 2007, p555) to assess the rate, outcomes and prevention of ischaemic events in 12,844 patients with different types of coronary stents who were treated with prasugrel plus aspirin or clopidogrel plus aspirin.

Results of the study, which was supported by a research grant from prasugrel’s developers, Daiichi Sankyo and Eli Lilly, showed that, compared with clopidogrel, prasugrel reduced the primary endpoint of a composite of cardiovascular death, non-fatal myocardial infarction or non-fatal stroke both in patients with drug-eluting stents (9.0 versus 11.1 per cent, hazard ratio 0.82; P=0.019) and in patients with bare-metal stents (10.0 versus 12.2 per cent, HR 0.80; P=0.003).

Stent thrombosis, which, when it occurred, was associated with death or myocardial infarction in 89 per cent of patients, was reduced with prasugrel compared with clopidogrel in patients with drug-eluting stents (0.84 versus 2.31 per cent, HR 0.36; P<0.0001) and bare metal stents (1.27 versus 2.41 per cent, HR0.52; P=0.0009).

The greatest reduction occurred in the first 30 days, although reductions were seen in late stent thrombosis for the entire cohort and for those with drug-eluting stents. In addition, the reduction of ischaemic events was maintained when events related to stent thrombosis were excluded, indicating a benefit for intensive antiplatelet therapy both at the site of and at sites distinct from the stent, suggest the researchers.

“When balancing risks and benefits of strategies to prevent ischaemic events, consideration should be given to patient characteristics, including risk of bleeding and ischaemic events, as well as stent and procedural characteristics,” the researchers conclude.