Abstract
The newly registered irreversible ADP receptor antagonist prasugrel is an important innovation in the area of antithrombotic therapy. Prasugrel is superior to clopidogrel, the drug used previously, in the reliability of anti-platelet activity, lower rate of resistance, and rapidity of onset of action.
The results of the TRITON-TIMI 38 trial in STEMI and NSTEMI patients with acute coronary syndromes scheduled for coronary angioplasty showed a significant reduction in atherothrombotic events. In comparison with the combination clopidogrel-acetylsalicylic acid (ASA), the combination prasugrel-ASA reduced the primary endpoint of cardiovascular mortality, myocardial infarction, or stroke by relative 19 % or absolute 2.2 %.
The greatest effect was seen in the diabetes mellitus subgroup where the same primary endpoint decreased by 30 % or 4.8 %, respectively. A more pronounced inhibition of primary homeostasis is associated with increased bleeding risk.
In the above-mentioned study, important bleeding (needing intervention) was by the relative 32 % or absolute 0.6 % less frequent than in the clopidogrel arm. Based on the positive results, prasugrel was approved for use in the treatment of STEMI and NSTEMI patients with acute coronary syndromes scheduled for coronary angioplasty