Prasugrel (marketing name Effient) is a novel platelet inhibitor developed by
Daiichi Sankyo Co. and produced by
Ube and currently under clinical development in cooperation with
Eli Lilly and Company for
acute coronary syndromes planned for
percutaneous coronary intervention (PCI). Prasugrel is a member of the
thienopyridine class of
ADP receptor inhibitors, like
ticlopidine (trade name Ticlid) and
clopidogrel (trade name Plavix). These agents are believed to reduce the aggregation ("clumping") of
platelets by irreversibly binding to
P2Y12 receptors.
TRITON-TIMI study
As published in the New England Journal of Medicine's online edition, the TRITON-TIMI 38 study of 13,608 patients with acute coronary syndromes compared prasugrel against clopidogrel, both in combination with aspirin, and found that, as a more potent anti-platelet agent, prasugrel reduced the combined rate of death from cardiovascular causes, nonfatal myocardial infarction, or nonfatal stroke (12.1% for clopidogrel vs. 9.9% for prasugrel). These favorable results were obtained at the expense of increasing the rate of serious bleeding (1.4%, vs. 0.9% in the clopidogrel group) and fatal bleeding (0.4% vs. 0.1%). This resulted in no overall mortality difference between treatment groups.
From the editorial in the NEJM, "In TRITON–TIMI 38, for each death from cardiovascular causes prevented by the use of prasugrel as compared with clopidogrel, approximately one additional episode of fatal bleeding was caused by prasugrel".
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