(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
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".