DOI: http://dx.doi.org/10.18203/2320-6012.ijrms20182052

Prasugrel versus ticagrelor in patients with Acute Coronary syndrome treated with percutaneous coronary intervention

Naveen Jamwal, Shiv Shanker Tripathi

Abstract


Background: No association studies for the efficacy and safety of ticagrelor vs. prasugrel have been published in India. Aim of the study was to compare the safety and efficacy of Prasugrel versus Ticagrelor in Patients with Acute Coronary Syndrome Treated with Percutaneous Coronary Intervention.

Methods: This retrospective study was designed to compare the efficacy and safety of prasugrel and ticagrelor in acute coronary syndromes (ACS) with percutaneous coronary intervention (PCI). A total of 480 patients were studied who had been prescribed either prasugrel or ticagrelor during PCI. Primary end-point was defined as death, re-infarction, urgent target vessel revascularization, serious bleeding requiring transfusion.

Results: Primary endpoint was different between the groups receiving prasugrel and ticagrelor (1.2% and 4.0%, respectively; OR (95% CI) 0.38 (0.098; 1.43); P=0.065). Difference was found in the need for urgenttarget vessel revascularization which was significantly lower in the prasugrel group.Rest of the parameters were almost similar with no significant difference.

Conclusions: This study comparing prasugrel and ticagrelor shows that Prasugrel is more effective than Ticagrelor in lowering ischemic events in the acute coronary syndromes treated with PCI strategy, especially incidence of stent thrombosis. These observations need further analysis and follow-up.


Keywords


Acute Coronary Syndrome, Prasugrel, Percutaneous coronary intervention, Ticagrelor

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References


Steg PG, James SK, Atar D, Badano LP, Blömstrom-Lundqvist C. Task Force on the management of ST-segment elevation acute myocardial infarction of the European Society of Cardiology (ESC). ESC Guidelines for the management of acute myocardial infarction in patients presenting with ST-segment elevation. Eur Heart J. 2012;33:2569-619.

Levine GN, Bates ER, Bittl JA, Brindis RG, Fihn SD. Focused Update Writing Group. 2016 ACC/AHA Guideline Focused Update on Duration of Dual Antiplatelet Therapy in Patients with Coronary Artery Disease: A Report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines. J Am Coll Cardiol 2016; published ahead of print.

Wallentin L, Becker RC, Budaj A, Cannon CP, Emanuelsson H. PLATO Investigators, Freij A, Thorsén M. Ticagrelor versus clopidogrel in patients with acute coronary syndromes. N Engl J Med. 2009;361:1045-57.

Wiviott SD, Braunwald E, McCabe CH, Montalescot G, Ruzyllo W. TRITON-TIMI 38 Investigators. Prasugrel versus clopidogrel in patients with acute coronary syndromes. N Engl J Med. 2007;357:2001-15.

Branny M, Mrozek J, Cervinka P. PRAGUE-18 Study Group. Prasugrel versus Ticagrelor in Patients with Acute Myocardial Infarction Treated with Primary Percutaneous Coronary Intervention.

Antman EM, Wiviott SD, Murphy SA, Voitk J, Hasin Y. Early and late benefits of prasugrel in patients with acute coronary syndromes undergoing percutaneous coronary intervention: a TRITON-TIMI 38 (TRial to Assess Improvement in Therapeutic Outcomes by Optimizing Platelet InhibitioN with Prasugrel-Thrombolysis In Myocardial Infarction) analysis. J Am Coll Cardiol. 2008;51:2028-33.

Silvain J, Bellemain-Appaix A, Barthélémy O, Beygui F, Collet JP. Optimal use of thienopyridines in non-ST-elevation acute coronary syndrome following CURRENT-OASIS 7. Circ Cardiovasc Interv. 2011;4:95-103.

Alexopoulos D, Xanthopoulou I, Gkizas V, Kassimis G, Theodoropoulos. Randomized assessment of ticagrelor versus prasugrel antiplatelet effects in patients with ST-segment-elevation myocardial infarction. Circ Cardiovasc Interv. 2012;5:797-804.

Montalescot G, Hof AW, Lapostolle F, Cantor WJ, Cequier A. ATLANTIC Investigators. Prehospital ticagrelor in ST-segment elevation myocardial infarction, N Engl J Med. 2014; 371:1016-27.

Bernat I, Horak D, Stasek J, Mates M, Pesek J. ST-segment elevation myocardial infarction treated by radial or femoral approach in a multicenter randomized clinical trial: the Stemi-Radial trial. J Am Coll Cardiol. 2014;63:964-72.