Real-world observations with prasugrel compared to clopidogrel in acute coronary syndrome patients treated with percutaneous coronary intervention in the United States

Bae, Jay; Faries, Douglas E.; Ernst, Frank R.; Lipkin, Craig; Zhao, Zhenxiang; Moretz, Chad; Lieu, Hsiao; Effron, Mark B.

doi:10.1185/03007995.2014.941055

Cited by 22 publications

(33 citation statements)

References 21 publications

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“…increased age, female gender, hypertension, prior stroke or poor renal function). Similar trends of patient selection when prescribing novel P2Y 12 receptor antagonists over clopidogrel have been previously reported [9,10,14,18]. No clear differences in efficacy and safety outcomes between prasugrel and ticagrelor have been reported in previous meta-analyses of the randomized trials involving these agents [19][20][21].…”

Section: Discussionsupporting

confidence: 64%

“…However, 47% of our patients were still prescribed clopidogrel at discharge. In line with this, other contemporary registries have also shown a high rate of clopidogrel use in 'real life' [9][10][11]14,18]. Factors affecting the implementation of guidelines have specifically previously analyzed for GRAPE [25].…”

Section: Discussionmentioning

confidence: 89%

“…As prescription of P2Y 12 receptor antagonists in real life occurs according to established contraindications and special precautions for each of them, significant differences in baseline characteristics that have an impact on both ischemic and bleeding outcomes are expected [10], [14,15]. Although statistical adjustment may account for some of these differences, prescription of prasugrel in a 'lower-risk, real-life' population may contribute to a reduced rate of MACE compared with clopidogrel.…”

Section: Discussionmentioning

confidence: 99%

“…The use of prasugrel and ticagrelor is increasing worldwide; however, data on their efficacy and safety in 'real life', outside randomized trials, are scarce [9][10][11][12][13][14]. Currently, no long-term efficacy and safety data have been reported for an ACS-PCI cohort treated with clopidogrel, prasugrel or ticagrelor.…”

Section: Introductionmentioning

confidence: 99%

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Contemporary antiplatelet treatment in acute coronary syndrome patients undergoing percutaneous coronary intervention: 1‐year outcomes from the GReek AntiPlatElet (GRAPE) Registry

Alexopoulos

Xanthopoulou

Deftereos

et al. 2016

Journal of Thrombosis and Haemostasis

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The comparative efficacy and safety of antiplatelet agents in ‘real life’ is not clear. We recruited acute coronary syndrome patients receiving percutaneous coronary intervention. At 1‐year follow‐up, prasugrel offers better anti‐ischemic protection than clopidogrel. Prasugrel and ticagrelor are accompanied by more frequent bleeding events. Summary BackgroundThe comparative efficacy and safety of antiplatelet treatment outside randomized trials is not clear. ObjectivesTo investigate long‐term efficacy and safety in ‘real‐life’ acute coronary syndrome (ACS) patients treated by percutaneous coronary intervention (PCI) with contemporary use of clopidogrel, prasugrel and ticagrelor. MethodsIn a prospective, observational, multicenter cohort study, 2047 patients were recruited into the GReek AntiPlatElet (GRAPE) Registry and were followed‐up for 1 year for major adverse cardiovascular events (MACE, a composite of death, non‐fatal myocardial infarction, urgent revascularization and stroke) and bleeding events (Bleeding Academic Research Consortium [BARC] classification). ResultsExposure to clopidogrel, prasugrel and ticagrelor by PCI occurred in 959, 363 and 717 patients, respectively. After adjustment, the rate of MACE (primary outcome endpoint) was lower in prasugrel‐treated patients (4.4%) than in clopidogrel‐treated patients (10.1%) (hazard ratio [HR], 0.53; 95% confidence interval [CI], 0.30–0.91), although not significantly different between ticagrelor (6.8%) and clopidogrel groups (HR, 0.78; 95% CI, 0.54–1.12). Any type of BARC‐classified bleeding (secondary outcome endpoint) was more frequent in prasugrel‐treated patients (51.2%) than in clopidogrel‐treated patients (37.6%) (HR, 1.61; 95% CI, 1.33–1.95) and more frequent in ticagrelor‐treated patients (56.9%) than in clopidogrel‐treated patients (HR, 1.81; 95% CI, 1.55–2.10). An adjusted comparison between prasugrel and ticagrelor‐treated groups did not reveal differences in any outcome measure. After adjustment, the death rate was more reduced by novel agents in comparison with clopidogrel (2.9% vs. 6.2%). ConclusionsIn ACS/PCI patients, prasugrel offered better anti‐ischemic protection than clopidogrel, whereas use of both novel agents is accompanied by more frequent bleeding events.

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Section: Discussionsupporting

confidence: 64%

Section: Discussionmentioning

confidence: 89%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

Contemporary antiplatelet treatment in acute coronary syndrome patients undergoing percutaneous coronary intervention: 1‐year outcomes from the GReek AntiPlatElet (GRAPE) Registry

Alexopoulos

Xanthopoulou

Deftereos

et al. 2016

Journal of Thrombosis and Haemostasis

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“…A limited number of studies [9,10,11,12,13,14,15] evaluating the use of novel P 2 Y 12 inhibitors in various settings have suggested a delayed uptake; however, these studies included mostly patients treated with prasugrel, and thus they effected a somewhat ‘biased' approach by excluding patients aged >75 years or those with a prior stroke or a body weight <60 kg. Furthermore, those studies addressed only the issue of in-hospital and short-term follow-up.…”

Section: Introductionmentioning

confidence: 99%

Real-World Use of Novel P2Y12 Inhibitors in Patients with Acute Myocardial Infarction: A Treatment Paradox

et al. 2016

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Objective: To assess the real-world use, clinical outcomes, and adherence to novel P₂Y₁₂ inhibitors. Methods: We evaluated 1,093 consecutive acute myocardial infarction patients undergoing a percutaneous intervention. Patients were derived from a prospective, multicenter, nationwide registry and were followed for 30 days; 381 patients (35%) received clopidogrel, 468 (43%) received prasugrel, and 244 (22%) received ticagrelor. Patients treated with clopidogrel were older and more likely to suffer from chronic renal failure and stroke and/or present with non-ST-elevation myocardial infarction (NSTEMI) (p < 0.01 for all). Independent predictors of undertreatment with novel P₂Y₁₂ inhibitors included: older age (OR 0.17; 95% CI 0.1-0.27, p < 0.0001), a prior stroke (OR 0.41; 95% CI 0.2-0.68, p = 0.008), and NSTEMI (OR 0.37; 95% CI 0.26-0.54, p < 0.0001). Results: Novel P₂Y₁₂ inhibitors were associated with a lower incidence of cardiovascular events, major bleeding, and/or death (7.6 vs.11%, HR 0.67; 95% CI 0.43-1, p = 0.05). However, after a multivariate analysis this trend was not statistically significant. Patients discharged with ticagrelor versus thienopyridines demonstrated a higher rate of crossover to other P₂Y₁₂ inhibitors (11 vs. 5%, p = 0.03). Conclusions: In a real-world cohort, there was an underutilization of novel P₂Y₁₂ inhibitors which was more pronounced in higher-risk subsets that might benefit from novel P₂Y₁₂ inhibitors at least as much as other patients.

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Efficacy and Safety of Ticagrelor vs. Clopidogrel in East Asian Patients with Acute Myocardial Infarction: A Nationwide Cohort Study

Chang

Tung

Liu

et al. 2020

Clin Pharma and Therapeutics

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Ticagrelor improves clinical outcomes in patients with acute myocardial infarction (AMI). This study aimed to compare the efficacy and safety of ticagrelor vs. clopidogrel in East Asian patients with AMI. Between July 2013 and December 2015, patients with AMI prescribed dual antiplatelet therapy were identified from the National Health Insurance Research Database of Taiwan. Using propensity score weighting, ticagrelor was compared with clopidogrel for the primary efficacy end point (a composite of all‐cause death, myocardial infarction (MI), and stroke) and bleeding. A total of 32,442 patients with AMI (ticagrelor: 10,057; clopidogrel: 22,385) were eligible for analysis. After propensity score weighting, ticagrelor was comparable to clopidogrel in the incidence rate of the primary efficacy end point (23.6 vs. 22.76/100 patient‐years; hazard ratio (HR) 0.97; 95% confidence interval (CI) 0.89–1.06; P = 0.513). Ticagrelor was associated with a lower risk of stroke (1.78 vs. 2.66/100 patient‐years; HR 0.64; 95% CI 0.49–0.85; P = 0.002) and higher risks of overall (21.59 vs. 18.35/100 patient‐years; HR 1.16; 95% CI 1.06–1.27; P = 0.002) and Bleeding Academic Research Consortium (BARC) type 2 bleeding (18.67 vs. 15.08/100 patient‐years; HR 1.22; 95% CI 1.11–1.36; P < 0.001). The risks of death, MI, and BARC 3 or 5 bleeding were comparable between ticagrelor and clopidogrel. In the present study, ticagrelor was comparable to clopidogrel in the composite of death, MI, and stroke, but had an increased risk of BARC type 2 bleeding. Ticagrelor may be beneficial in preventing post‐MI stroke in East Asian patients.

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Real-world observations with prasugrel compared to clopidogrel in acute coronary syndrome patients treated with percutaneous coronary intervention in the United States

Cited by 22 publications

References 21 publications

Contemporary antiplatelet treatment in acute coronary syndrome patients undergoing percutaneous coronary intervention: 1‐year outcomes from the GReek AntiPlatElet (GRAPE) Registry

Contemporary antiplatelet treatment in acute coronary syndrome patients undergoing percutaneous coronary intervention: 1‐year outcomes from the GReek AntiPlatElet (GRAPE) Registry

Real-World Use of Novel P2Y12 Inhibitors in Patients with Acute Myocardial Infarction: A Treatment Paradox

Efficacy and Safety of Ticagrelor vs. Clopidogrel in East Asian Patients with Acute Myocardial Infarction: A Nationwide Cohort Study

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