The role of prasugrel in the management of acute coronary syndromes - Current evidence and future perspectives

Postgraduate Thesis uoadl:1453060 562 Read counter

Unit:
ΠΜΣ Θρόμβωση-Αιμορραγία-Ιατρική των Μεταγγίσεων
Library of the School of Health Sciences
Deposit date:
2017-04-19
Year:
2017
Author:
Michael Spartalis
Supervisors info:
Μαριάννα Πολίτου, Αναπληρώτρια Καθηγήτρια, Ιατρική, ΕΚΠΑ
Σερένα Βαλσάμη, Επίκουρη Καθηγήτρια, Ιατρική, ΕΚΠΑ
Κωνσταντίνος Τούτουζας, Αναπληρωτής Καθηγητής, Ιατρική, ΕΚΠΑ
Original Title:
Ο ρόλος της πρασουγρέλης στην αντιμετώπιση καρδιαγγειακών συμβαμάτων - Νεότερα δεδομένα
Languages:
Greek
Translated title:
The role of prasugrel in the management of acute coronary syndromes - Current evidence and future perspectives
Summary:
Dual antiplatelet therapy remains the cornerstone of the medical management of patients with acute coronary syndrome (ACS). In ACS patients receiving a coronary stent, the combination of aspirin and a P2Y12 inhibitor reduces rates of stent thrombosis and major adverse cardiovascular events. However, patients with acute coronary syndrome still remain at risk of recurrent cardiovascular events despite the advance of medical therapy. Given the well‐known limitations of clopidogrel with variable antiplatelet effects and delayed onset of action, newer P2Y12 inhibitors have been developed. Prasugrel is a prodrug that requires biologic conversion to active metabolites. Prasugrel is a selective adenosine diphosphate (ADP) receptor antagonist indicated for use in patients with acute coronary syndromes (ACS). Prasugrel has a faster onset of action and provides greater inhibition of platelet aggregation than clopidogrel. in the large, randomized, double-blind, multicentre, TRITON TIMI 38 trial in adult patients with ACS, treatment with prasugrel was more effective than clopidogrel in reducing the incidence of the primary composite endpoint of non-fatal myocardial infarction, stroke, or cardiovascular (CV) death. Prasugrel also reduced all-cause mortality relative to clopidogrel. Benefit with prasugrel was seen in invasively managed patients. Prasugrel was generally well tolerated and was associated with an increased risk of major bleeding relative to clopidogrel. The risk of major bleeding with prasugrel (including bleeds related to CABG and non-CABG) was higher than with clopidogrel. After taking into account the higher bleeding rates, the net clinical benefit still favored prasugrel use compared with clopidogrel. However, patients with prior stroke or TIA, patients older than 75 years, and patients weighing <60 kg did not demonstrate a net clinical benefit with prasugrel use. The TRILOGY ACS trial found no benefit with prasugrel compared to clopidogrel in patients with medically treated ACS. Prasugrel and ticagrelor are now the recommended first-line agents in patients presenting with non-ST-segment elevation ACS and ST-segment elevation ACS, due to large-scale randomized trials that demonstrated net clinical benefit of these agents over clopidogrel, as stated in the European guidelines. In 2009, the European Commission and US Food and Drug Administration (FDA) approved the use of prasugrel in combination with aspirin for the reduction of thrombotic cardiovascular events (including stent thrombosis) in patients with acute coronary syndrome who are to be managed with PCI. Prasugrel is currently challenged by ticagrelor, a P2Y12 receptor antagonist with different pharmacokinetic/pharmacodynamic properties. The superiority of one drug to the other cannot be reliably estimated from the current trials. Further long-term and comparative efficacy and tolerability data are required to definitively position prasugrel with respect to other antiplatelet agents, including ticagrelor. Ongoing randomized and observational studies may help to provide valuable information on the safety and efficacy of these two drugs and their respective places with ACS patients. Current evidence indicates that prasugrel is a useful option for the prevention of thrombotic CV events in ACS patients managed invasively.
Main subject category:
Health Sciences
Keywords:
Prasugrel, Clopidogrel, Ticagrelor, Acute coronary syndromes
Index:
No
Number of index pages:
0
Contains images:
Yes
Number of references:
64
Number of pages:
85
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