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Evaluation of the Relative Efficacy and Safety of Prasugrel and Clopidogrel in Medically Managed High Risk UA/NSTEMI ACS Population


Affiliations
1 Department of medicine, Unit-5, Guru Nanak Dev Hospital, Amritsar, Punjab, India
 

Background: The term "acute coronary syndrome" encompasses unstable angina and non-ST-segment elevation myocardial infarction (UA/NSTEMI) and ST-segment elevation myocardial infarction (STEMI). Antiplatelet therapy is one of the cornerstones of therapy in UA/NSTEMI.

Objective: To compare efficacy and safety of Prasugrel and clopidogrel both theinopyridines antiplatelet drugs in high risk (TIMI Score 3 or more) medically managed UA/NSTEMI.

Materials and Methods: A prospective, randomized study was conducted in GNDH, Amritsar. 100 patients were included, 50 patients received Prasugrel and 50 received clopidogrel. Outcomes like angina episodes, bleeding, stroke, ischemic ECG changes, and arrhythmia were compared during hospital stay and follow-up for 3 months.

Results: Prasugrel was associated with significant lower incidence of major adverse cardiac event (MACE) 9 compared to 19 with clopidogrel during hospital stay. During follow up for 3 months 2 events occurred with Prasugrel and 3 with clopidogrel which were non-significant.

Conclusion: Use of Prasugrel was associated with less number of MACE than the patients who were on clopidogrel. Although for the individual adverse coronary events, except for angina there was no statically significant difference, but when the total MACE observed during the study was compared, it was significantly less in the patient on Prasugrel therapy. Safety of the Prasugrel in present study was identical to clopidogrel.


Keywords

1. Braunwald E, Antman EM, Beasley JW. ACC/AHA guideline update for the management of patients with unstable angina and non-ST segment elevation myocardial infarction. A report of the American College of Cardiology/American Heart Association Task force on practice Guidelines (Committee on the management of patients with unstable angina). Circulation 2002;106:1893-900. 2. Fuster V, Badimon L, Badimon JJ. The pathogenesis of coronary artery disease and the acute coronary syndromes. N Engl J Med 1992;326:242-50. 3. Patrono C. Drug therapy: aspirin as an antiplatelet agent. N Engl J Med 1994;330:1287-94. 4. Antiplatelet Trialists Collaboration. Collaborative overview of randomized trials of antiplatelet therapy. Prevention of death, myocardial infarction, and strokeUnstable Angina, Non ST Elevation Myocardial Infarction, Prasugrel, Clopidogrel.
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  • Braunwald E, Antman EM, Beasley JW. ACC/AHA guideline update for the management of patients with unstable angina and non-ST segment elevation myocardial infarction. A report of the American College of Cardiology/American Heart Association Task force on practice Guidelines (Committee on the management of patients with unstable angina). Circulation 2002;106:1893-900.

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  • Evaluation of the Relative Efficacy and Safety of Prasugrel and Clopidogrel in Medically Managed High Risk UA/NSTEMI ACS Population

Abstract Views: 301  |  PDF Views: 151

Authors

Praveen Kumar Garg
Department of medicine, Unit-5, Guru Nanak Dev Hospital, Amritsar, Punjab, India
Jaswant Singh
Department of medicine, Unit-5, Guru Nanak Dev Hospital, Amritsar, Punjab, India
Tarsem Pal Singh
Department of medicine, Unit-5, Guru Nanak Dev Hospital, Amritsar, Punjab, India
Sapna
Department of medicine, Unit-5, Guru Nanak Dev Hospital, Amritsar, Punjab, India
Nikhil Verma
Department of medicine, Unit-5, Guru Nanak Dev Hospital, Amritsar, Punjab, India

Abstract


Background: The term "acute coronary syndrome" encompasses unstable angina and non-ST-segment elevation myocardial infarction (UA/NSTEMI) and ST-segment elevation myocardial infarction (STEMI). Antiplatelet therapy is one of the cornerstones of therapy in UA/NSTEMI.

Objective: To compare efficacy and safety of Prasugrel and clopidogrel both theinopyridines antiplatelet drugs in high risk (TIMI Score 3 or more) medically managed UA/NSTEMI.

Materials and Methods: A prospective, randomized study was conducted in GNDH, Amritsar. 100 patients were included, 50 patients received Prasugrel and 50 received clopidogrel. Outcomes like angina episodes, bleeding, stroke, ischemic ECG changes, and arrhythmia were compared during hospital stay and follow-up for 3 months.

Results: Prasugrel was associated with significant lower incidence of major adverse cardiac event (MACE) 9 compared to 19 with clopidogrel during hospital stay. During follow up for 3 months 2 events occurred with Prasugrel and 3 with clopidogrel which were non-significant.

Conclusion: Use of Prasugrel was associated with less number of MACE than the patients who were on clopidogrel. Although for the individual adverse coronary events, except for angina there was no statically significant difference, but when the total MACE observed during the study was compared, it was significantly less in the patient on Prasugrel therapy. Safety of the Prasugrel in present study was identical to clopidogrel.


Keywords


1. Braunwald E, Antman EM, Beasley JW. ACC/AHA guideline update for the management of patients with unstable angina and non-ST segment elevation myocardial infarction. A report of the American College of Cardiology/American Heart Association Task force on practice Guidelines (Committee on the management of patients with unstable angina). Circulation 2002;106:1893-900. 2. Fuster V, Badimon L, Badimon JJ. The pathogenesis of coronary artery disease and the acute coronary syndromes. N Engl J Med 1992;326:242-50. 3. Patrono C. Drug therapy: aspirin as an antiplatelet agent. N Engl J Med 1994;330:1287-94. 4. Antiplatelet Trialists Collaboration. Collaborative overview of randomized trials of antiplatelet therapy. Prevention of death, myocardial infarction, and strokeUnstable Angina, Non ST Elevation Myocardial Infarction, Prasugrel, Clopidogrel.

References





DOI: https://doi.org/10.18311/ijmds%2F2015%2F79808