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Prasugrel: A Guide to Its Use in Patients with Acute Coronary Syndromes Undergoing Percutaneous Coronary Intervention in the US

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Abstract

Oral prasugrel (Effient®; Efient®) provides rapid, potent inhibition of platelet aggregation. It is indicated (in combination with aspirin) for the prevention of atherothrombotic events in patients with acute coronary syndromes (ACS) undergoing percutaneous coronary intervention (PCI). In the pivotal clinical trial in this patient population, prasugrel-based therapy was associated with a significantly lower incidence of ischemic events than clopidogrel-based therapy. However, the efficacy of prasugrel was offset by a higher risk of bleeding than clopidogrel, with patients aged ≥75 years, those weighing <60 kg and those with a history of stroke or transient ischemic attack at the greatest risk. Prasugrel appears to have an overall favorable risk: benefit ratio in ACS patients undergoing PCI who do not have these three easily identifiable clinical characteristics. Limited pharmacoeconomic analyses suggest that prasugrel-based therapy is an economically attractive treatment strategy relative to clopidogrel-based therapy from a US healthcare payer perspective.

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Acknowledgments and Disclosures

This article was reviewed by E.R. Bates, Internal Medicine, University of Michigan, Ann Arbor, Michigan, USA.

The preparation of this article was not supported by any external funding. During the peer review process, the manufacturer of the agent under review was offered an opportunity to comment on the article. Changes resulting from comments received were made by the author on the basis of scientific and editorial merit.

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    Katherine A. Lyseng-Williamson

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  1. Katherine A. Lyseng-Williamson
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Correspondence to Katherine A. Lyseng-Williamson.

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Lyseng-Williamson, K.A. Prasugrel: A Guide to Its Use in Patients with Acute Coronary Syndromes Undergoing Percutaneous Coronary Intervention in the US. Am J Cardiovasc Drugs 12, 207–216 (2012). https://doi.org/10.2165/11209640-000000000-00000

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