Blood Thinners prasugrel and clopidogrel go head to head

By Liam O’Neill at TCT, 2014.

Results of the largest longitudinal study observing treatment outcomes of acute myocardial infarction were presented at the 26th annual Transcatheter Cardiovascular Therapeutics (TCT) scientific symposium today (16th September 2014). TCT is the world’s premier interventional cardiology meeting.

While advances in medicine and technology in the last few years have been shown to reduce the risk of death and recurrent cardiovascular events, there has been a lack of how this translates in everyday life. TRANSLATE-ACS is designed to further understanding of how novel antiplatelet therapies are adopted into real world clinical practice.

This observational study compared prasugrel and clopidogrel among myocardial infarction (MI) patients undergoing percutaneous coronary intervention (PCI).  11,969 patients treated with PCI were observed in the trial. Primary endpoints included a composite of major adverse coronary events, stent thrombosis, as well as GUSTO moderate to severe bleeding at one year follow-up.

Prasugrel was associated with significantly lower adjusted risk of definite stent thrombosis per ARC criteria. Among all-comers, prasugrel was also associated with significantly higher adjusted bleeding risk relative to clopidogrel.  In propensity matched secondary analyses, the associations with MACE and stent thrombosis showed consistent results, whereas the association with bleeding was no longer statistically significant.

While unadjusted comparisons demonstrated lower MACE in patients receiving prasugrel vs. clopidogrel, these differences were no longer significant after risk adjustment (Adj. HR=1.03, 95% CI, 0.92 – 1.16, p=0.59).

“TRANSLATE-ACS represents the largest prospective longitudinal study of acute MI patients undergoing PCI in contemporary community practice in the United States.” said lead investigator Tracy Y. Wang, MD, MHS, MS. Dr. Wang is an Associate Professor of Medicine at Duke University. “This observational study found that patients treated with prasugrel vs. clopidogrel significantly differ, and the trial provided a unique opportunity to compare their effectiveness and safety in the real world.”

Prasugrel was used in 25.5 percent of MI patients at the time of PCI. Those treated with prasugrel were younger (57 vs. 61 median years, p<0.0001), more likely to present with ST elevated myocardial infarction and less likely to have prior MI (14.6 percent vs. 21.3 percent, <0.0001) or diabetes (24.6 percent vs. 27.2 percent, p= 0.003) than clopidogrel-treated patients.