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Prasugrel versus clopidogrel for acute coronary syndromes without revascularization.

Publication ,  Journal Article
Roe, MT; Armstrong, PW; Fox, KAA; White, HD; Prabhakaran, D; Goodman, SG; Cornel, JH; Bhatt, DL; Clemmensen, P; Martinez, F; Ardissino, D ...
Published in: N Engl J Med
October 4, 2012

BACKGROUND: The effect of intensified platelet inhibition for patients with unstable angina or myocardial infarction without ST-segment elevation who do not undergo revascularization has not been delineated. METHODS: In this double-blind, randomized trial, in a primary analysis involving 7243 patients under the age of 75 years receiving aspirin, we evaluated up to 30 months of treatment with prasugrel (10 mg daily) versus clopidogrel (75 mg daily). In a secondary analysis involving 2083 patients 75 years of age or older, we evaluated 5 mg of prasugrel versus 75 mg of clopidogrel. RESULTS: At a median follow-up of 17 months, the primary end point of death from cardiovascular causes, myocardial infarction, or stroke among patients under the age of 75 years occurred in 13.9% of the prasugrel group and 16.0% of the clopidogrel group (hazard ratio in the prasugrel group, 0.91; 95% confidence interval [CI], 0.79 to 1.05; P=0.21). Similar results were observed in the overall population. The prespecified analysis of multiple recurrent ischemic events (all components of the primary end point) suggested a lower risk for prasugrel among patients under the age of 75 years (hazard ratio, 0.85; 95% CI, 0.72 to 1.00; P=0.04). Rates of severe and intracranial bleeding were similar in the two groups in all age groups. There was no significant between-group difference in the frequency of nonhemorrhagic serious adverse events, except for a higher frequency of heart failure in the clopidogrel group. CONCLUSIONS: Among patients with unstable angina or myocardial infarction without ST-segment elevation, prasugrel did not significantly reduce the frequency of the primary end point, as compared with clopidogrel, and similar risks of bleeding were observed. (Funded by Eli Lilly and Daiichi Sankyo; TRILOGY ACS ClinicalTrials.gov number, NCT00699998.).

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Published In

N Engl J Med

DOI

EISSN

1533-4406

Publication Date

October 4, 2012

Volume

367

Issue

14

Start / End Page

1297 / 1309

Location

United States

Related Subject Headings

  • Ticlopidine
  • Thiophenes
  • Stroke
  • Purinergic P2 Receptor Antagonists
  • Prasugrel Hydrochloride
  • Platelet Aggregation Inhibitors
  • Piperazines
  • Myocardial Infarction
  • Middle Aged
  • Male
 

Citation

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Roe, M. T., Armstrong, P. W., Fox, K. A. A., White, H. D., Prabhakaran, D., Goodman, S. G., … TRILOGY ACS Investigators, . (2012). Prasugrel versus clopidogrel for acute coronary syndromes without revascularization. N Engl J Med, 367(14), 1297–1309. https://doi.org/10.1056/NEJMoa1205512
Roe, Matthew T., Paul W. Armstrong, Keith A. A. Fox, Harvey D. White, Dorairaj Prabhakaran, Shaun G. Goodman, Jan H. Cornel, et al. “Prasugrel versus clopidogrel for acute coronary syndromes without revascularization.N Engl J Med 367, no. 14 (October 4, 2012): 1297–1309. https://doi.org/10.1056/NEJMoa1205512.
Roe MT, Armstrong PW, Fox KAA, White HD, Prabhakaran D, Goodman SG, et al. Prasugrel versus clopidogrel for acute coronary syndromes without revascularization. N Engl J Med. 2012 Oct 4;367(14):1297–309.
Roe, Matthew T., et al. “Prasugrel versus clopidogrel for acute coronary syndromes without revascularization.N Engl J Med, vol. 367, no. 14, Oct. 2012, pp. 1297–309. Pubmed, doi:10.1056/NEJMoa1205512.
Roe MT, Armstrong PW, Fox KAA, White HD, Prabhakaran D, Goodman SG, Cornel JH, Bhatt DL, Clemmensen P, Martinez F, Ardissino D, Nicolau JC, Boden WE, Gurbel PA, Ruzyllo W, Dalby AJ, McGuire DK, Leiva-Pons JL, Parkhomenko A, Gottlieb S, Topacio GO, Hamm C, Pavlides G, Goudev AR, Oto A, Tseng C-D, Merkely B, Gasparovic V, Corbalan R, Cinteză M, McLendon RC, Winters KJ, Brown EB, Lokhnygina Y, Aylward PE, Huber K, Hochman JS, Ohman EM, TRILOGY ACS Investigators. Prasugrel versus clopidogrel for acute coronary syndromes without revascularization. N Engl J Med. 2012 Oct 4;367(14):1297–1309.

Published In

N Engl J Med

DOI

EISSN

1533-4406

Publication Date

October 4, 2012

Volume

367

Issue

14

Start / End Page

1297 / 1309

Location

United States

Related Subject Headings

  • Ticlopidine
  • Thiophenes
  • Stroke
  • Purinergic P2 Receptor Antagonists
  • Prasugrel Hydrochloride
  • Platelet Aggregation Inhibitors
  • Piperazines
  • Myocardial Infarction
  • Middle Aged
  • Male