Related Experiment Videos

Mortality benefit with prasugrel in the TRITON-TIMI 38 coronary artery bypass grafting cohort: risk-adjusted

Peter K Smith1, Lawrence T Goodnough, Jerrold H Levy

  • 1Duke University Medical Center, Durham, NC 27710, USA. smith058@mc.duke.edu

Journal of the American College of Cardiology
|May 29, 2012
PubMed

Insights

Prasugrel use before coronary artery bypass grafting (CABG) increased bleeding but significantly lowered mortality compared to clopidogrel. This suggests a potential benefit despite increased bleeding risks in CABG patients.

Area of Science:

  • Cardiology
  • Cardiovascular Surgery
  • Pharmacology

Background:

  • Limited evidence exists for prasugrel use in patients requiring urgent or emergency coronary artery bypass grafting (CABG).
  • Previous experience with clopidogrel in CABG patients has raised concerns about perioperative bleeding complications.

Purpose of the Study:

  • To characterize bleeding, transfusion, and other outcomes in patients undergoing CABG.
  • To compare outcomes related to the timing of prasugrel or clopidogrel withdrawal before CABG.

Main Methods:

  • Analysis of a subset of the TRITON-TIMI 38 study involving patients randomized to aspirin with either clopidogrel or prasugrel who underwent isolated CABG (N = 346).
  • Data collection via a supplemental case report form, combined with the existing TRITON-TIMI 38 database.
  • Statistical correction for baseline imbalances using elements of the European System for Cardiac Operative Risk Evaluation and The Society of Thoracic Surgeons predictive algorithm.

Main Results:

  • Patients receiving prasugrel showed significantly higher mean 12-hour chest tube blood loss (655 ± 580 ml) compared to clopidogrel (503 ± 378 ml; p = 0.050).
  • No significant differences were observed in red blood cell transfusion or total donor exposure between the prasugrel and clopidogrel groups.
  • All-cause mortality was significantly reduced with prasugrel (2.31%) compared to clopidogrel (8.67%; adjusted odds ratio: 0.26; p = 0.025).

Conclusions:

  • Although prasugrel was associated with increased bleeding and re-exploration for bleeding, it demonstrated a lower rate of death post-CABG compared to clopidogrel.
  • These findings suggest that the survival benefit of prasugrel may outweigh the increased bleeding risk in select CABG patients.
Abstract

Related Concept Videos

Antiplatelet Drugs: Prostaglandin Synthesis, P2Y12 and Glycoprotein IIb/IIIa Inhibitors01:20

Antiplatelet Drugs: Prostaglandin Synthesis, P2Y12 and Glycoprotein IIb/IIIa Inhibitors

Antiplatelet drugs emerge as frontline defenders against the insidious threat of thromboembolic diseases, where abnormal clots obstruct vital blood vessels. These drugs stand as bulwarks, inhibiting platelet aggregation and clot formation, thereby mitigating the risk of life-threatening conditions like myocardial infarction, coronary artery disease, and thrombotic strokes.
Prostaglandin synthesis inhibitors, exemplified by the widely known aspirin, wield their power by irreversibly acetylating...
Acute Coronary Syndrome III: Diagnostic Studies01:30

Acute Coronary Syndrome III: Diagnostic Studies

Diagnosing acute coronary syndrome or ACS begins with a thorough patient history. Notable symptoms include central, crushing chest pain radiating to the left arm, neck, jaw, or back, along with shortness of breath, sweating (diaphoresis), nausea, vomiting, dizziness, and palpitations.It is crucial to note any history of cardiac illnesses and assess risk factors, including age, gender, smoking, hypertension, diabetes, hyperlipidemia, and a sedentary lifestyle.During physical examination, vital...