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Prasugrel and ticagrelor: is there a winner?
Nuccia Morici1, Paola Colombo, Antonio Mafrici
1aFirst Division of Cardiology bCoronary Care Unit, Dipartimento Cardio-toraco-vascolare 'A. De Gasperis', Azienda Ospedaliera Ospedale Niguarda Cà Granda, Milan cDivision of Cardiology, IRCCS Arcispedale S. Maria Nuova, Reggio Emilia, Italy.
Journal of Cardiovascular Medicine (Hagerstown, Md.)
|February 7, 2014
Summary
Newer antiplatelet drugs like prasugrel and ticagrelor show improved efficacy over clopidogrel, but careful consideration of bleeding risks and cost is essential for optimal patient care.
Area of Science:
- Pharmacology
- Cardiology
- Clinical Trials
Background:
- Clopidogrel, a prodrug, has variable antiplatelet effects due to CYP enzyme metabolism and genetic polymorphisms.
- Poor response to clopidogrel is linked to increased risks of coronary ischemic events and stent thrombosis.
Purpose of the Study:
- To critically appraise the current literature on antiplatelet agents.
- To outline the benefits and drawbacks of clopidogrel, prasugrel, and ticagrelor in relevant clinical scenarios.
Main Methods:
- Review of current literature and sub-analyses of randomized clinical trials.
- Critical appraisal of efficacy and safety data for antiplatelet agents.
Main Results:
- Prasugrel and ticagrelor demonstrated superiority over clopidogrel in reducing ischemic events, with increased bleeding.
- Subgroup analyses suggest tailored antiplatelet therapy, but these analyses may be prone to bias.
Conclusions:
- Weighing the efficacy and safety of antiplatelet agents presents a clinical challenge.
- Formulary decisions must balance clinical outcomes with economic constraints and generic clopidogrel availability.
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