Short-term Safety and Mid-term Efficacy of Prasugrel Versus Clopidogrel in Patients Undergoing Percutaneous Coronary Intervention
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- Koyabu Yota
- Department of Cardiovascular Medicine, Dokkyo Medical University, Japan
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- Abe Shichiro
- Department of Cardiovascular Medicine, Dokkyo Medical University, Japan
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- Sakuma Masashi
- Department of Cardiovascular Medicine, Dokkyo Medical University, Japan
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- Kanaya Tomoaki
- Department of Cardiovascular Medicine, Dokkyo Medical University, Japan
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- Obi Syotaro
- Department of Cardiovascular Medicine, Dokkyo Medical University, Japan
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- Yoneda Shuichi
- Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center, Japan
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- Toyoda Shigeru
- Department of Cardiovascular Medicine, Dokkyo Medical University, Japan
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- Nakajima Toshiaki
- Department of Cardiovascular Medicine, Dokkyo Medical University, Japan
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- Inoue Teruo
- Department of Cardiovascular Medicine, Dokkyo Medical University, Japan
Abstract
<p>Objective Although several clinical trials have shown that the mid- and long-term safety and efficacy of prasugrel are better than those of clopidogrel after percutaneous coronary intervention (PCI), there are few data regarding the short-term safety. </p><p>Methods In this study, we retrospectively analyzed the short-term (72 hours) PCI-related bleeding complications and mid-term (12 months) efficacy in 250 consecutive coronary artery disease patients who underwent PCI and received aspirin plus prasugrel (prasugrel group; 67.7±10.0 years, 200 men). </p><p>Patients The comparison group consisted of 250 age- and gender-matched patients who received aspirin plus clopidogrel (clopidogrel group: 67.2±11.2 years, 199 men). </p><p>Results The incidence of a composite of PCI-related bleeding complications in the acute phase post-PCI was significantly higher in the prasugrel group than in the clopidogrel group (22.4% vs. 13.2%, p=0.007), although the incidence of non-PCI-related bleeding complications over 12 months was comparable between the 2 groups. The cumulative incidence of major cardiovascular events (MACEs) was comparable between the prasugrel and clopidogrel groups (log-rank test; p=0.561). A multivariate logistic regression analysis of the 250 prasugrel-treated patients showed that acute coronary syndrome tended to be negatively associated with the incidence of PCI-related bleeding complications (p=0.061). </p><p>Conclusion Prasugrel and clopidogrel may have similar efficacy for preventing cardiovascular events as the post-PCI antiplatelet regimen; however, prasugrel should be used cautiously because of the risk of PCI-related bleeding complications. </p>
Journal
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- Internal Medicine
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Internal Medicine 58 (16), 2315-2322, 2019-08-15
The Japanese Society of Internal Medicine