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Balancing efficacy and safety of antiplatelet therapy in acute coronary syndrome

Antiplatelet therapy for PCI. 1Patrono C, et al. Eur Hear J 2004;25:166812Bertrand ME, et al. Circulation 2000;102:6249. Dual antiplatelet therapy (aspirin thienopyridine) is standard of care1,2. Clopidogrel. Used in patients that do not tolerate aspirin (CAPRIE)1Dual antiplatelet therapy indi

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Balancing efficacy and safety of antiplatelet therapy in acute coronary syndrome

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    1. Balancing efficacy and safety of antiplatelet therapy in acute coronary syndrome Steen D Kristensen, MD, DMSc, FESC Department of Cardiology Aarhus University Hospital Skejby, Denmark

    2. Antiplatelet therapy for PCI Dual antiplatelet therapy (aspirin + thienopyridine) is standard of care1,2

    3. Clopidogrel Used in patients that do not tolerate aspirin (CAPRIE)1 Dual antiplatelet therapy indicated for 1 year after ACS and/or PCI (CURE, PCI CURE, CREDO)25 Drug-eluting stents 6 to 12 months6 Bare-metal stents usually 1 month6

    4. Inhibition of platelet aggregation at 24 hours (healthy volunteers)

    5. Antiplatelet therapy for PCI Dual antiplatelet therapy (aspirin + thienopyridine) is standard of care1,2 Clinical need to improve on benefits observed with clopidogrel Prasugrel3,4 Novel thienopyridine Efficient generation of active metabolite High levels of IPA achieved rapidly High IPA in clopidogrel hyporesponders Encouraging Phase II data

    6. TRITON TIMI 38 study design

    7. Primary endpoint: CV death/non-fatal MI/ non-fatal stroke

    8. Balance of efficacy and safety

    9. Components of endpoints

    10. Stent analysis objective To compare the efficacy and safety of prasugrel and clopidogrel in 12,844 patients with at least one stent as part of the index procedure with respect to: stent thrombosis (ARC definitions) ischaemic events, bleeding overall and stratified by stent type received

    11. Definite/probable stent thrombosis: any stent (n=12,844)

    12. Definite/probable stent thrombosis: any stent (n=12,844)

    13. Definite/probable stent thrombosis: drug-eluting stent only (n=5,743)

    14. Definite/probable stent thrombosis: bare-metal stent only (n=6,461)

    15. Stent analysis: conclusions and implications Stent thrombosis is a rare, but devastating complication of PCI associated with a high mortality Efforts to reduce stent thrombosis have focused on compliance with and duration of aspirin/clopidogrel These data indicate that an agent with more rapid, consistent, and greater inhibition of platelet aggregation (prasugrel) results in major reductions in stent thrombosis regardless of stent type, both early and late, and across a broad array of clinical and procedural characteristics

    16. Conclusions from TRITON TIMI 38: higher IPA to support PCI

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