ST-segment elevation myocardial infarction (STEMI) patients who, at the time of coronary intervention need to be complemented by sustained and effective antiplatelet drugs. Prasugrel is a fast-acting potent thianthrene and pyridines antiplatelet drug, Clopidogrel is an alternative choice.
As with clopidogrel, Prasugrel is also an inactive precursor drugs needed by the cytochrome P450 enzyme metabolism to the active metabolite to irreversibly inhibit P2Y12 adenosine diphosphate receptor on platelets. Prasugrel is superior to Clopidogrel, although it may reduce the incidence of ischemic events, but will increase the incidence of hemorrhagic events.
Recently, the JACC:Cardiovascular published an article on the interventions in patients with ST-segment elevation myocardial infarction after percutaneous coronary interventional therapy, combined with Clopidogrel therapy, followed by Prasugrel study looked at safety. Switzerland Bern, Lorenz r BER University medical school, he led his team to the non-randomized observational studies.
In this study, researchers into between September 2009 and October 2012, participating in COMFORTABLE and SPUM-ACS two trials and received a loading dose of prasugrel and Clopidogrel therapy, or received treatment after using a loading dose of clopidogrel Prasugrel for the treatment of patients with STEMI. In 2023 in STEMI patients undergoing percutaneous coronary intervention, 427 (21.1%) first received a loading dose of clopidogrel therapy, and later received a loading dose of prasugrel, 447 (22.1%) only received a loading dose of prasugrel; the rest of the people only received Clopidogrel treatment. Primary safety endpoint of this study was 30 days in the hospital bleeding occurred in academic research consortium (BRAC) gives definitions of bleeding 3-5 standard.
The findings, in 30 days, received a loading dose of clopidogrel in the treatment of a loading dose of prasugrel-treated patients, the incidence of primary safety endpoint is 1.9% only accept doses in the Prasugrel group incidence of primary safety endpoint was 3.4%, there is no significant difference in the two groups.
Researchers of the two groups compared the HAS-BLED of bleeding score, found no significant differences between two sets of bleeding score, but only in patients treated with Prasugrel tends to be a greater risk of bleeding. When using the HAS-BLED scores after adjusting for a primary safety endpoint, researchers concluded that consistent with the earlier conclusion. Within 30 days of two groups of cardiac death, myocardial infarction, no significant difference in the overall risk of stroke.
Therefore, the authors come to the conclusion that: first use of clopidogrel and Prasugrel compared with Prasugrel alone does not cause increased bleeding events. Thus, use of gray horses first and then with Prasugrel patients still need to worry about this treatment? The answer may be no.