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Prevalence of contraindications and conditions for precaution for prasugrel administration in a real world acute coronary syndrome population

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Abstract

The prevalence of prasugrel contraindications and specific conditions requiring precaution for its use in a real world acute coronary syndrome (ACS) population is not known. We performed a prospective descriptive study in 1016 consecutive moderate to high risk ACS patients. In 646 patients (63.6%) subjected to percutaneous coronary intervention, analysis of absolute contraindications (history of stroke/transient ischemic attack or active bleeding), relative contraindications and specific conditions (age ≥ 75 years and/or weight < 60 kg) for prasugrel theoretical administration was performed. In 242 (37.5%) patients there was at least one absolute or relative contraindication or specific condition requiring attention for its use. Overall, 23.1% of patients in our cohort had a prior stroke/transient ischemic attack and/or specific condition to be considered for prasugrel administration. Specifically, the prevalence of stroke/TIA was 3.6%, the prevalence of patients ≥75 years 20% and the prevalence of patients weighing <60 kg 2.2%. Among patients ≥75 years old, 63 (9.8%) had diabetes mellitus or previous myocardial infarction, consisting a high risk subgroup that might benefit from prasugrel administration. In a real world ACS population a relatively high proportion of patients have a potential contraindication for prasugrel administration or necessitate special attention for its use.

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References

  1. Brandt JT, Payne CD, Wiviott SD et al (2007) A comparison of prasugrel and clopidogrel loading doses on platelet function: magnitude of platelet inhibition is related to active metabolite formation. Am Heart J 153:66.e9–66.e16

    Article  Google Scholar 

  2. Jakubowski JA, Matsushima N, Asai F et al (2007) A multiple dose study of prasugrel (CS-747), a novel thienopyridine P2Y12 inhibitor, compared with clopidogrel in healthy humans. Br J Clin Pharmacol 63:421–430

    Article  PubMed  CAS  Google Scholar 

  3. Wallentin L, Varenhorst C, James S et al (2008) Prasugrel achieves greater and faster P2Y12 receptor-mediated platelet inhibition than clopidogrel due to more efficient generation of its active metabolite in aspirin-treated patients with coronary artery disease. Eur Heart J 29:21–30

    Article  PubMed  CAS  Google Scholar 

  4. Wiviott SD, Braunwald E, McCabe CH et al (2007) Prasugrel versus clopidogrel in patients with acute coronary syndromes. N Engl J Med 357:2001–2015

    Article  PubMed  CAS  Google Scholar 

  5. Prasugrel prescribing information. Center for drug evaluation and research. www.accessdata.fda.gov/drugsatfda_docs/label/2009/022307s000lbl.pdf. Access date 23/12/2010

  6. Kushner FG, Hand M, Smith SC Jr et al (2009) American College of Cardiology Foundation/American Heart Association task force on practice guidelines 2009 focused updates: ACC/AHA guidelines for the management of patients with ST-elevation myocardial infarction (updating the 2004 guideline and 2007 focused update) and ACC/AHA/SCAI guidelines on percutaneous coronary intervention (updating the 2005 guideline and 2007 focused update). A report of the American College of Cardiology Foundation/American Heart Association task force on practice guidelines circulation, vol 120, pp 2271–2306

  7. Bhatt DL (2009) Prasugrel in clinical practice. N Engl J Med 361:940–942

    Article  PubMed  CAS  Google Scholar 

  8. Antman EM, Cohen M, Bernink PJ et al (2000) The TIMI risk score for unstable angina/non-ST elevation MI: a method for prognostication and therapeutic decision making. JAMA 284:876–878

    Article  Google Scholar 

  9. Alexander KP, Chen AY, Roe MT et al (2005) Excess dosing of antiplatelet and antithrombin agents in the treatment of non-ST-segment elevation acute coronary syndromes. JAMA 294:3108–3116

    Article  PubMed  CAS  Google Scholar 

  10. Mahaffey KW, Harrington RA, Simoons ML et al (1999) Stroke in patients with acute coronary syndromes: incidence and outcomes in the platelet glycoprotein IIb/IIIa in unstable angina. Receptor suppression using integrilin therapy (PURSUIT) trial. Circulation 99:2371–2377

    PubMed  CAS  Google Scholar 

  11. Wiviott SD, Braunwald E, Angiolillo DJ et al (2008) Greater clinical benefit of more intensive oral antiplatelet therapy with prasugrel in patients with diabetes mellitus in the trial to assess improvement in therapeutic outcomes by optimizing platelet inhibition with prasugrel-thrombolysis in myocardial infarction 38. Circulation 118:1626–1636

    Article  PubMed  CAS  Google Scholar 

  12. Wrishko RE, Ernest CS II, Small DS et al (2009) Population pharmacokinetic analyses to evaluate the influence of intrinsic and extrinsic factors on exposure of prasugrel active metabolite in TRITON-TIMI 38. J Clin Pharmacol 49:984–998

    Article  PubMed  CAS  Google Scholar 

  13. Serebruany VL, Albert MJs, Hanley DF (2008) Prasugrel in the poststroke cohort of the TRITON trial. Clear Present Danger Cerebrovasc Dis 26:93–94

    Google Scholar 

  14. Wallentin L, Becker RC, Budaj A et al (2009) Ticagrelor versus clopidogrel in patients with acute coronary syndromes. N Engl J Med 361:1045–1057

    Article  PubMed  CAS  Google Scholar 

  15. Steg PG, James S, Harrington RA et al (2010) Ticagrelor versus clopidogrel in patients with ST-elevation acute coronary syndromes intended for reperfusion with primary percutaneous coronary intervention: a platelet inhibition and patient outcomes (PLATO) trial subgroup analysis. Circulation 122:2131–2141

    Article  PubMed  Google Scholar 

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Correspondence to Dimitrios Alexopoulos.

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Alexopoulos, D., Xanthopoulou, I., Mylona, P. et al. Prevalence of contraindications and conditions for precaution for prasugrel administration in a real world acute coronary syndrome population. J Thromb Thrombolysis 32, 328–333 (2011). https://doi.org/10.1007/s11239-011-0610-9

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  • DOI: https://doi.org/10.1007/s11239-011-0610-9

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