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Prasugrel in all ACS Patients! Giuseppe Biondi-Zoccai, MD Sapienza University of Rome, Italy giuseppe.biondizoccai@uniroma1.it
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First and foremost: both prasugrel and ticagrelor are lifesaving vs clopidogrel Biondi-Zoccai et al, Int J Cardiol 2011
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Prasugrel has an established and favorable risk-benefit profile Wiviott et al, New Engl J Med 2008
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Risk stratification is of course key Montalescot et al, Lancet 2009
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Short-term regimens are not enough Murphy et al, Eur Heart J 2008
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Dose adjustment is possible Erlinge et al, J Am Coll Cardiol 2012
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Loading with both clopidogrel and prasugrel is not prohibitive Loh et al, Am J Cardiol 2013
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Particularly risk-beneficial in diabetics Wiviott et al, Circulation 2008
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And even more so in IDDM Wiviott et al, Circulation 2008
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Non-CABG bleeding also ↑ by ticagrelor Wallentin et al, New Engl J Med 2009
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And are shortness of breath and bradyarrhythmias minor issues? Wallentin et al, New Engl J Med 2009
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Last but not least Are you afraid of increased neoplastic risk after assuming prasugrel? Do you know how long does it take to develop cancer after you are exposed to a nuclear bomb (e.g. Hiroshima)? Any purported association between prasugrel and cancer risk in TRITON-TIMI 38 patently lacks biologic plausibility
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Do you trust platelet responsiveness assays? Alexopoulos et al, J Am Coll Cardiol 2012
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I personally don’t Biondi-Zoccai et al, BMJ 2008 (but also Gurbel et al, JAMA 2012; Collet et al, NEJM 2012; Gaglia et al, Cardiovasc Revasc Med 2013; etc)
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Even if you believe… Alexopoulos et al, Circ Cardiovasc Interv 2012
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Adjusted indirect comparison Biondi-Zoccai et al, Int J Cardiol 2011
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Adjusted indirect comparison Biondi-Zoccai et al, Int J Cardiol 2011
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Adjusted indirect comparison Biondi-Zoccai et al, Int J Cardiol 2011
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Reconciling the evidence Biondi-Zoccai et al, Curr Vasc Pharmacol 2012
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Many thanks for your attention For these slides and further ones on similar topics feel free to visit: www.metcardio.org/slides.html For additional details or queries feel free to contact me directly: giuseppe.biondizoccai@uniroma1.it
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