News Release

New drug treatment could reduce ischaemic outcomes in patients with coronary stents

Peer-Reviewed Publication

The Lancet_DELETED

Prasugrel, a new antiplatelet agent that provides higher levels of platelet inhibition than current standard therapies, could provide more consistent protection from ischemic events than standard treatment in patients who have had at least one coronary stent, according to an Article published Online and in an upcoming issue of The Lancet. The results of this trial are being presented at the American College of Cardiology Meeting on Saturday March 29.

Narrowing or blockages in the arteries that supply blood to the heart can result in acute coronary syndromes, such as heart attack, stroke, and unstable angina. Interventions such as balloon angioplasty and stents are used to treat the narrowing of these arteries. Although stent use has resulted in greater procedural success and lower rates of re-narrowing of the arteries than has balloon angioplasty alone, the use of coronary stents can result in blood clots which can block the stented artery, a condition known as stent thrombosis. Patients therefore need to take antiplatelet medications or anticoagulants after stent insertion to prevent blood clots from forming. Standard treatment is to use clopidogrel, one of a group of compounds known as thienopyridines that prevent platelet aggregation, together with aspirin.

The TRITON-TIMI* 38 study assessed the effect of prasugel, a new thienopyridine, compared with clopidogrel in patients with moderate to high risk acute coronary syndromes who were undergoing percutaneous coronary intervention. Stephen Wiviott (Brigham and Women’s Hospital and Harvard Medical School, Boston, USA), colleagues from the TIMI Study Group, and their international collaborators did a subanalysis of the TRITON-TIMI 38 data to assess the rate, outcomes, and prevention of ischaemic events in 12 844 patients with different types of intracoronary stents who were treated with prasugrel plus aspirin or clopidogrel plus aspirin. The investigators found that intensive antiplatelet therapy with prasugel resulted in fewer ischaemic outcomes, including stent thrombosis, than with standard clopidogrel, irrespective of the type of stent used.

The authors state that: “These data highlight the importance of aggressive antiplatelet therapy to reduce ischaemic events in patients with acute coronary syndromes undergoing percutaneous coronary intervention. When balancing risks and benefits of strategies to prevent ischaemic events, consideration should be given to patient characteristics including risk of bleeding and ischaemic events as well as stent and procedural characteristics”

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Correspondence to: Dr Stephen D Wiviott, TIMI Study Group, Cardiovascular Division, Brigham and Women’s Hospital, Boston, MA 02115, USA swiviott@partners.org

*TRITON-TIMI= Trial to Assess Improvement in Therapeutic Outcomes by Optimizing Platelet Inhibition with Prasugrel–Thrombolysis in Myocardial Infarction


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