While waiting for the results of PLATO study at the upcoming ESC Congress 2009 in Barcelona, an additional sub-analysis of TRITON TIMI 38 shows ischemic advantage of prasugrel over clopidogrel irrespective of the use of glycoprotein 2b/2a inhibitors.
Researchers in the TRITON–TIMI 38 randomized 13,608 subjects with acute coronary syndrome undergoing percutaneous coronary intervention to prasugrel versus clopidogrel. The use of a GP IIb/IIIa inhibitor was at the physician’s discretion.
A total of 7,414 subjects (54.5%) received a GP IIb/IIIa inhibitor during their index hospitalization. There was a consistent benefit of prasugrel over clopidogrel for reducing cardiovascular death, myocardial infarction, or stroke in patients who did (hazard ratio: 0.76; 95% confidence interval: 0.64 to 0.90) or did not receive a GP IIb/IIIa inhibitor (hazard ratio: 0.78; 95% confidence interval: 0.63 to 0.97, pinteraction = 0.83). Prasugrel significantly reduced myocardial infarction, urgent revascularization, and stent thrombosis irrespective of GP IIb/IIIa inhibitor use. Although subjects treated with a GP IIb/IIIa inhibitor had greater rates of bleeding, the risk of Thrombolysis in Myocardial Infarction major or minor bleeding with prasugrel versus clopidogrel was not significantly different in patients who were or were not treated with GP IIb/IIIa inhibitor (pinteraction = 0.19).
Efficacy Outcomes Through 30 Days’ Follow-Up Stratified by the Use of a GP IIb/IIIa Inhibitor During Index Hospitalization