Evaluation of prasugrel compared with clopidogrel in patients with acute coronary syndromes: design and rationale for the TRial to assess Improvement in Therapeutic Outcomes by optimizing platelet InhibitioN with prasugrel Thrombolysis In Myocardial Infarction 38 (TRITON-TIMI 38)

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

“…Inclusion and exclusion criteria for the main trial have previously been published in detail. 24 Briefly, subjects were eligible for enrollment if they had moderate-to high-risk unstable angina (UA/NSTEMI), after medical treatment for ST-segment elevation MI (STEMI) with coronary anatomy known to be suitable for PCI, or before cardiac catheterization with planned primary PCI for STEMI. Key exclusion criteria included increased risk of bleeding and any thienopyridine within 5 days before enrollment.…”

“…25,26 The key safety end point was noncoronary artery bypass grafting (CABG)-related TIMI major bleeding; secondary analysis was of non-CABG-related TIMI major or minor bleeding as previously defined. 24 Net clinical benefit was defined as the composite of all-cause mortality, nonfatal MI, nonfatal stroke, or nonfatal TIMI major bleeding not related to CABG. 18 Efficacy event rates are calculated from intention-to-treat analyses, and safety analyses are based on the safety cohort.…”

“…18,24 All components of the end points were adjudicated by a clinical events committee blinded to treatment assignment. The primary end point of TRITON-TIMI 38 and this analysis was the composite of cardiovascular death, nonfatal MI, or nonfatal stroke.…”

Cangrelor for the management and prevention of arterial thrombosis

“…Prasugrel has the advantage of more efficient and consistent active metabolite production compared to clopidogrel and therefore achieves higher mean levels of inhibition of platelet aggregation with less variability [24]. However, prasugrel also possesses the limitation of delayed recovery of platelet reactivity following cessation, which can lead to increased rates of major bleeding in patients managed with CABG surgery [25].…”

Impact of the New P2Y12 Receptor Inhibitors on Mortality in STElevation Myocardial Infarction Patients with Cardiogenic Shock and / or After Cardiopulmonary Resuscitation Undergoing Percutaneous Coronary Intervention

“…In STEMI patients, an initial delay in the onset of newer P2Y12 antiplatelet action was observed and ticagrelor did not appear superior to prasugrel [3]. However, patients with Cardiogenic Shock (CS) or after Cardio Pulmonary Resuscitation (CPR) were mostly excluded from randomized studies and data on the clinical efficacy of these drugs comparing to clopidogrel in these patients is sparse [11][12][13].CS has a profound effect on drug absorption and metabolism due to the disturbance of microcirculation, the use of catecholamines and opioids which results in slower platelet inhibition [13][14][15]. The pharmacological properties of the newer P2Y12 are promising in a CS setting since their bioactivation is more rapid and consistent when compared to clopidogrel [2,13].…”