Pcv64 Index, Follow-Up and Total Hospitalization Costs in Patients With Acute Coronary Syndromes Undergoing Planned Percutaneous Coronary Intervention Treated With Prasugrel vs. Clopidogrel in the Triton-Timi 38 Trial

Mahoney, EM; Wang, K; Yan, Lei; Arnold, SV; McCollam, PL; Riesmeyer, Jeffrey S.; Plat, F.; Cohen, Dov

doi:10.1016/s1098-3015(10)66362-0

Cited by 1 publication

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“…Until then, careful patient selection and patient education about benefits and risks will minimize the risk of bleeding with dual antiplatelet therapy and maximize the outcomes. 73 …”

Section: Discussionmentioning

confidence: 99%

“…69 Both bleeding and thrombotic events have been shown to increase costs, 71,72 but the overall costs associated with managing recurrent ischemia are higher than the costs of managing bleeding, particularly hospitalization costs. 73 This was the finding in a prospective analysis of costs during follow-up in the Therapeutic Outcomes by Optimizing Platelet Inhibition with Prasugrel Thrombolysis in Myocardial Infarction (TRITON-TIMI) 38 trial, which compared prasugrel + aspirin with clopidogrel + aspirin in patients with ACS. 73 The lower overall cost of managing bleeding events could be attributed to the lower incidence of these events relative to ischemic events in clinical trials.…”

Section: Balancing Bleeding Versus Ischemic Riskmentioning

confidence: 97%

“…6). 73 Patient selection is the key to minimizing bleeding events after ACS. Clopidogrel should be used in patients aged $75 years and those with a history of stroke or TIA.…”

Section: Comparative Impact Of Clopidogrel and Prasugrel On Bleeding mentioning

confidence: 99%

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Preventing Serious Sequelae After an Acute Coronary Syndrome: The Consequences of Thrombosis Versus Bleeding With Antiplatelet Therapy

Islam

Patel²

2010

Journal of Cardiovascular Pharmacology

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Acute coronary syndrome (ACS) is associated with a persistent prothrombotic state, placing patients at high risk of subsequent ischemic events. Guidelines recommend the use of dual antiplatelet therapy with aspirin + a thienopyridine (clopidogrel) for at least a year after ACS in most patients, except those who undergo coronary artery bypass grafting. Clinical studies demonstrate that this strategy significantly reduces the risk of ischemic events at the expense of a small increase in the risk of bleeding. Physicians must balance the risk of bleeding against the benefit of ischemia prevention, bearing in mind that ischemic events are generally more common than major bleeding and often associated with more catastrophic consequences or ongoing morbidity. The relationship between bleeding and mortality is complicated by the fact that many risk factors for bleeding are also those for mortality and that bleeding may lead to discontinuation of antiplatelet therapy, thereby increasing the risk for an ischemic event. Data suggest that physicians tend to overestimate the risk of bleeding and underestimate the risk of ischemia. Careful patient selection and thorough patient education are the keys to managing antiplatelet therapy after ACS, especially as newer more potent antiplatelet agents, such as prasugrel, become available.

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“…Until then, careful patient selection and patient education about benefits and risks will minimize the risk of bleeding with dual antiplatelet therapy and maximize the outcomes. 73 …”

Section: Discussionmentioning

confidence: 99%