New Trials May Cut Clopidogrel Use

By Gebhart, Fred | Drug Topics, December 10, 2007 | Go to article overview

New Trials May Cut Clopidogrel Use


Gebhart, Fred, Drug Topics


Atrio of late-breaking clinical trials could change standard drug treatment for patients undergoing percutaneous coronary intervention, or PCI. Dual antiplatelet therapy, aspirin plus a thienopyridine, is standard to prevent dirombotic complications in patients with acute coronary syndrome (ACS) and those undergoing PCI.

A phase III trial, TRITON-TIMI 38, could open the door for a new diienopyridine agent-prasugrel (Daiichi Sankyo/Lilly)-to compete with clopidogrel (Plavix, sanofiaventis/Bristol-Meyers Squibb) to reduce complications in patients who have undergone PCI. And two trials support institutions that are replacing abciximab (ReoPro, Centocor/Lilly) with eptifibatide (Integrilin, Schering-Plough) to maintain coronary perfusion following PCI. The three trials were discussed at the American Heart Association's annual Scientific Sessions in Orlando, Fla., last month.

Head-to-head

A head-to-head trial of prasugrel and clopidogrel concluded that prasugrel is more potent, works more quickly, and has more consistent antiplatelet activity. "There was an early and sustained benefit from prasugrel mat started with the loading dose [LD]," said Elliott Antman, M.D., professor of medicine at Harvard Medical School. "The benefits the higher degree of inhibition of platelet aggregation achieved with prasugrel in TRITON-TIMI 38 represent the latest advance in antiplatelet therapy."

The international trial enrolled 13,608 patients at 707 sites, Antman said. All of the patients had moderate- to high-risk ACS and were scheduled to undergo PCI. Patients were randomized to receive either prasugrel (60 mg LD plus 10 mg daily maintenance) or clopidogrel (300 mg LD plus 75 mg daily maintenance) following PCI. Treatment continued for up to 15 months after PCI.

Prasugrel significandy reduced myocardial infarction (MI), urgent target vessel revascularization, and stent thrombosis compared with clopidogrel, Antman reported. The downside of the new drug is increased bleeding. The risk of major bleeding was concentrated in patients with prior stroke or transient ischemic attack (TLA) and the frail elderly (over 75, weighing <60 kg), he added. "This is an approvable drug. But I would not give it to a patient with a prior stroke or TLA. Fully 80% of the individuals in this trial had a net clinical benefit from prasugrel. …

The rest of this article is only available to active members of Questia

Already a member? Log in now.

Notes for this article

Add a new note
If you are trying to select text to create highlights or citations, remember that you must now click or tap on the first word, and then click or tap on the last word.
One moment ...
Default project is now your active project.
Project items
Notes
Cite this article

Cited article

Style
Citations are available only to our active members.
Buy instant access to cite pages or passages in MLA 8, MLA 7, APA and Chicago citation styles.

(Einhorn, 1992, p. 25)

(Einhorn 25)

(Einhorn 25)

1. Lois J. Einhorn, Abraham Lincoln, the Orator: Penetrating the Lincoln Legend (Westport, CT: Greenwood Press, 1992), 25, http://www.questia.com/read/27419298.

Note: primary sources have slightly different requirements for citation. Please see these guidelines for more information.

Cited article

New Trials May Cut Clopidogrel Use
Settings

Settings

Typeface
Text size Smaller Larger Reset View mode
Search within

Search within this article

Look up

Look up a word

  • Dictionary
  • Thesaurus
Please submit a word or phrase above.
Print this page

Print this page

Why can't I print more than one page at a time?

Help
Full screen
Items saved from this article
  • Highlights & Notes
  • Citations
Some of your highlights are legacy items.

Highlights saved before July 30, 2012 will not be displayed on their respective source pages.

You can easily re-create the highlights by opening the book page or article, selecting the text, and clicking “Highlight.”

matching results for page

    Questia reader help

    How to highlight and cite specific passages

    1. Click or tap the first word you want to select.
    2. Click or tap the last word you want to select, and you’ll see everything in between get selected.
    3. You’ll then get a menu of options like creating a highlight or a citation from that passage of text.

    OK, got it!

    Cited passage

    Style
    Citations are available only to our active members.
    Buy instant access to cite pages or passages in MLA 8, MLA 7, APA and Chicago citation styles.

    "Portraying himself as an honest, ordinary person helped Lincoln identify with his audiences." (Einhorn, 1992, p. 25).

    "Portraying himself as an honest, ordinary person helped Lincoln identify with his audiences." (Einhorn 25)

    "Portraying himself as an honest, ordinary person helped Lincoln identify with his audiences." (Einhorn 25)

    "Portraying himself as an honest, ordinary person helped Lincoln identify with his audiences."1

    1. Lois J. Einhorn, Abraham Lincoln, the Orator: Penetrating the Lincoln Legend (Westport, CT: Greenwood Press, 1992), 25, http://www.questia.com/read/27419298.

    Cited passage

    Thanks for trying Questia!

    Please continue trying out our research tools, but please note, full functionality is available only to our active members.

    Your work will be lost once you leave this Web page.

    Buy instant access to save your work.

    Already a member? Log in now.

    Search by... Author
    Show... All Results Primary Sources Peer-reviewed

    Oops!

    An unknown error has occurred. Please click the button below to reload the page. If the problem persists, please try again in a little while.