Comparison of lower loading dose of prasugrel with conventional loading dose of prasugrel in Indian patients undergoing percutaneous coronary interventions

BACKGROUND: Although conventional 60 mg of prasugrel allows for rapid and potent platelet inhibition within 30 min after loading dose, the efficacy and safety of lower doses of prasugrel in Indian patients has not yet been investigated. OBJECTIVE: The study sought to compare the efficacy of a lower loading dose of prasugrel with conventional loading dose of prasugrel in Indian patients. MATERIAL AND METHODS: Three hundred thirty-two Indian patients undergoing elective percutaneous coronary intervention (PCI) were enrolled in the study. Participants were randomly administered loading doses of prasugrel 60 mg (group A, n = 166) or 30 mg (group B, n = 166) before undergoing elective PCI in a 1:1 manner. Primary efficacy end point was composite of in-hospital death and stent thrombosis at 96 h, while safety end point was in-hospital bleeding. RESULTS: The two groups did not differ in their baseline characteristics. The primary efficacy end point was 0.6% in both the conventional 60 mg loading dose (LD) and lower 30 mg LD groups (p = not significant). Minor bleeding was significantly less in group B [Bleeding Academic Research Consortium 1, A = 6.63% vs B = 1.81%, odds ratio (OR) = 3.86, 95% confidence interval (CI) = 1.06–14.08, P = 0.05]. Major bleeding was higher in group A (A = 3.61%, vs B = 1.81%, OR = 2.04, 95% CI = 0.50–8.29, P = 0.50). CONCLUSION: In Indian patients, 30 mg of prasugrel loading is as effective as 60 mg of prasugrel with significantly less minor bleeding.