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A Japanese Dose of Prasugrel versus a Standard Dose of Clopidogrel in Patients with Acute Myocardial Infarction from the K-ACTIVE Registry

Background: Dual antiplatelet therapy (DAPT) with aspirin plus P2Y12 inhibitor is used as a standard therapy for patients with acute myocardial infarction (AMI) treated with drug-eluting stents (DESs). In Japan, clopidogrel was the major P2Y12 inhibitor used for a decade until the new P2Y12 inhibito...

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Autores principales: Mori, Hiroyoshi, Mizukami, Takuya, Maeda, Atsuo, Fukui, Kazuki, Akashi, Yoshihiro, Ako, Junya, Ikari, Yuji, Ebina, Toshiaki, Tamura, Kouichi, Namiki, Atsuo, Michishita, Ichiro, Kimura, Kazuo, Suzuki, Hiroshi
Formato: Online Artículo Texto
Lenguaje:English
Publicado: MDPI 2022
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8999969/
https://www.ncbi.nlm.nih.gov/pubmed/35407624
http://dx.doi.org/10.3390/jcm11072016
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author Mori, Hiroyoshi
Mizukami, Takuya
Maeda, Atsuo
Fukui, Kazuki
Akashi, Yoshihiro
Ako, Junya
Ikari, Yuji
Ebina, Toshiaki
Tamura, Kouichi
Namiki, Atsuo
Michishita, Ichiro
Kimura, Kazuo
Suzuki, Hiroshi
author_facet Mori, Hiroyoshi
Mizukami, Takuya
Maeda, Atsuo
Fukui, Kazuki
Akashi, Yoshihiro
Ako, Junya
Ikari, Yuji
Ebina, Toshiaki
Tamura, Kouichi
Namiki, Atsuo
Michishita, Ichiro
Kimura, Kazuo
Suzuki, Hiroshi
author_sort Mori, Hiroyoshi
collection PubMed
description Background: Dual antiplatelet therapy (DAPT) with aspirin plus P2Y12 inhibitor is used as a standard therapy for patients with acute myocardial infarction (AMI) treated with drug-eluting stents (DESs). In Japan, clopidogrel was the major P2Y12 inhibitor used for a decade until the new P2Y12 inhibitor, prasugrel, was introduced. Based on clinical studies considering Japanese features, the set dose for prasugrel was reduced to 20 mg as a loading dose (LD) and 3.75 mg as a maintenance dose (MD); these values are 60 and 10 mg, respectively, globally. Despite this dose discrepancy, little real-world clinical data regarding its efficacy and safety exist. Methods: From the K-ACTIVE registry, based on the DAPT regimen, patients were divided into a prasugrel group and a clopidogrel group. The ischemic event was a composite of cardiovascular death, non-fatal MI, and non-fatal stroke. The bleeding event was type 3 or 5 bleeding based on the Bleeding Academic Research Consortium (BARC) criteria. Results: Substantially more patients were prescribed prasugrel (n = 2786) than clopidogrel (n = 890). Clopidogrel tended to be selected over prasugrel in older patients with numerous comorbidities. Before adjustments were made, the cumulative incidence of ischemic events at 1 year was significantly greater in the clopidogrel group than in the prasugrel group (p = 0.007), while the cumulative incidence of bleeding events at 1 year was comparable between the groups (p = 0.131). After adjustments were made for the age, sex, body weight, creatine level, type of AMI, history of MI, approach site, oral anticoagulation therapy, presence of multivessel disease, Killip classification, and presence of intra-aortic balloon pumping, both ischemic and bleeding events became comparable between the groups. Conclusion: A Japanese dose of prasugrel was commonly used in AMI patients in the real-world database. Both the prasugrel and clopidogrel groups showed comparable rates of 1 year ischemic and bleeding events.
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spelling pubmed-89999692022-04-12 A Japanese Dose of Prasugrel versus a Standard Dose of Clopidogrel in Patients with Acute Myocardial Infarction from the K-ACTIVE Registry Mori, Hiroyoshi Mizukami, Takuya Maeda, Atsuo Fukui, Kazuki Akashi, Yoshihiro Ako, Junya Ikari, Yuji Ebina, Toshiaki Tamura, Kouichi Namiki, Atsuo Michishita, Ichiro Kimura, Kazuo Suzuki, Hiroshi J Clin Med Article Background: Dual antiplatelet therapy (DAPT) with aspirin plus P2Y12 inhibitor is used as a standard therapy for patients with acute myocardial infarction (AMI) treated with drug-eluting stents (DESs). In Japan, clopidogrel was the major P2Y12 inhibitor used for a decade until the new P2Y12 inhibitor, prasugrel, was introduced. Based on clinical studies considering Japanese features, the set dose for prasugrel was reduced to 20 mg as a loading dose (LD) and 3.75 mg as a maintenance dose (MD); these values are 60 and 10 mg, respectively, globally. Despite this dose discrepancy, little real-world clinical data regarding its efficacy and safety exist. Methods: From the K-ACTIVE registry, based on the DAPT regimen, patients were divided into a prasugrel group and a clopidogrel group. The ischemic event was a composite of cardiovascular death, non-fatal MI, and non-fatal stroke. The bleeding event was type 3 or 5 bleeding based on the Bleeding Academic Research Consortium (BARC) criteria. Results: Substantially more patients were prescribed prasugrel (n = 2786) than clopidogrel (n = 890). Clopidogrel tended to be selected over prasugrel in older patients with numerous comorbidities. Before adjustments were made, the cumulative incidence of ischemic events at 1 year was significantly greater in the clopidogrel group than in the prasugrel group (p = 0.007), while the cumulative incidence of bleeding events at 1 year was comparable between the groups (p = 0.131). After adjustments were made for the age, sex, body weight, creatine level, type of AMI, history of MI, approach site, oral anticoagulation therapy, presence of multivessel disease, Killip classification, and presence of intra-aortic balloon pumping, both ischemic and bleeding events became comparable between the groups. Conclusion: A Japanese dose of prasugrel was commonly used in AMI patients in the real-world database. Both the prasugrel and clopidogrel groups showed comparable rates of 1 year ischemic and bleeding events. MDPI 2022-04-04 /pmc/articles/PMC8999969/ /pubmed/35407624 http://dx.doi.org/10.3390/jcm11072016 Text en © 2022 by the authors. https://creativecommons.org/licenses/by/4.0/Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license (https://creativecommons.org/licenses/by/4.0/).
spellingShingle Article
Mori, Hiroyoshi
Mizukami, Takuya
Maeda, Atsuo
Fukui, Kazuki
Akashi, Yoshihiro
Ako, Junya
Ikari, Yuji
Ebina, Toshiaki
Tamura, Kouichi
Namiki, Atsuo
Michishita, Ichiro
Kimura, Kazuo
Suzuki, Hiroshi
A Japanese Dose of Prasugrel versus a Standard Dose of Clopidogrel in Patients with Acute Myocardial Infarction from the K-ACTIVE Registry
title A Japanese Dose of Prasugrel versus a Standard Dose of Clopidogrel in Patients with Acute Myocardial Infarction from the K-ACTIVE Registry
title_full A Japanese Dose of Prasugrel versus a Standard Dose of Clopidogrel in Patients with Acute Myocardial Infarction from the K-ACTIVE Registry
title_fullStr A Japanese Dose of Prasugrel versus a Standard Dose of Clopidogrel in Patients with Acute Myocardial Infarction from the K-ACTIVE Registry
title_full_unstemmed A Japanese Dose of Prasugrel versus a Standard Dose of Clopidogrel in Patients with Acute Myocardial Infarction from the K-ACTIVE Registry
title_short A Japanese Dose of Prasugrel versus a Standard Dose of Clopidogrel in Patients with Acute Myocardial Infarction from the K-ACTIVE Registry
title_sort japanese dose of prasugrel versus a standard dose of clopidogrel in patients with acute myocardial infarction from the k-active registry
topic Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8999969/
https://www.ncbi.nlm.nih.gov/pubmed/35407624
http://dx.doi.org/10.3390/jcm11072016
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