Praktické lekárnictvo 1/2011

Prasugrel – a novel antiplatelet agent

Dual antiplatelet therapy with acetylsalicylic acid (ASA) and clopidogrel is the mainstay of treatment in patients with acute coronary syndrome (ACS) and following percutaneous coronary intervention (PCI). Despite the proven protective effect of this treatment, a significant proportion of patients remain unprotected by medication because neither ASA nor clopidogrel (Plavix, and others) are effective in all patients. Prasugrel (EFIENT) as another advancement in the group of thienopyridine antiplatelet agents represents a shift towards improved treatment in terms of a more reliable effect. The paper explains that this is mainly due to the more substantial and standard conversion of prasugrel to an active metabolite, which is not always the case for clopidogrel. The enzymatic cytochrome oxidase system converting parental clopidogrel to an active metabolite is subject to genetic polymorphism and this is very likely the reason why up to one third of patients are unaffected by clopidogrel. The clinical use of prasugrel is based on the data obtained in the TRITON-TIMI 38 trial. It showed a significantly higher protective effect of prasugrel in terms of a reduced rate of ischaemic coronary and cerebrovascular events compared to clopidogrel within 15 months of the date of PCI. In addition to the improved protective effect, however, a somewhat increased risk of bleeding was observed. Prasugrel is a clear advance in antiplatelet therapy options.

Keywords: prasugrel, clopidogrel, antiplatelet therapy, acute coronary syndrome.