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Publication Details
AFRICAN RESEARCH NEXUS
SHINING A SPOTLIGHT ON AFRICAN RESEARCH
medicine
Prasugrel versus clopidogrel for acute coronary syndromes without revascularization
New England Journal of Medicine, Volume 367, No. 14, Year 2012
Notification
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Description
BACKGROUND: The effect of intensified platelet inhibition for patients with unstable angina or myocardial infarction without ST-segment elevation who do not undergo revascularization has not been delineated. METHODS: In this double-blind, randomized trial, in a primary analysis involving 7243 patients under the age of 75 years receiving aspirin, we evaluated up to 30 months of treatment with prasugrel (10 mg daily) versus clopidogrel (75 mg daily). In a secondary analysis involving 2083 patients 75 years of age or older, we evaluated 5 mg of prasugrel versus 75 mg of clopidogrel. RESULTS: At a median follow-up of 17 months, the primary end point of death from cardiovascular causes, myocardial infarction, or stroke among patients under the age of 75 years occurred in 13.9% of the prasugrel group and 16.0% of the clopidogrel group (hazard ratio in the prasugrel group, 0.91; 95% confidence interval [CI], 0.79 to 1.05; P = 0.21). Similar results were observed in the overall population. The prespecified analysis of multiple recurrent ischemic events (all components of the primary end point) suggested a lower risk for prasugrel among patients under the age of 75 years (hazard ratio, 0.85; 95% CI, 0.72 to 1.00; P = 0.04). Rates of severe and intracranial bleeding were similar in the two groups in all age groups. There was no significant between-group difference in the frequency of nonhemorrhagic serious adverse events, except for a higher frequency of heart failure in the clopidogrel group. CONCLUSIONS: Among patients with unstable angina or myocardial infarction without ST-segment elevation, prasugrel did not significantly reduce the frequency of the primary end point, as compared with clopidogrel, and similar risks of bleeding were observed. (Funded by Eli Lilly and Daiichi Sankyo; TRILOGY ACS ClinicalTrials.gov number, NCT00699998.) Copyright © 2012 Massachusetts Medical Society.
Authors & Co-Authors
Roe, Matthew T.
United States, Durham
Duke Clinical Research Institute
United States, Durham
Duke University Medical Center
Armstrong, Paul W.
Canada, Edmonton
University of Alberta
Fox, Keith A.A.
United Kingdom, Edinburgh
Edinburgh Medical School
White, Harvey D.
New Zealand, Auckland
Auckland City Hospital
Prabhakaran, Dorairaj
India, New Delhi
Center for Chronic Disease Control
Goodman, Shaun G.
Canada, Toronto
Saint Michael's Hospital University of Toronto
Cornel, Jan Hein
Netherlands, Alkmaar
Alkmaar Medical Centre
Bhatt, Deepak L.
United States, Boston
Harvard Medical School
Clemmensen, Peter Michael
Denmark, Copenhagen
Københavns Universitet
Martínez, Felipe A.
Argentina, Cordoba
Universidad Nacional de Córdoba
Ardissino, Diego
Italy, Parma
Azienda Ospedaliero-universitaria Di Parma
Nicolau, José Carlos
Brazil, Sao Paulo
Universidade de São Paulo
Boden, William E.
United States, Albany
Albany Medical College
Gurbel, Paul Alfred
United States, Baltimore
Sinai Center for Thrombosis Research
Ruźyłło, Witold
Poland, Warsaw
Instytut Kardiologii Im. Prymasa Tysiaclecia Stefana Kardynała Wyszynskiego
Dalby, Anthony John
South Africa, Johannesburg
Milpark Hospital
McGuire, Darren K.
United States, Dallas
Ut Southwestern Medical Center
Leiva-Pons, José Luís
Mexico, San Luis Potosi
Central Hospital Dr. Ignacio Morones Prieto
Parkhomenko, Alexander N.
Ukraine, Kyiv
National Scientific Center M.d. Strazhesko Institute of Cardiology
Gottlieb, Shmuel L.
Israel, Jerusalem
Bikur Cholim Hospital
Topacio, Gracita O.
Philippines, Manila
Medical Center Manila
Hamm, Chrisitian Wilhelm
Germany, Bad Nauheim
Kerckhoff-klinik Gmbh
Pavlides, Gregory
Greece, Athens
Onassis Cardiac Surgery Centre
Goudev, Assen Rachev
Bulgaria, Sofia
University Hospital Alexandrovska
Oto, Ali
Turkey, Ankara
Hacettepe Üniversitesi
Tseng, Chuen Den
Taiwan, Taipei
National Taiwan University College of Medicine
Merkely, Béla D.Signla
Hungary, Budapest
Semmelweis Egyetem
Gasparovic, Vladimir
Croatia, Zagreb
Kbc Zagreb
Corbalàn, Ramõn L.
Chile, Santiago
Pontificia Universidad Católica de Chile
Cintezǎ, Mircea A.
Romania, Bucharest
Universitatea de Medicina si Farmacie Carol Davila Din Bucuresti
McLendon, R. Craig
United States, Durham
Duke Clinical Research Institute
Winters, Kenneth J.
United States, Indianapolis
Eli Lilly and Company
Brown, Eileen B.
United States, Indianapolis
Eli Lilly and Company
Lokhnygina, Yuliya
United States, Durham
Duke Clinical Research Institute
Aylward, Philip E.G.
Australia, Adelaide
Flinders University
Huber, Kurt H.
Austria, Vienna
Wiener Krankenanstaltenverbund
Hochman, Judith S.
United States, New York
Nyu Grossman School of Medicine
Öhman, Erik Magnus
United States, Durham
Duke Clinical Research Institute
United States, Durham
Duke University Medical Center
Statistics
Citations: 459
Authors: 38
Affiliations: 35
Identifiers
Doi:
10.1056/NEJMoa1205512
ISSN:
00284793
e-ISSN:
15334406
Research Areas
Disability
Environmental
Noncommunicable Diseases
Study Design
Cross Sectional Study
Cohort Study