Intensity of Antiplatelet Therapy in Patients with Acute Coronary Syndromes and Percutaneous Coronary Intervention: the Promise of Prasugrel?

Platelet activation and aggregation play key roles in the management of ischemic complications of acute coronary syndromes and percutaneous coronary intervention. Dual antiplatelet therapy with aspirin and the thienopyridine clopidogrel has become the standard of care for prevention of such complications. Prasugrel, a novel thienopyridine antiplatelet agent, has been demonstrated to have favorable pharmacologic properties, including rapid onset and potent and consistent inhibition of platelet aggregation. When compared directly against clopidogrel in the Trial to Assess Improvement in Therapeutic Outcomes by Optimizing Platelet Inhibition with Prasugrel—Thrombolysis in Myocardial Infarction 38 (TRITON-TIMI 38), prasugrel resulted in significant reductions in ischemic events including myocardial infarction and stent thrombosis, but with more bleeding.