Journal Article

Comparison of short-term clinical outcomes between low-dose prasugrel and clopidogrel as part of triple antithrombotic therapy in patients requiring oral anticoagulant therapy and percutaneous coronary intervention

Yusuke Inaba, Yoshio Kobayashi, Yuki Shiko, Takahiro Inoue, Hideki Kitahara, Kazuya Tateishi

2022

Overview

Triple antithrombotic therapy, including dual antiplatelet therapy and oral anticoagulant (OAC), is recommended for a short-term period after percutaneous coronary intervention (PCI) in patients requiring anticoagulation therapy. The purpose of this study was to compare in-hospital clinical outcomes between low-dose prasugrel (3.75 mg/day) and clopidogrel, as part of triple antithrombotic therapy, using a large database in Japan. Overall, 5,777 patients were eligible in this analysis. The patients were divided into 4 subgroups according to the type of P2Y12 inhibitor and OAC: clopidogrel/DOAC (n = 1,628), clopidogrel/VKA (n = 1,334), prasugrel/DOAC (n = 1,607), and prasugrel/VKA (n = 1,208). There was no significant difference in the incidence of death and gastrointestinal bleeding among the 4 subgroups. The prasugrel/DOAC group had significantly lower incidence of MI (OR 0.566, 95% CI 0.348-0.921). The incidence of ischemic stroke was significantly lower in the prasugrel/DOAC group (OR 0.701, 95% CI 0.502-0.979), and significantly higher in the clopidogrel/VKA group (OR 1.680, 95% CI 1.273-2.216). Need for blood transfusion was less frequent in the prasugrel/DOAC group (OR 0.729, 95% CI 0.598-0.890), and more frequent in both the clopidogrel/VKA group (OR 1.424, 95% CI 1.187-1.708) and the prasugrel/VKA group (OR 1.633, 95% CI 1.367-1.950). Combination of low-dose prasugrel and DOAC was associated with lower incidence of MI, ischemic stroke, and blood transfusion. Low-dose prasugrel may be feasible as part of triple therapy in patients undergoing PCI.

• Publisher: Public Library of Science (PLoS),Public Library of Science
• Subject: Age / Aggregation / Angina pectoris / Angioplasty / Anti-inflammatory agents / Anticoagulants / Anticoagulants (Medicine) / Antiplatelet therapy / Aspirin / Bleeding / Blood / Blood platelets / Blood transfusion / Blood transfusions / Body mass index / Cardiovascular agents / Cardiovascular disease / Cardiovascular diseases / Care and treatment / Cerebral infarction / Clinical outcomes / Clopidogrel / Coronary artery disease / Diabetes / Diagnosis / Dosage and administration / Drug dosages / Drug Therapy, Combination / Fibrinolytic Agents / Gastrointestinal Hemorrhage / Heart attacks / Heart diseases / Hospitalization / Humans / Hypertension / Inhibitors / Ischemia / Ischemic Stroke / Medicine / Medicine and Health Sciences / Myocardial infarction / Patient outcomes / Patients / Percutaneous Coronary Intervention / Platelet Aggregation Inhibitors / Prasugrel Hydrochloride / Prevention / Q / R / Research Article / Risk factors / Science / Statistical analysis / Steroids / Stroke / Stroke (Disease) / Subgroups / Therapy / Transfusion / Transluminal angioplasty / Treatment Outcome / Variance analysis / Vitamin K