Abstract
Objective: The aim of this study is to see and compare the effect of two combinations of dual antiplatelet therapy (aspirin plus clopidogrel with aspirin plus prasugrel) that includes event rates of stent thrombosis, re-infarction, revascularization and bleeding in patient of acute coronary syndrome undergoing PCI.
Method: 223 patients of ACS attending cardiology OPD and emergency department were enrolled. Subjects were recruited through emergency presenting with a primary diagnosis of Acute Coronary Syndrome, after obtaining clearance from ethical and research committee and written informed consent from the patients.
Results: Though our study supports the idea of increased incidence in bleeding with prasugrel then clopidogrel group. This has also been validated by various studies that were carried in this regard (15,16). In our study we didn’t find any evidence of re-stenosis, re-infarction, Re-vascularization and mortality at 1,3,6,12 month follow up in both groups.
Conclusion: Despite less number of patient in prasugrel group the number of major and minor bleeding events were higher as compared to clopidogrel group with more number of patients, it can’t be concluded with certainty that the complications can be high in prasugrel group. Although prasugrel a more potent antiplatelet drug as compared to clopidogrel ideally benefit should be more as per the previous studies but due to its cost, availability and lack of long term follow up clopidogrel can be still a preferred drug in these groups of patient.
References
1. White HD, Chew DP; Chew "Acute myocardial infarction. Lancet 372 (9638): 570–84.
2. O'Gara PT, Kushner FG, Ascheim DD, et al. "ACCF/AHA guideline for the management of ST-elevation myocardial infarction: a report of the American College of Cardiology Foundation/ American Heart Association Task Force on Practice Guidelines." Circulation 2013; 127 (4): 362–425.
3. Coventry LL, Finn J, Bremner AP. Sex differences in symptom presentation in acute myocardial infarction: a systematic review and meta-analysis. Heart & lung Journal of Critical Care 2011; 40: 477–91
4. "What Is a Heart Attack?". Nhlbi.nih.gov. National Heart, Lung, and Blood Institute (NHLBI) - NHLBI, NIH [Internet]. 2013 [cited 17 december 2013]. Available from: http://www.nhlbi.nih.gov.
5. Steg PG, James SK, Atar D. ESC Guidelines for the management of acute myocardial infarction in patients presenting with ST-segment elevation. European Heart Journal 2011; 33: 2569–619.
6. Valensi P, Lorgis L, Cottin Y. Prevalence, incidence, predictive factors and prognosis of silent myocardial infarction: a review of the literature. Arch Cardiovasc Dis 2011; 10:178–88.
7. Moran AE, Forouzanfar MH, Roth GA et al. "The global burden of ischemic heart disease in 1990 and 2010: the Global Burden of Disease 2010 study." . Circulation 2010; 129 (14): 1493–501.
8. Thygesen, K., Alpert, J. S., Jaffe, A. S., Simoons, M. L., Chaitman, B. R. And White, H. Det al. "Third Universal Definition Of Myocardial Infarction". Circulation 126.16 (2012): 2020-2035. Web. 23 Dec. 2015.
9. Mehta PK, Wei J, Wenger NK. Ischemic heart disease in women: A focus on risk factors. Trends in Cardiovascular Medicine 2014; 25 (2): 140–151.
10. "What Causes a Heart Attack?". Nhlbi.nih.gov. National Heart, Lung, and Blood Institute (NHLBI) - NHLBI, NIH [Internet]. 2013 [cited 17 december 2013]. Available from: http://www.nhlbi.nih.gov.
11. "How Is a Heart Attack Diagnosed?". Nhlbi.nih.gov. National Heart, Lung, and Blood Institute (NHLBI) - NHLBI, NIH [Internet]. 2015 [cited 17 december 2013]. Available from: http://www.nhlbi.nih.gov.
12. O'Connor, RE; Brady W; Brooks SC. Part 10: acute coronary syndromes: American Heart Association Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care. Circulation 2012;122: S787–817.
13. Hamm CW, Bassand JP, Agewall S. ESC Guidelines for the management of acute coronary syndromes in patients presenting without persistent ST-segment elevation: The Task Force for the management of acute coronary syndromes (ACS) in patients presenting without persistent ST-segment elevation of the European Society of Cardiology (ESC). Eur. Heart J. 2010 32 (23): 2999–3054.
14. McDaniel MC, Willis P, Walker B, et al. Plaque necrotic core content is greater immediately distal to bifurcations compared to bifurcations in the proximal lad of patients with CAD. Am J Cardiol. 2008; 102(8): 242i.
15. Wiviott SD, Trenk D, Frelinger AL. Prasugrel compared with high loading- and maintenance-dose clopidogrel in patients with planned percutaneous coronary intervention: the Prasugrel in Comparison to Clopidogrel for Inhibition of Platelet Activation and Aggregation-Thrombolysis in Myocardial Infarction trial. Circulation 2007;116:2923–32.
16. Wiviott SD, Braunwald E, McCabe CH. Prasugrel versus clopidogrel in patients with acute coronary syndromes. N Engl J Med 2007;357:2001–15.
DOI: http://dx.doi.org/10.18535/jmscr/v4i3.45
