Frequency and Practice-Level Variation in Inappropriate and Nonrecommended Prasugrel Prescribing Insights From the NCDR PINNACLE Registry

Prasugrel significantly decreased cardiovascular death, myocardial infarction (MI), and stroke compared with clopidogrel in TRITON-TIMI 38 (Trial to Assess Improvement in Therapeutic Outcomes by Optimizing Platelet Inhibition with Prasugrel—Thrombolysis in Myocardial Infarction 38) (1). However, prasugrel use was associated with increased bleeding in patients with a history of previous stroke or transient ischemic attack (TIA) and was not associated with benefit in those ≥75 years of age. The prasugrel package insert (2) includes a black box warning for patients with previous stroke/TIA and also recommends against its use in patients aged ≥75 years due to an increased risk of fatal intracranial bleeding and uncertain benefit, except in high-risk situations (age ≥75 years with history of diabetes or a previous MI). The current American College of Cardiology Foundation/American Heart Association guidelines for patients with ST-segment elevation myocardial infarction and unstable angina/non–ST-segment elevation myocardial infarction (3,4) assign a Class I recommendation for prasugrel use at the time of percutaneous coronary intervention (PCI) and a Class III (harm) recommendation for its use in patients with history of TIA or stroke.
Source: Journal of the American College of Cardiology: Cardiovascular Interventions - Category: Cardiology Source Type: research