Currently, dual antiplatelet
therapy with
aspirin and
clopidogrel represents the key treatment strategy for the prevention of ischemic events in patients with
acute coronary syndrome (ACS) and/or undergoing
percutaneous coronary intervention (PCI). However, there is a broad inter-individual response variability to such treatment strategy, and a considerable number of patients persist with inadequate platelet inhibition, which has been associated with an increased risk of ischemic events. Overall, these findings underscore the need for novel
antiplatelet agents able to achieve greater platelet inhibition; this can potentially reduce ischemic event rates.
Prasugrel (
CS-747;
LY 640315), a novel third-generation oral
thienopyridine, is a specific, irreversible antagonist of the platelet
adenosine diphosphate P2Y(12) receptor. Laboratory studies have shown
prasugrel to be associated with more prompt, potent and predictable degrees of platelet inhibition compared with
clopidogrel. In a large-scale clinical study, which was comprised of high-risk ACS patients undergoing PCI,
prasugrel was shown to significantly reduce the short- and long-term risk of ischemic events, including
stent thrombosis. However, such significant reduction in ischemic events occurred at the expense of a higher risk of
bleeding. Recent clinical trial data analyses have led to a better understanding of the efficacy and safety of
prasugrel. This article reviews the currently available data regarding the efficacy and safety of
prasugrel in ACS patients.