Reduction in Recurrent Cardiovascular Events with Prasugrel Compared with Clopidogrel in Patients with Acute Coronary Syndromes from the TRITON-TIMI 38 Trial

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Reduction in Recurrent Cardiovascular Events with Prasugrel Compared with Clopidogrel in Patients with Acute Coronary Syndromes from the TRITON-TIMI 38 Trial

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dc.contributor.author Murphy, Sabina A.
dc.contributor.author Weerakkody, Govinda
dc.contributor.author Morocutti, Giorgio
dc.contributor.author Huber, Kurt
dc.contributor.author Lopez-Sendon, Jose
dc.contributor.author Antman, Elliott Marshall
dc.contributor.author Wiviott, Stephen Daniel
dc.contributor.author McCabe, Carolyn Hoss
dc.contributor.author Braunwald, Eugene
dc.date.accessioned 2011-02-07T17:04:06Z
dc.date.issued 2008
dc.identifier.citation Murphy, Sabina A., Elliott M. Antman, Stephen D. Wiviott, Govinda Weerakkody, Giorgio Morocutti, Kurt Huber, Jose Lopez-Sendon, Carolyn H. McCabe, and Eugene Braunwald. 2008. Reduction in recurrent cardiovascular events with prasugrel compared with clopidogrel in patients with acute coronary syndromes from the TRITON-TIMI 38 trial. European Heart Journal 29(20): 2473-2479. en_US
dc.identifier.issn 0195-668X en_US
dc.identifier.issn 1522-9645 en_US
dc.identifier.uri http://nrs.harvard.edu/urn-3:HUL.InstRepos:4706326
dc.description.abstract Aims: In the TRITON-TIMI 38 trial, greater platelet inhibition with prasugrel reduced the first occurrence of the primary endpoint (cardiovascular death, MI, or stroke) compared with clopidogrel in patients with an acute coronary syndrome (ACS) undergoing planned percutaneous coronary intervention. We hypothesized that prasugrel would reduce not only first events but also recurrent primary endpoint events and therefore total events compared with clopidogrel. Methods and results: Poisson regression analysis was performed to compare the number of occurrences of the primary endpoint between prasugrel and clopidogrel in TRITON-TIMI 38. Landmark analytic methods were used to evaluate the risk of a recurrent primary endpoint event following an initial non-fatal endpoint event. Among patients with an initial non-fatal event, second events were significantly reduced with prasugrel compared to clopidogrel (10.8 vs. 15.4%, HR 0.65, 95% CI 0.46–0.92; P = 0.016), as was CV death following the non-fatal event (3.7 vs. 7.1%, HR 0.46, 95% CI 0.25–0.82; P = 0.008). Overall there was a reduction of 195 total primary efficacy events with prasugrel vs. clopidogrel (rate ratio 0.79, 95% CI 0.71–0.87; P < 0.001). Recurrent bleeding events occurred infrequently (TIMI major non-CABG bleeds: four with prasugrel and two with clopidogrel). Study drug discontinuation was frequent following the initial major bleeding event (42% of patients discontinued study drug). Conclusion: While standard statistical analytic techniques for clinical trials censor patients who experience a component of the primary composite endpoint, total cardiovascular events remain important to both patients and clinicians. Prasugrel, a more potent anti-platelet agent, reduced both first and subsequent cardiovascular events compared with clopidogrel in patients with ACS. en_US
dc.language.iso en_US en_US
dc.publisher Oxford University Press en_US
dc.relation.isversionof doi://10.1093/eurheartj/ehn362 en_US
dc.relation.hasversion http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2567025/pdf/ en_US
dash.license LAA
dc.subject acute coronary syndrome en_US
dc.subject percutaneous coronary intervention en_US
dc.subject prasugrel en_US
dc.subject clopidogrel en_US
dc.title Reduction in Recurrent Cardiovascular Events with Prasugrel Compared with Clopidogrel in Patients with Acute Coronary Syndromes from the TRITON-TIMI 38 Trial en_US
dc.type Journal Article en_US
dc.description.version Version of Record en_US
dc.relation.journal European Heart Journal en_US
dash.depositing.author Antman, Elliott Marshall
dc.date.available 2011-02-07T17:04:06Z
dash.affiliation.other HMS^Medicine-Brigham and Women's Hospital en_US
dash.affiliation.other HMS^Medicine-Brigham and Women's Hospital en_US
dash.affiliation.other HMS^Medicine-Brigham and Women's Hospital en_US
dash.affiliation.other HMS^Academic Programs en_US

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