Prasugrel vs clopidogrel: TRITON-TIMI 38

Prasugrel vs clopidogrel: TRITON-TIMI 38

TRITON-TIMI 38 trial [1] compared prasugrel with clopidogrel in around thirteen thousand six hundred patients with acute coronary syndrome {unstable angina, ST segment elevation myocardial infarction (STEMI) or non ST segment elevation myocardial infarction (NSTEMI)} in whom percutaneous coronary intervention (PCI) was being planned. In this double blind trial aspirin was common to both arms, and one arm received 300 mg clopidogrel loading followed by 75 mg per day maintenance while the other arm received 60 mg prasugrel loading followed by 10 mg per day maintenance. Median duration of therapy was one year. The primary endpoint was the composite of cardiovascular death, myocardial infarction and stroke. Secondary endpoints were combinations of these and re-hospitalization for recurrent ischemia. Stent thrombosis was classified into definite and probable by ARC criteria. Safety endpoints were TIMI major bleeds and life-threatening bleeds. Key sub studies were pharmacokinetic and genomic. There was an overall increase in TIMI major bleeds with prasugrel. Risk was higher in those weighing less than 60 Kg, elderly and those with a history of stroke. Prasugrel was more beneficial in PCI patients with STEMI, diabetes and stent thrombosis.

Reference

  1. Stephen D Wiviott, Eugene Braunwald, Carolyn H McCabe, Gilles Montalescot, Witold Ruzyllo, Shmuel Gottlieb, Franz-Joseph Neumann, Diego Ardissino, Stefano De Servi, Sabina A Murphy, Jeffrey Riesmeyer, Govinda Weerakkody, C Michael Gibson, Elliott M Antman, TRITON-TIMI 38 Investigators. Prasugrel Versus Clopidogrel in Patients With Acute Coronary Syndromes. N Engl J Med. 2007 Nov 15;357(20):2001-15.