Post-PCI Clinical Outcomes of Reduced Dose Prasugrel in Comparison to Clopidogrel

Introduction: Patients with ACS undergoing PCI with drug-eluting stent (DES), a one-year regimen with Dual Antiplatelet therapy (DAPT) is recommended to avoid thrombotic events in which any of the two-combination therapy comprising of a P2Y12 inhibitor (Clopidogrel or Prasugrel) and thromboxane A2 inhibitor (Aspirin) is given.

Objectives: This study highlights the differences between the two DAPT regimens (clopidogrel + aspirin, reduced dose prasugrel + aspirin) for primary bleeding events post PCI within 48-72 hours, and calculates MACE events at (15 days, 3 months, 6 months) post PCI.

Methods: It was a single-centered, prospective study done in a teritary care hospital. The study included 100 subjects with ACS who underwent PCI with DES using clopidogrel or reduced dose prasugrel as the antiplatelet agent along with aspirin. All the patients were observed for primary bleeding events post PCI within 48 hours while in-patient. 15 days, 3 months, and 6 months after their discharge, and initiation of DAPT bleeding and ischemic events were observed. Alongside, MACE events and ADRs were observed 6 months duration.

Results: There were 50 patients in clopidogrel group and 50 patients in reduced dose Prasugrel group. Mean age of the study population in the clopidogrel group was 60.3000± 6.670 years (mean ± SD). The mean age of the study population in the reduced dose prasugrel group was 60.1600± 8.39913 years (mean ± SD). There were no events as such in the reduced dose prasugrel group whereas, in the clopidogrel group, 1 patient (2.5%) had an In-hospital major bleeding event post PCI. Two patients from the clopidogrel group and four patients from the prasugrel group died and the cause was unascertained. Minor bleeding events were higher in the Reduced dose Prasugrel group when compared to the clopidogrel group within 6 months post PCI.

Conclusion: This study suggests that Reduced dose prasugrel is as safe and efficacious as clopidogrel to prevent stent thrombosis and prevent bleeding events in elderly and in patients of weight 50-60 kgs, post- PCI. Hence, reduced dose Prasugrel as well as clopidogrel can be used in routine clinical practice in patients with high bleeding risk post-PCI. However, studies with a larger sample size and study duration are needed to confirm the above findings.