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Prasugrel has no advantages over clopidogrel in patients with ACS

Prasugrel has no advantage over clopidogrel in patients with ACS without ST-segment elevation receiving conservative treatment (TRILOGY ACS trial).

At the congress of the European Society of Cardiology on August 26, 2012, the results of the TRILOGY ACS study were presented, comparing the efficacy of two platelet aggregation aggregators - prasugrel and clopidogrel - in the prevention of death, myocardial infarction and stroke in patients with acute coronary syndrome (ACS) who received conservative treatment.

A double-blind, randomized trial included more than 7,000 patients under the age of 75 years with unstable angina or non-ST-elevated myocardial infarction who received prasugrel 10 mg / day or clopidogrel 75 mg / day for up to 30 months in combination with standard therapy. The frequency of the primary endpoint was not significantly different between the two groups and was 13.9% in the treatment with prasugrel and 16.0% in the treatment with clopidogrel (p = 0.21).

Similar results were obtained in the entire sample of patients, including an additional 2083 patients aged 75 years and older who received prasugrel at a reduced dose of 5 mg / day or clopidogrel at a dose of 75 mg / day. The incidence of large, life-threatening, fatal and intracranial hemorrhages was low and comparable in the two groups, both in the sample of patients older than 75 years, and in the entire sample of patients. The incidence of nonhemorrhagic serious adverse events was also comparable, with the exception of a higher incidence of heart failure in the clopidogrel group.

The efficacy and safety of prasugrel and clopidogrel were first compared in the TRITON trial in patients with ACS who planned percutaneous intervention on the coronary arteries. In this study, treatment with prasugrel resulted in a more significant decrease in the incidence of ischemic outcomes, including stent thrombosis, but was accompanied by an increase in the frequency of large bleeding. The study TRILOGY ACS was conducted in the continuation of the study TRITON. Its results are of great importance for clinical practice, since in Russia the majority of patients with ACS undergo conservative treatment.

Data from the TRILOGY ACS study indicate that the new antiaggregant drug in this situation has no advantages over clopidogrel for efficacy or safety.