ARASHI Hiroyuki
   Department   School of Medicine(Tokyo Women's Medical University Hospital), School of Medicine
   Position   Assistant Professor
Article types Original article
Language English
Peer review Peer reviewed
Title Safety and Efficacy of Low-Dose Prasugrel as Part of Triple Therapy With Aspirin and Oral Anticoagulants in Patients With Atrial Fibrillation Undergoing Percutaneous Coronary Intervention - From the TWMU-AF PCI Registry.
Journal Formal name:Circulation journal : official journal of the Japanese Circulation Society
Abbreviation:Circ J
ISSN code:1346-9843/1347-4820
Domestic / ForeginDomestic
Publisher The Japanese Circulation Society
Volume, Issue, Page 83(5),1000-1005頁
Author and coauthor OOTSUKI Hisao†, YAMAGUCHI Junichi*, KAWAMOTO Takanori, YOSHIKAWA Masafumi, EBIHARA Suguru, TANAKA Kazuki, NAKAO Masashi, JUJO Kentaro, ARASHI Hiroyuki, OOTA Yoshimi, SAITO Katsumi, TAKAGI Atsushi, TANAKA Hiroyuki, FUJII Shinya, HONDA Atsushi, MORI Fumiaki, HAGIWARA Nobuhisa
Publication date 2019/04
Summary BACKGROUND:
Using the standard maintenance dose of prasugrel (10 mg/day) as part of triple therapy with aspirin and an oral anticoagulant (OAC) is not recommended in the current guidelines because it increases the risk of bleeding compared with clopidogrel. However, the safety and efficacy of low-dose prasugrel (3.75 mg/day) as part of triple therapy has not been reported. Methods and Results: We registered 816 consecutive patients with atrial fibrillation (AF) who underwent percutaneous coronary intervention (PCI) from January 2011 to June 2016 at 8 hospitals in Japan. We examined the clinical outcomes of patients who received either low-dose prasugrel (n=57) or clopidogrel (n=451) as part of triple therapy after PCI. The incidences of bleeding (TIMI major and minor) and major adverse cerebrocardiovascular events (MACCE; all-cause death, nonfatal myocardial infarction, stent thrombosis, unplanned revascularization, and stroke) were evaluated. The cumulative 1-year incidence of bleeding was not significantly different (prasugrel 5.6% vs. clopidogrel 8.1%, log-rank P=0.55). In addition, the cumulative 1-year incidence of MACCE was also not significantly different (prasugrel 11.5% vs. clopidogrel 12.3%, log-rank P=0.88).

CONCLUSIONS:
Low-dose prasugrel, as part of triple therapy, did not increase the risk of bleeding compared with clopidogrel. Therefore, it can be an alternative to clopidogrel for patients with AF undergoing PCI.
DOI 10.1253/circj.CJ-18-1113
PMID 30918236