ARASHI Hiroyuki
   Department   School of Medicine(Tokyo Women's Medical University Hospital), School of Medicine
   Position   Assistant Professor
Language English
Title Safety and efficacy of low dose prasugrel as part of triple antithrombotic therapy with aspirin and oral anticoagulation in patients with atrial fibrillation undergoing PCI
Conference Euro PCR 2018
Promoters European Society of Cardiology
Conference Type International society and overseas society
Presentation Type Poster notice
Lecture Type General
Publisher and common publisher◎OOTSUKI Hisao, KONAMI Yutaka, TANAKA Kazuki, NAKAO Masashi, JUJO Kentaro, ARASHI Hiroyuki, YAMAGUCHI Junichi, HAGIWARA Nobuhisa
Date 2018/05/23
(city and name of the country)
Summary AIMS
The use of standard dose prasugrel (10mg/day) as part of triple antithrombotic therapy with aspirin and oral anticoagulation (OAC) is not recommended in current guidelines because it increase the risk of bleeding compared with clopidogrel. However, whether low dose prasugrel also increase the risk of bleeding is unclear. The aim of this study was to evaluate the safety and efficacy of Japanese domestic dose of prasugrel (3.75mg/day) combined with aspirin and OAC in atrial fibrillation (AF) patients undergoing percutaneous coronary intervention (PCI).

Consecutive 816 AF patients undergoing PCI from January 2011 to June 2016 were registered at 8 hospitals in Japan. We examined clinical outcomes of patients who took aspirin and OAC with either prasugrel (n=57) or clopidogrel (n=451) after PCI. The incidence of bleeding (TIMI criteria major and minor bleeding) and major adverse cerebro-cardiovascular events (MACCE, all cause death, non-fatal myocardial infarction, non-fatal stroke and unplanned revascularization) within one-year after PCI were evaluated. The mean age of whole population was 73.3±8.4 years old, 81% of them were male, 42% were diabetes, and 45% were CKD ? stage3. In terms of OAC, 77% of whole population were prescribed vitamin K antagonist and the others were non-vitamin-K oral anticoagulant (NOAC). The mean duration of triple antithrombotic therapy was 287±157 days. The mean CHADS2 score, CHA2DS2-VASc score and modified HAS-BLED score (omitting labile INR) were 2.4±1.2, 4.5±1.5 and 2.3±0.8, respectively. These baseline characteristics were not significantly different between prasgurel group and clopidogrel group. The cumulative incidence of MACCE was not significantly different (prasugrel group 11.5% vs. clopidogrel group 12.3%, Log-rank p=0.87). Moreover, the cumulative incidence of bleeding was not significantly different either (prasugrel group 5.6% vs. clopidogrel group 8.1%, Log-rank p=0.56).

Low dose prasugrel as part of thriple antithrombotic therpy with aspirin and OAC did not increase the risk of bleeding compared with clopidogrel. It might be an alternative to clopidogrel for the patients with AF undergoing PCI. Further studies are warranted to determine the potential benefit of prasugrel.