Navigation Links
Anti-clotting drugs yield similar results
Date:8/26/2012

DURHAM, N.C. The first trial to study patients with acute coronary syndrome who do not undergo coronary stenting or bypass surgery found no significant difference between two anti-clotting drugs prasugrel and clopidogrel in preventing the first occurrence of death, heart attack or stroke, according to Duke University Medical Center cardiologists.

The study also showed no difference in serious bleeding complications.

At the same time, the Duke researchers observed an unexpected reduction in heart attack, stroke and death among patients treated with prasurgrel beyond one year of treatment. The researchers say this potential time-dependent benefit requires further exploration.

The results were presented by the Duke researchers at the European Society of Cardiology Scientific Sessions in Munich, Germany today, and published online in the New England Journal of Medicine.

"If you look at this study as a comparison of two drugs, it doesn't tell the whole story," says E. Magnus Ohman, M.D., a professor of medicine at Duke and chairman of the TRILOGY ACS study. "This is a unique patient population that has never before been studied."

Acute coronary syndrome (ACS) refer to a group of conditions that include heart attacks and chest pain caused by clogged coronary arteries. To date, most trials evaluating anti-clotting drugs for ACS patients have focused on patients who undergo revascularization procedures such as stent implantation with percutaneous coronary intervention and coronary artery bypass surgery to restore blood flow.

Up to 60 percent of ACS patients worldwide undergo revascularization procedures according to published data. The remaining 40 percent are managed solely with drug therapy. These patients are at higher risk for repeated cardiovascular-related events, such as heart attack, stroke, and death.

"Optimizing medical therapy for these patients is extremely important," Ohman says.

Prasugrel and clopidogrel are members of the thienopyridine class of adenosine diphosphate receptor inhibitors that prevent the formation of blood clots in arteries by binding to specific receptors and inhibiting the clumping of platelets.

The efficacy and safety of the two drugs were first compared in a Phase III trial called TRITON that evaluated 13,608 ACS patients who planned to undergo stent implantation. The TRITON study, published in 2007, found that 10 mg of prasugrel was 19 percent more effective in preventing cardiovascular death, nonfatal heart attacks and strokes than clopidogrel. It also found prasurgrel caused a higher incidence of fatal bleeding.

TRILOGY ACS is a Phase III, double-blind, randomized trial that was developed as a follow-up to the TRITON trial.

"We designed our study to see if prasugrel was just as effective in patients who aren't getting coronary stents or coronary bypass surgery," says Ohman.

TRILOGY ACS enrolled 9,326 participants at 966 sites in 52 countries. It compared up to 2.5 years of treatment with prasugrel 10 mg daily vs. clopidogrel 75 mg daily, both in combination with aspirin, in ACS patients who were younger than age 75 years. The prasugrel dose was reduced to 5 mg daily for patients weighing less than 60 kilograms. A secondary analysis also looked at patients who were age 75 years or older who received 5 mg of prasurgrel daily vs. clopidogrel 75 mg daily because TRITON demonstrated an increased risk of major bleeding in these patients when they were treated with prasugrel 10mg daily.

After a median of 17 months of follow up, the primary end point - described as the time to first occurrence of death, heart attack or stoke - occurred in 13.9 percent of patients under age 75 years vs. 16.0 percent of those treated with clopidogrel. This is considered a non-significant difference.

However, a lower risk of recurrent adverse events with prasugrel was observed after 12 months of treatment. "This finding has not been observed in previous studies such as TRITON that evaluated a shorter duration of treatment," said Dr. Ohman. "We believe further exploration of this finding is needed."

The researchers did not observe an increase in severe or life-threatening bleeding complications with prasugrel as seen in the TRITON study. "Because we modified the prasugrel dose for patients with a higher risk of bleeding, we observed that prasugrel is as safe as clopidogrel with long-term treatment," said Dr. Ohman.


'/>"/>
Contact: Debbe Geiger
Debbe.Geiger@duke.edu
919-660-9461
Duke University Medical Center
Source:Eurekalert

Related medicine news :

1. Pharmacy Robots Linked to Bacterial Contamination of Drugs
2. Penn study cautions use of drugs to block niacin flush
3. Urinary Incontinence Drugs May Be More Trouble Than Theyre Worth
4. Discovery could help to develop drugs for organ transplant and cancer patients
5. Not taking gastroprotective drugs prescribed with anti-inflammatory medicines
6. Live imaging shows response to cancer drugs can be boosted by altering tumor microenvironment
7. Weight-Loss Surgery Beat Drugs for Cutting Diabetes in Very Obese
8. Seniors Stop Taking Heart Drugs In Medicare Donut Hole
9. New Psoriasis Drugs Not Much Better Than Standard Therapy, Study Finds
10. About 1 baby born each hour addicted to opiate drugs in U.S., U-M study shows
11. Blood pressure drugs linked with lower PTSD symptoms
Post Your Comments:
*Name:
*Comment:
*Email:
(Date:12/2/2016)... ... December 02, 2016 , ... Lori G. Cohen and ... will speak at the American Conference Institute’s 21st Drug & Medical Device Litigation ... Lead Sponsor of the conference. , Cohen, who chairs the firm’s Pharmaceutical, Medical Device ...
(Date:12/2/2016)... ... 2016 , ... More than 100 business, civic, community and ... the UNCF Dothan-Wiregrass Mayor’s Luncheon Dec. 9, 2016. This inaugural event, hosted by ... support to UNCF-member institutions, including Miles College, Oakwood University, Tuskegee University, Stillman College ...
(Date:12/2/2016)... ... 2016 , ... The annual time frame to change Medicare health and prescription ... December 7th. Currently-enrolled Medicare beneficiaries who are looking to switch from their current plan ... to make changes during this period order for their new policy to go into ...
(Date:12/2/2016)... ... December 02, 2016 , ... Dr. Raffi Hovsepian, ... included in the 2016 “Guide to America’s Top Plastic Surgeons” for seven consecutive ... of their education, experience, and professional associations. , One the most frequently ...
(Date:12/2/2016)... Hawaii (PRWEB) , ... December 02, 2016 , ... ... 2016 at the Hyatt Regency Waikiki Beach Resort and Spa in Honolulu, offering ... in the field of pain management. , The demand for supplemental training ...
Breaking Medicine News(10 mins):
(Date:12/2/2016)... in the ECG Cables And ECG Leadwires Market owing to ... devices. On the other hand, the Asia-Pacific ... rate during the forecast period. The market players ... plc ( Ireland ), Koninklijke Philips N.V. ( ... ( China ), held major share of the ...
(Date:12/2/2016)... 2016 Quantum Radiology,s Mobile Breast Center (QR ... directly to women at the workplace, thereby maximizing convenience ... Delta Air Lines and SunTrust Bank, and community health ... of wellness initiatives. "I think it,s a ... them to have a mammogram without taking a large ...
(Date:12/2/2016)... Dec. 2, 2016  Eli Lilly and Company (NYSE: ... for 2017 and provide updated financial guidance for 2016 ... a conference call on that day with the investment ... guidance. The conference call will begin at ... can access a live webcast of the conference call ...
Breaking Medicine Technology: