52190
document
Residual platelet reactivity , bleedings , and adherence to treatment in patients having coronary stent implantation treated with prasugrel . Recent guidelines have recommended the use of aspirin and prasugrel in patients with acute coronary syndromes undergoing percutaneous coronary intervention . However , prasugrel use has been evaluated only in randomized trials . This study sought to evaluate bleeding rates and adherence to treatment in " real-world " patients treated with prasugrel . In total 298 consecutive patients 68 ± 10 years old ( 31 % > 75 years old ) underwent stent implantation and received prasugrel therapy . Indications to prasugrel therapy were ( 1 ) ST-elevation acute myocardial infarction ( 41 % ) , ( 2 ) drug-eluting stent implantation in diabetics ( 24 % ) , ( 3 ) stent thrombosis ( 3 % ) , ( 4 ) left main coronary artery drug-eluting stent implantation ( 6 % ) , and ( 5 ) percutaneous coronary intervention in patients with high residual platelet reactivity on clopidogrel therapy ( 26 % ) . All patients received a loading of prasugrel 60 mg . Patients ≥75 years old and with body weight ≤60 kg received a maintenance dose of 5 mg/day ( 10 mg/day for all the other patients ) . Follow-up data including adherence to prasugrel therapy were collected by telephone interviews or outpatient visits . Minimal follow-up length was 6 months ( mean 9 ± 3 ) . Major , minor , and minimal bleedings ( Thrombolysis In Myocardial Infarction criteria ) occurred in 2.7 % , 4.7 % , and 15.1 % of enrolled patients . Low residual platelet reactivity ( p = 0.001 ) and female gender ( p = 0.29 ) were independent predictors of bleeding events . The most frequent minimal bleeding event was epistaxis . Only 8 patients ( 2.7 % ) permanently discontinued prasugrel therapy because of bleeding events ( n = 4 ) , possible side effects ( n = 2 ) , or medical decisions not associated with bleeding or side effects ( n = 2 ) . Fourteen patients ( 4.7 % ) temporarily discontinued prasugrel ( average 6.5 days ) mainly because of surgical procedures . No definite or probable stent thrombosis occurred , although 3 patients develop de novo myocardial infarction and 1 an ischemic stroke . There were 11 deaths because of heart failure or refractory cardiogenic shock in 9 , pulmonary embolism in 1 , and cancer in 1 . In conclusion , in clinical practice , major and minor bleeding event rates associated with prasugrel therapy are comparable to those reported in controlled randomized trials . The minimal bleeding event rate is higher than reported but does not seem to affect adherence to treatment .
52191
Intervention_Pharmacological
prasugrel
52192
Intervention_Pharmacological
prasugrel
52193
Intervention_Pharmacological
prasugrel
52194
Intervention_Pharmacological
prasugrel
52195
Intervention_Pharmacological
prasugrel
52196
Outcome_Physical
bleeding rates