Abstract 133: Comparative Effectiveness and Clinical Outcomes of Clopidogrel versus Prasugrel in Acute Coronary Syndrome Patients with Diabetes Mellitus Undergoing Percutaneous Coronary Intervention

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Background: Compared to the common antiplatelet clopidogrel, randomized trials have shownthe novel antiplatelet prasugrel reduces ischemic events without increasing major bleeding in diabetic acute coronary syndrome (ACS) patients undergoing percutaneous coronary intervention (PCI). However, the clinical and cost implications of clopidogrel versus prasugrel in diabetic ACS patients are limited in real-world settings. Methods: Using a shared electronic medical record we reviewed all primary PCI cases at three high volume centers from July 1, 2009 to December 31, 2013. Any complication, red blood cell transfusions, bleeding <72 hours, peri-procedural myocardial infarction, cerebrovascular accident, mortality, length of stay (LOS) and total variable costs were compared between diabetic ACS patients receiving clopidogrel or prasugrel. All patients ≥75 years, <60 kilograms, or with history of cerebrovascular disease were excluded to account for contraindications and bleeding risk factors associated with prasugrel use. Results: Among 2,165 PCI cases, 1,899 (87.7%) received clopidogrel and 266 (12.3%) received prasugrel. The only difference in baseline demographic and clinical characteristics was older age in patients who received clopidogrel (62 years vs. 60 years; p<0.001). No significant differences in any complication, red blood cell transfusions, bleeding <72 hours, peri-procedural myocardial infarction, cerebrovascular accident or mortality were observed between treatment groups. Total variable costs were $1,271 higher in patients who received prasugrel (p<0.001) and LOS was 0.2 days longer (p=0.011) (Table). Conclusions: In diabetic ACS patients undergoing PCI in a real-world clinical setting, there was no significant difference in peri-procedural complications with prasugrel versus clopidogrel antiplatelet therapy. Prasugrel was associated with higher costs and longer LOS.