Prasugrel in percutaneous coronary intervention (PIPCI): a single centre study

Abstract

AbstractBackgroundPrasugrel is a potent antiplatelet agent for use in percutaneous coronary interventions, but it carries a significant risk of adverse events.AimsThe aims of this study were to review the use of prasugrel in a population requiring treatment for acute coronary syndrome (ACS), review adherence to guidelines, and assess the adverse event (AE) rates associated with its use.MethodThis study was a retrospective single‐centre case series conducted at a metropolitan hospital in Victoria, Australia. All patients who were admitted for treatment intervention for ACS and initiated on prasugrel between July 2011 and April 2013 were included. The primary outcome measures were the adherence to international cardiac guidelines and to subsidy restrictions. Secondary outcomes included adherence to guidelines for prasugrel and heparin dosing, rates of concomitant use of glycoprotein IIb/IIIa inhibitors, rates of AEs and the severity of these according to TRITON‐TIMI criteria. Chi‐squared testing was conducted using SPSS 19.ResultsPrasugrel was initiated in 79 patients during the study period. Of these patients, 87% were deemed high risk for further cardiovascular events and the use of prasugrel adhered to international guidelines. Over 10% of patients were started on prasugrel despite being assessed as high risk for bleeding, with haemorrhages occurring in 29.1% of patients. A significant proportion of patients had prasugrel dosing outside the guideline recommendations in relations to age and weight.ConclusionsThe majority of patients initiated on prasugrel conformed to international and national guidelines; however, a high bleeding rate was observed, which may warrant reviews with larger studies.