Efficacy and Safety of Prasugrel by Stroke Subtype: A Sub-Analysis of the PRASTRO-I Randomized Controlled Trial
| Autor: | Takehiko Nagao, Kenji Abe, Kazuo Kitagawa, Masayasu Matsumoto, Shinichiro Uchiyama, Izumi Nagata, Shinsuke Nanto, Kazuo Minematsu, Norio Tanahashi, Akira Ogawa, Hiroshi Yamagami, Toshiaki Shirai, Kazunori Toyoda, Yasuo Ikeda, Masakatsu Nishikawa, Takanari Kitazono |
|---|---|
| Jazyk: | angličtina |
| Rok vydání: | 2021 |
| Předmět: |
Male
medicine.medical_specialty Prasugrel Thienopyridine Arteriosclerosis Subtype Hemorrhage 030204 cardiovascular system & hematology law.invention 03 medical and health sciences 0302 clinical medicine Randomized controlled trial law Internal medicine Ischemic Internal Medicine medicine Humans Cumulative incidence Myocardial infarction cardiovascular diseases Stroke Ischemic Stroke business.industry Biochemistry (medical) Hazard ratio Arteries Organ Size Middle Aged medicine.disease Clopidogrel Atherosclerosis Outcome and Process Assessment Health Care Treatment Outcome Original Article Female Drug Monitoring Cardiology and Cardiovascular Medicine business Prasugrel Hydrochloride 030217 neurology & neurosurgery Platelet Aggregation Inhibitors medicine.drug |
| Zdroj: | Journal of Atherosclerosis and Thrombosis |
| ISSN: | 1880-3873 1340-3478 |
| Popis: | Aims: The efficacy of antiplatelet therapy may vary among different disease subtypes. Prasugrel is generally a more potent, consistent, and fast-acting platelet inhibitor than clopidogrel. This sub-analysis of the phase III comparison of PRAsugrel and clopidogrel in Japanese patients with ischemic STROke (PRASTRO-I) trial aimed to assess the differences in efficacy of these treatments for each stroke subtype. Methods: In the PRASTRO-I trial, a total of 3,753 patients with ischemic stroke were recruited from 224 centers throughout Japan and randomized (1:1) to prasugrel (3.75 mg/day) or clopidogrel (75 mg/day) for 96 weeks. For the sub-analysis, strokes were classified as large-artery atherosclerosis, small-artery occlusion (lacunar), stroke of other etiology, and stroke of undetermined etiology. The cumulative incidence of primary events (ischemic stroke, myocardial infarction, and death from other vascular cause) and hazard ratios (HRs) were calculated for each subgroup. Results: For patients with large-artery atherosclerosis, the primary event incidence was 3.8% in the prasugrel group and 4.8% in the clopidogrel group (HR 0.79; 95% confidence interval [CI] 0.45–1.41). For patients with small-artery occlusion, the incidence was 3.3% in the prasugrel group and 3.9% in the clopidogrel group (HR 0.82; 95% CI 0.45–1.50). For patients with stroke of undetermined etiology, the incidence was 4.6% in the prasugrel group and 3.0% in the clopidogrel group (HR 1.56; 95% CI 0.90–2.72). The incidence of bleeding was similar across subtypes. Conclusions: Although statistical significance was not reached, the efficacy of prasugrel was potentially different between stroke subtypes, warranting further studies. |
| Databáze: | OpenAIRE |
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