Prasugrel: A New Thienopyridine Inhibitor

The objective of this review is to report the pharmaco-logic and pharmacokinetic properties of prasugrel, the potential advantages and disadvantages over the other agent in its class, clopidogrel, and the clinical data establishing its efficacy in the management of patients with acute coronary syndromes receiving stent implantation. A MEDLINE (1966 to May 2008) search using the key word prasugrel was performed to identify pertinent literature. Additional references were selected from the bibliographies of the articles cited. Searches were not limited by time or human subject. Preclinical studies evaluating the pharmacolo-gic and pharmacokinetic properties of prasugrel in humans were selected for review. Clinical trials assessing the efficacy of prasugrel for the treatment of patients with acute coronary syndromes receiving percutaneous coronary intervention were included as long as they were randomized, blinded, and controlled. The authors concluded that prasugrel is a thienopyridine antiplatelet agent with a faster onset of action and increased potency, in terms of inhibit-ing platelet aggregation, than clopidogrel. It has been shown in one major clinical trial that this enhanced pharmacological effect of prasugrel reduces the com-bined incidence of cardiovascular death, nonfatal myocardial infarction, and nonfatal stroke when compared with clopidogrel. However, this enhanced effect of prasugrel did result in an increased risk of bleeding