Upendra Kaul1, Arvind Sethi2, P Arambam3, A K Omar4, R Keshava5, Sanjeeb Roy6, Shuvanan Ray7, Rakesh Jaswal8, Ripan K Gupta9, Rakesh Rai Sapra10, Rane Sandip Keshav11, Rajpal Singh12, Vineet Bhatia13, Vinay Sanghi14, Arun Chopra15. 1. Executive Director and Dean, Cardiology, Fortis Escorts Heart Institute, New Delhi, India. Electronic address: upendra.kaul@fortishealthcare.com. 2. Associate Consultant, Interventional Cardiology, Fortis Escorts Heart Institute, New Delhi, India. 3. Chief Clinical Research Coordinator, Fortis Escorts Heart Institute, New Delhi, India. 4. Director, Non Invasive Cardiology & Head of Department Heart Command & Emergency, Fortis Escorts Heart Institute, New Delhi, India. 5. Senior Consultant, Department of Cardiology, Fortis Hospital, Bangalore, India. 6. Senior Consultant, Department of Cardiology, Fortis Escorts Hospital, Jaipur, India. 7. Chief, Cardiology Intervention, Fortis Hospital, Kolkata, India. 8. Director, Department of Cardiology, Fortis Hospital, Mohali, India. 9. Principal Consultant, Fortis Hospital, Vasant Kunj, New Delhi, India. 10. Senior Consultant & Head of Interventional Cardiology, Fortis Escorts Hospital, Faridabad, India. 11. Director, Department of Cardiology, Fortis Hospital, Navi Mumbai, India. 12. Interventional Cardiologist, Fortis Hospital, Bangalore, India. 13. Consultant, Department of Cardiology, Fortis Hospital, Noida, India. 14. Associate Director, Department of Cardiology, Fortis Hospital, Shalimar Bagh, Delhi, India. 15. Director, Department of Cardiology, Fortis Hospital, Amritsar, India.
Abstract
BACKGROUND: Clopidogrel has been the only available antiplatelet drug used along with aspirin in patients of ACS. In recent years 2 new antiplatelet drugs (Prasugrel and Ticagrelor) have become available. Prasugrel in the dose of 10 mg OD has been found to be more efficacious but with increased risk of major bleeding. For this reason it has not gained widespread usage in ACS patients undergoing PCI. There are no systematic data on the use of Prasugrel in Indian population. METHOD: This is a prospective, multicentric, hospital registry of 1000 patients with ACS undergoing PCI who were administered Prasugrel. The primary safety endpoint of this study was major and minor bleeding while the efficacy endpoint is the composite of CV death, nonfatal MI, nonfatal stroke up to 30 days after PCI. Patients with high bleeding risk were excluded. RESULTS: Most patients (91%) received loading dose of Prasugrel along with the maintenance dose getting according to the defined protocol. Patients were followed up to 30 days post procedure. Primary efficacy end point was reached in 3 patients only with two of them dying due to possible stent thrombosis and the third requiring revascularization of the target vessel for stent thrombosis. One major and 19 minor bleeding complications were recorded, with access site bleeding in 0.7% & non-access site bleeding in 1.2% of the subjects. CONCLUSION: Prasugrel was found to be effective & not associated with a high incidence of bleeding in the high risk ACS patients when those at a high bleeding risk were excluded.
BACKGROUND:Clopidogrel has been the only available antiplatelet drug used along with aspirin in patients of ACS. In recent years 2 new antiplatelet drugs (Prasugrel and Ticagrelor) have become available. Prasugrel in the dose of 10 mg OD has been found to be more efficacious but with increased risk of major bleeding. For this reason it has not gained widespread usage in ACSpatients undergoing PCI. There are no systematic data on the use of Prasugrel in Indian population. METHOD: This is a prospective, multicentric, hospital registry of 1000 patients with ACS undergoing PCI who were administered Prasugrel. The primary safety endpoint of this study was major and minor bleeding while the efficacy endpoint is the composite of CV death, nonfatal MI, nonfatal stroke up to 30 days after PCI. Patients with high bleeding risk were excluded. RESULTS: Most patients (91%) received loading dose of Prasugrel along with the maintenance dose getting according to the defined protocol. Patients were followed up to 30 days post procedure. Primary efficacy end point was reached in 3 patients only with two of them dying due to possible stent thrombosis and the third requiring revascularization of the target vessel for stent thrombosis. One major and 19 minor bleeding complications were recorded, with access site bleeding in 0.7% & non-access site bleeding in 1.2% of the subjects. CONCLUSION:Prasugrel was found to be effective & not associated with a high incidence of bleeding in the high risk ACSpatients when those at a high bleeding risk were excluded.
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