Reduced-dose prasugrel lowers bleeding risk in elderly ACS patients: Study
Germany: A reduced dose of prasugrel versus standard dose of ticagrelor helped in maintaining anti-ischemic efficacy in elderly or low-weight patients with acute coronary syndrome (ACS), suggests a recent study in the journal Annals of Internal Medicine. Also, it (prasugrel) protected these patients against the excess risk for bleeding.
Adnan Kastrati, German Center for Cardiovascular Research (DZHK), Partner Site Munich Heart Alliance, Germany, and colleagues investigated the effect of age- and weight-adapted dose of prasugrel versus a standard dose of ticagrelor in patients with ACS.
For the purpose, they conducted a prespecified analysis of the multicenter, randomized ISAR-REACT 5 trial across 23 centers in Germany and Italy. It included 3997 patients with ACS planned for invasive management. The patients were randomly assigned to receive a standard dose of ticagrelor or prasugrel (reduced dose in the elderly or low-weight group and standard dose in neither elderly nor low-weight group).
The efficacy endpoint was a composite of death, myocardial infarction, or stroke, and the safety endpoint was bleeding, both at 12 months.
Key findings of the study include:
- In the elderly or low-weight group, the efficacy endpoint occurred in 12.7% of patients assigned to receive prasugrel and 14.6% of those assigned to receive ticagrelor (hazard ratio [HR], 0.82); in neither elderly nor low-weight group, the efficacy endpoint occurred in 4.8% of patients assigned to receive prasugrel and 7.3% of those assigned to receive ticagrelor (HR, 0.65).
- In the elderly or low-weight group, Bleeding Academic Research Consortium type 3 to 5 bleeding occurred in 8.1% of patients assigned to receive prasugrel and 10.6% of those assigned to receive ticagrelor (HR, 0.72), and in 3.7% and 3.8%, respectively, of patients in neither elderly nor low-weight group (HR, 0.98).
"In elderly or low-weight patients with ACS, a reduced dose of prasugrel compared with the standard dose of ticagrelor is associated with maintained anti-ischemic efficacy while protecting these patients against the excess risk for bleeding," concluded the authors.
The study, "Age- and Weight-Adapted Dose of Prasugrel Versus Standard Dose of Ticagrelor in Patients With Acute Coronary Syndromes: Results From a Randomized Trial," is published in the journal Annals of Internal Medicine.
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