ACC 2015: New findings from TRANSLATE-ACS indicate bleeding risk is a factor in choosing prasugrel or clopidogrel

March 14, 2015 – Few studies have been done about how clinicians select antiplatelet medications for heart attack patients and whether they take into account individual bleeding or mortality risks.

Antiplatelet medications are typically given to people who have experienced a heart attack to lower their risk for future cardiac events. Studies have shown that prasugrel is more effective than clopidogrel at preventing additional heart attacks, but it is also associated with increased bleeding risk for certain groups of patients.

amit-vora-newsFew studies have been done about how clinicians select antiplatelet medications for heart attack patients and whether they take into account individual bleeding or mortality risks. In a new analysis of the TRANSLATE-ACS study, researchers sought to identify which patients were more likely to receive prasugrel versus clopidogrel. The results were presented at the American College of Cardiology Annual Scientific Sessions in San Diego. DCRI Fellow Amit N. Vora, MD, was the lead author (pictured, right).

“Prasugrel has consistently been found to be more effective than clopidogrel, but it has a higher bleeding risk for patients who are older, have low body weight, or who have a prior history of stroke or mini-stroke,” said Vora. “Selecting the right antiplatelet medication is a balancing act of identifying patients who will benefit without an increased risk of bleeding.”

In this new study, researchers found that the strongest predictors of prasugrel use were cardiogenic shock, drug-eluting stent use, and younger age, whereas clopidogrel use was highest in patients transferred from another hospital, those already on blood-thinning therapy, and those with a history of stroke or mini-stroke.

Researchers also compared antiplatelet selection against validated risk scores for bleeding and mortality. Prasugrel use was highest among patients who had a low risk of mortality combined with a low risk of bleeding complications.

“It appears that physicians are taking into account bleeding risk when deciding whether to use prasugrel or clopidogrel,” said Vora. “In previous studies, we have found that patients who have a high risk of bleeding and are taking prasugrel have a higher rate of adverse outcomes than patients taking clopidogrel. Assessing a patient’s risk of bleeding complications is an important consideration.”

Other Duke authors on the presentation include Eric Peterson, MD, MPH; Lisa McCoy; Kevin Anstrom, PhD; and Tracy Wang, MD.