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Low-dose prasugrel versus standard-dose ticagrelor in east Asian patients with acute coronary syndrome

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Abstract

Low-dose prasugrel demonstrated a similar effectiveness profile to clopidogrel in East Asian ACS patients, but its comparison with another new-generation potent P2Y12 inhibitor, ticagrelor, remains unclear. To compare the effectiveness and safety of low-dose prasugrel against those of standard-dose ticagrelor in East Asian patients with ACS. This retrospective cohort study used Taiwan’s National Health and Welfare Database. This study included ACS patients who underwent percutaneous coronary intervention and, at discharge between January 1, 2018 and December 31, 2020, were prescribed with low-dose prasugrel plus aspirin or standard-dose ticagrelor plus aspirin. Stabilized inverse probability of treatment weighting was used to balance the covariates across these two groups. The primary effectiveness outcome was a composite of acute myocardial infarction, ischemic stroke, and cardiovascular death; the secondary effectiveness outcome was each of the individual components of the primary outcome, transient ischemic attack, and repeat revascularization. The primary safety outcome was a composite of intracranial hemorrhage and gastrointestinal bleeding, and the two secondary safety outcomes were intracranial hemorrhage and gastrointestinal bleeding. A total of 24,807 patients were included in this study. Among them, 1,493 were low-dose prasugrel users and 23,314 were standard-dose ticagrelor users. No significant differences were found in primary effectiveness [HR: 0.97 (0.74–1.28)] or primary safety outcomes [HR: 1.22 (0.73–2.01)] between the two study groups. For East Asian patients with ACS, low-dose prasugrel provides comparable effectiveness without increasing bleeding risk compared to standard-dose ticagrelor. Low-dose prasugrel may be an appropriate alternative for East Asian populations.

Key Points

Effectiveness and safety of low-dose prasugrel in a real-world East Asian population are not fully understood, particularly in comparison to another potent P2Y12 inhibitor, ticagrelor.

This study aim to evaluate whether low-dose prasugrel use in an East Asian population can maintain its effectiveness and prevent excessive bleeding compared to standard-dose ticagrelor in ACS patients undergoing PCI.

Our findings suggest that for East Asian patients with ACS, low-dose prasugrel can maintain effectiveness without increasing bleeding risk compared to standard-dose ticagrelor. Low-dose prasugrel may be an appropriate alternative for East Asian populations.

Further research could explore the correlation between the platelet function testing results and clinical outcomes in East Asian patients with ACS using low-dose prasugrel.

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Acknowledgements

The authors acknowledge Ms. Ling-Ya Huang, MS, from School of Pharmacy, College of Medicine, National Taiwan University, for her support with data analysis.

Funding

This study was supported by the National Science and Technology Council of Taiwan (MOST 111-2636-B-002-019) and National Taiwan University Hospital (NTUH 112-S0100). The sponsors had no role in the preparation of the manuscript or analysis of the study results. No payment was received for writing this article.

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Authors and Affiliations

  1. Department of Pharmacy, National Taiwan University Hospital, Taipei, Taiwan

    Yee-Jen Wu, Chien-Chih Wu, Chi-Yun Wu & Chi-Chuan Wang

  2. School of Pharmacy, College of Medicine, National Taiwan University, Room 203, No. 33 Linsen S. Rd., Zhongzheng Dist, Taipei, 10050, Taiwan

    Chien-Chih Wu, Hsin-Yi Huang & Chi-Chuan Wang

  3. Division of Cardiology, Department of Internal Medicine and Cardiovascular Center, National Taiwan University Hospital, Taipei, Taiwan

    Ching-Chang Huang

  4. Graduate Institute of Clinical Pharmacy, College of Medicine, National Taiwan University, Room 203, No. 33 Linsen S. Rd., Zhongzheng Dist, Taipei, 10050, Taiwan

    Chi-Chuan Wang

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Contributions

All authors contributed to the study conception and design. Conceptualization: Yee-Jen Wu, Chien-Chih Wu, Chi-Chuan Wang; Methodology: Yee-Jen Wu, Chien-Chih Wu, Chi-Chuan Wang; Formal analysis and investigation: Yee-Jen Wu, Chi-Chuan Wang; Writing - original draft preparation: Yee-Jen Wu, Hsin-Yi Huang; Writing - review and editing: Chien-Chih Wu, Chi-Yun Wu, Ching-Chang Huang; Funding acquisition: Yee-Jen Wu, Chi-Chuan Wang; Resources: Chi-Chuan Wang; Supervision: Chien-Chih Wu, Hsin-Yi Huang, Chi-Yun Wu, Ching-Chang Huang, Chi-Chuan Wang; Project administration: Chi-Chuan Wang; Validation: Chien-Chih Wu, Hsin-Yi Huang, Chi-Yun Wu, Ching-Chang Huang, Chi-Chuan Wang. All authors read and approved the final manuscript.

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Correspondence to Chi-Chuan Wang.

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Wu, YJ., Wu, CC., Huang, HY. et al. Low-dose prasugrel versus standard-dose ticagrelor in east Asian patients with acute coronary syndrome. J Thromb Thrombolysis 57, 537–546 (2024). https://doi.org/10.1007/s11239-024-02965-4

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