Safety and Efficacy of Low-Dose Prasugrel as Part of Triple Therapy With Aspirin and Oral Anticoagulants in Patients With Atrial Fibrillation Undergoing Percutaneous Coronary Intervention　― From the TWMU-AF PCI Registry ―

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  • Otsuki Hisao
    Department of Cardiology, The Heart Institute of Japan, Tokyo Women’s Medical University
  • Yamaguchi Junichi
    Department of Cardiology, The Heart Institute of Japan, Tokyo Women’s Medical University
  • Kawamoto Takanori
    Department of Cardiology, The Heart Institute of Japan, Tokyo Women’s Medical University
  • Yoshikawa Masafumi
    Department of Cardiology, The Heart Institute of Japan, Tokyo Women’s Medical University
  • Ebihara Suguru
    Department of Cardiology, The Heart Institute of Japan, Tokyo Women’s Medical University
  • Tanaka Kazuki
    Department of Cardiology, The Heart Institute of Japan, Tokyo Women’s Medical University
  • Nakao Masashi
    Department of Cardiology, The Heart Institute of Japan, Tokyo Women’s Medical University
  • Jujo Kentaro
    Department of Cardiology, The Heart Institute of Japan, Tokyo Women’s Medical University
  • Arashi Hiroyuki
    Department of Cardiology, The Heart Institute of Japan, Tokyo Women’s Medical University
  • Ota Yoshimi
    Department of Cardiology, Saiseikai-Kurihashi Hospital
  • Saito Katsumi
    Department of Cardiology, Nishiarai Heart Center
  • Takagi Atsushi
    Department of Cardiology, Saiseikai-Kawaguchi General Hospital
  • Tanaka Hiroyuki
    Department of Cardiology, Tokyo Metropolitan Tama Medical Center
  • Fujii Shinya
    Department of Cardiology, Sendai Cardiovascular Center
  • Honda Atsushi
    Department of Cardiology, Tokyo Women’s Medical University Yachiyo Medical Center
  • Mori Fumiaki
    Department of Cardiology, National Hospital Organization Yokohama Medical Center
  • Hagiwara Nobuhisa
    Department of Cardiology, The Heart Institute of Japan, Tokyo Women’s Medical University

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Abstract

<p>Background: Using the standard maintenance dose of prasugrel (10 mg/day) as part of triple therapy with aspirin and an oral anticoagulant (OAC) is not recommended in the current guidelines because it increases the risk of bleeding compared with clopidogrel. However, the safety and efficacy of low-dose prasugrel (3.75 mg/day) as part of triple therapy has not been reported. </p><p>Methods and Results: We registered 816 consecutive patients with atrial fibrillation (AF) who underwent percutaneous coronary intervention (PCI) from January 2011 to June 2016 at 8 hospitals in Japan. We examined the clinical outcomes of patients who received either low-dose prasugrel (n=57) or clopidogrel (n=451) as part of triple therapy after PCI. The incidences of bleeding (TIMI major and minor) and major adverse cerebrocardiovascular events (MACCE; all-cause death, nonfatal myocardial infarction, stent thrombosis, unplanned revascularization, and stroke) were evaluated. The cumulative 1-year incidence of bleeding was not significantly different (prasugrel 5.6% vs. clopidogrel 8.1%, log-rank P=0.55). In addition, the cumulative 1-year incidence of MACCE was also not significantly different (prasugrel 11.5% vs. clopidogrel 12.3%, log-rank P=0.88). </p><p>Conclusions: Low-dose prasugrel, as part of triple therapy, did not increase the risk of bleeding compared with clopidogrel. Therefore, it can be an alternative to clopidogrel for patients with AF undergoing PCI. </p>

Journal

  • Circulation Journal

    Circulation Journal 83 (5), 1000-1005, 2019-04-25

    The Japanese Circulation Society

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