Safety and efficacy of prasugrel compared with clopidogrel in different regions of the world

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dc.contributorSistema FMUSP-HC: Faculdade de Medicina da Universidade de São Paulo (FMUSP) e Hospital das Clínicas da FMUSP
dc.contributor.authorRUFF, Christian T.
dc.contributor.authorGIUGLIANO, Robert P.
dc.contributor.authorANTMAN, Elliott M.
dc.contributor.authorMURPHY, Sabina A.
dc.contributor.authorLOTAN, Chaim
dc.contributor.authorHEUER, Herbertus
dc.contributor.authorBela Merkely
dc.contributor.authorBARACIOLI, Luciano
dc.contributor.authorSCHERSTEN, Fredrik
dc.contributor.authorSEABRO-GOMES, Ricardo
dc.contributor.authorBRAUNWALD, Eugene
dc.contributor.authorWIVIOTT, Stephen D.
dc.contributor.groupauthorTRITON-TIMI 38 Investigators
dc.date.accessioned2013-07-30T17:52:39Z
dc.date.available2013-07-30T17:52:39Z
dc.date.issued2012
dc.description.abstractBackground: Among patients with acute coronary syndrome(ACS), demographics, procedural characteristics and adjunctive medications differ globally. We examined whether there were differential effects of prasugrel compared with clopidogrel in the multinational TRITON-TIMI 38 study. Methods: We divided the enrollment into 5 pre-specified geographic regions. Patients were randomized to prasugrel or clopidogrel without regard to country of enrollment. End points are expressed as Kaplan-Meier failure estimates through 15 months. Heterogeneity was evaluated using Cox proportional hazards model. Additional sensitivity analyses were performed by dividing countries into categories based on the Human Development Index (HDI), which is a composite measure of social and economic development. Results: 13,608 patients were enrolled. Clinical characteristics including age, comorbidities, ACS presentation, stent types, and adjunctive medications differed broadly among regions. Despite these differences, no regional heterogeneity was observed with prasugrel compared to clopidogrel in the reduction of ischemic events (HR range: 0.76-0.87, p(interaction)>0.10 for each) and stent thrombosis (HR range: 0.34-0.72, p(interaction)>0.10 for each) or in the increased rate of non-CABG TIMI major bleeding (HR range: 1.16-1.76, p(interaction)>0.10 for each). There was a consistent trend in net clinical benefit (all cause death/MI/stroke/non-CABG TIMI major bleeding) favoring prasugrel (HR range: 0.81-0.97, p(interaction)>0.10 for each). Consistent results were also observed regarding the safety and efficacy of prasugrel compared with clopidogrel in both developed and developing countries. Conclusions: Despite differences in patient demographics, procedural techniques and adjunctive medications, consistent reduction in ischemic events and increased bleeding were seen with prasugrel compared with clopidogrel throughout the world.
dc.description.indexMEDLINE
dc.identifier.citationINTERNATIONAL JOURNAL OF CARDIOLOGY, v.155, n.3, p.424-429, 2012
dc.identifier.doi10.1016/j.ijcard.2010.10.040
dc.identifier.issn0167-5273
dc.identifier.urihttps://observatorio.fm.usp.br/handle/OPI/1519
dc.language.isoeng
dc.publisherELSEVIER IRELAND LTD
dc.relation.ispartofInternational Journal of Cardiology
dc.rightsrestrictedAccess
dc.rights.holderCopyright ELSEVIER IRELAND LTD
dc.subjectPrasugrel
dc.subjectClopidogrel
dc.subjectTRITON-TIMI 38
dc.subjectRegional differences
dc.subjectHDI
dc.subject.otheracute coronary syndromes
dc.subject.otheracute myocardial-infarction
dc.subject.otherst-segment elevation
dc.subject.othercardiovascular clinical-trials
dc.subject.otheroptimizing platelet inhibition
dc.subject.other2007 focused update
dc.subject.otherinternational differences
dc.subject.othertask-force
dc.subject.otherinterregional differences
dc.subject.othertherapeutic outcomes
dc.subject.wosCardiac & Cardiovascular Systems
dc.titleSafety and efficacy of prasugrel compared with clopidogrel in different regions of the world
dc.typearticle
dc.type.categoryoriginal article
dc.type.versionpublishedVersion
dspace.entity.typePublication
hcfmusp.affiliation.countrySuécia
hcfmusp.affiliation.countryPortugal
hcfmusp.affiliation.countryHungria
hcfmusp.affiliation.countryAlemanha
hcfmusp.affiliation.countryIsrael
hcfmusp.affiliation.countryEstados Unidos
hcfmusp.affiliation.countryisous
hcfmusp.affiliation.countryisoil
hcfmusp.affiliation.countryisode
hcfmusp.affiliation.countryisohu
hcfmusp.affiliation.countryisose
hcfmusp.affiliation.countryisopt
hcfmusp.author.externalRUFF, Christian T.:Harvard Univ, Brigham & Womens Hosp, Div Cardiovasc, TIMI Study Grp,Dept Med,Med Sch, Boston, MA 02115 USA
hcfmusp.author.externalGIUGLIANO, Robert P.:Harvard Univ, Brigham & Womens Hosp, Div Cardiovasc, TIMI Study Grp,Dept Med,Med Sch, Boston, MA 02115 USA
hcfmusp.author.externalANTMAN, Elliott M.:Harvard Univ, Brigham & Womens Hosp, Div Cardiovasc, TIMI Study Grp,Dept Med,Med Sch, Boston, MA 02115 USA
hcfmusp.author.externalMURPHY, Sabina A.:Harvard Univ, Brigham & Womens Hosp, Div Cardiovasc, TIMI Study Grp,Dept Med,Med Sch, Boston, MA 02115 USA
hcfmusp.author.externalLOTAN, Chaim:Hadassah Univ Hosp, IL-91120 Jerusalem, Israel
hcfmusp.author.externalHEUER, Herbertus:St Johannes Hosp Dortmund, Dortmund, Germany
hcfmusp.author.externalBela Merkely:Semmelweis Egyet, Budapest, Hungary
hcfmusp.author.externalSCHERSTEN, Fredrik:Helsingborgs Lasarett, Dept Med, Helsingborg, Sweden
hcfmusp.author.externalSEABRO-GOMES, Ricardo:Inst Coracao, Carnaxide, Portugal
hcfmusp.author.externalWIVIOTT, Stephen D.:Harvard Univ, Brigham & Womens Hosp, Div Cardiovasc, TIMI Study Grp,Dept Med,Med Sch, Boston, MA 02115 USA
hcfmusp.citation.scopus13
hcfmusp.contributor.author-fmusphcLUCIANO MOREIRA BARACIOLI
hcfmusp.description.beginpage424
hcfmusp.description.endpage429
hcfmusp.description.issue3
hcfmusp.description.volume155
hcfmusp.origemWOS
hcfmusp.origem.pubmed21093072
hcfmusp.origem.scopus2-s2.0-84857789982
hcfmusp.origem.wosWOS:000300840000022
hcfmusp.publisher.cityCLARE
hcfmusp.publisher.countryIRELAND
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