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- W2059875511 abstract "Recently published and presented, the Trial to Assess Improvement in Therapeutic Outcomes by Optimizing Platelet Inhibition With Prasugrel–Thrombolysis In Myocardial Infarction 38 (TRITON-TIMI 38) was a pivotal phase III, randomized, double-blind, parallel-group, multinational clinical study. The trial compared head to head the efficacy of the experimental antiplatelet agent prasugrel with standard care with clopidogrel. 1 Wiviott S.D. Antman E.M. Gibson C.M. Montalescot G. Riesmeyer J. Weerakkody G. Winters K.J. Warmke J.W. McCabe C.H. Braunwald E. TRITON-TIMI 38 InvestigatorsEvaluation of prasugrel compared with clopidogrel in patients with acute coronary syndromes: design and rationale for the Trial to Assess Improvement in Therapeutic Outcomes by Optimizing Platelet Inhibition With Prasugrel Thrombolysis In Myocardial Infarction 38 (TRITON-TIMI 38). Am Heart J. 2006; 152: 627-635 Abstract Full Text Full Text PDF PubMed Scopus (291) Google Scholar Patients (n = 13,608) with moderate- to high-risk acute coronary syndromes (ACS) with the defined anatomy who underwent percutaneous coronary intervention were randomized to a 60-mg loading dose of prasugrel followed by 10 mg/day or to a 300-mg loading dose of clopidogrel followed by 75 mg/day for 6 to 15 months. The primary end point was the time of the first event of cardiovascular death, myocardial infarction (MI), or stroke, which occurred in 12.1% of patients treated with clopidogrel and 9.9% of patients randomized to prasugrel. 2 Wiviott S.D. Braunwald E. McCabe C.H. Montalescot G. Ruzyllo W. Gottlieb S. Neumann F.J. Ardissino D. De Servi S. Murphy S.A. et al. TRITON-TIMI 38 InvestigatorsPrasugrel versus clopidogrel in patients with acute coronary syndromes. N Engl J Med. 2007; 357: 2001-2015 Crossref PubMed Scopus (5507) Google Scholar Triaging 3 components of the combined efficacy end point suggests that the difference between the 2 TRITON-TIMI 38 arms was driven by the rates of nonfatal MI (475 vs 620 events), favoring prasugrel. In contrast, mortality was identical (154 deaths with prasugrel, 155 with clopidogrel), and for each cardiovascular death prevented by prasugrel (133 with prasugrel, 150 with clopidogrel), 1 additional fatal bleeding event occurred (21 with prasugrel, 5 with clopidogrel), as correctly reflected in the accompanying editorial. 3 Bhatt D.L. Intensifying platelet inhibition—navigating between Scylla and Charybdis. N Engl J Med. 2007; 357: 2078-2081 Crossref PubMed Scopus (157) Google Scholar Therapy with the 2 agents was associated with an equal distribution of strokes (61 with prasugrel, 60 with clopidogrel). However, the survival rate for second MI in TRITON-TIMI 38 was much higher than previously reported. Therefore, we sought to compare the TRITON-TIMI 38 efficacy results with the available randomized evidence, which is similar and comparable with regard to the severity and duration of myocardial ischemia, identical dosing regimens with clopidogrel, long-term outcomes in patients with ACS, and the use of concomitant medications. Considering that most efficacy end points in TRITON-TIMI 38 occurred during the first 3 days after the initial qualifying events, short-term, 1-month follow-up studies (the Clopidogrel and Metoprolol in Myocardial Infarction Trial [COMMIT] and the Acute Catheterization and Urgent Intervention Triage Strategy Trial [ACUITY]) were also included. Major randomized efficacy outcome measures in patients treated with clopidogrel are summarized in Table 1. 2 Wiviott S.D. Braunwald E. McCabe C.H. Montalescot G. Ruzyllo W. Gottlieb S. Neumann F.J. Ardissino D. De Servi S. Murphy S.A. et al. TRITON-TIMI 38 InvestigatorsPrasugrel versus clopidogrel in patients with acute coronary syndromes. N Engl J Med. 2007; 357: 2001-2015 Crossref PubMed Scopus (5507) Google Scholar , 4 CAPRIE Steering CommitteeA randomized, blinded, trial of clopidogrel versus aspirin in patients at risk of ischaemic events. Lancet. 1996; 348: 1329-1339 Abstract Full Text Full Text PDF PubMed Scopus (6083) Google Scholar , 5 CURE Trial InvestigatorsEffects of clopidogrel in addition to aspirin in patients with acute coronary syndromes without ST-segment elevation. N Eng J Med. 2001; 345: 494-502 Crossref PubMed Scopus (6016) Google Scholar , 6 Mehta S.R. Yusuf S. Peters R.J. Bertrand M.E. Lewis B.S. Natarajan M.K. Malmberg K. Rupprecht H. Zhao F. Chrolavicius S. et al. Clopidogrel in Unstable Angina to Prevent Recurrent Events Trial (CURE) InvestigatorsEffects of pretreatment with clopidogrel and aspirin followed by long-term therapy in patients undergoing percutaneous coronary intervention: the PCI-CURE study. Lancet. 2001; 358: 527-533 Abstract Full Text Full Text PDF PubMed Scopus (3022) Google Scholar , 7 Steinhubl S.R. Berger P.B. Mann III, J.T. Fry E.T. DeLago A. Wilmer C. Topol E.J. CREDO InvestigatorsEarly and sustained dual oral antiplatelet therapy following percutaneous coronary intervention: a randomized controlled trial. JAMA. 2002; 288: 2411-2420 Crossref PubMed Scopus (3016) Google Scholar , 8 Chen Z.M. Jiang L.X. Chen Y.P. Xie J.X. Pan H.C. Peto R. Collins R. Liu L.S. COMMIT (Clopidogrel and Metoprolol in Myocardial Infarction Trial) Collaborative GroupAddition of clopidogrel to aspirin in 45,852 patients with acute myocardial infarction: randomised placebo-controlled trial. Lancet. 2005; 366: 1607-1621 Abstract Full Text Full Text PDF PubMed Scopus (1714) Google Scholar , 9 Bhatt D.L. Fox K.A. Hacke W. Berger P.B. Black H.R. Boden W.E. Cacoub P. Cohen E.A. Creager M.A. Easton J.D. et al. CHARISMA InvestigatorsClopidogrel and aspirin versus aspirin alone for the prevention of atherothrombotic events. N Engl J Med. 2006; 354: 1706-1717 Crossref PubMed Scopus (2437) Google Scholar Table 1Randomized evidence of vascular death, nonfatal myocardial infarction, and stroke in patients treated with clopidogrel Trial n ⁎ Number of patients in the clopidogrel arm. Indication Follow-Up (mo) Death (%) Stroke (%) Nonfatal MI (%) CAPRIE 4 CAPRIE Steering CommitteeA randomized, blinded, trial of clopidogrel versus aspirin in patients at risk of ischaemic events. Lancet. 1996; 348: 1329-1339 Abstract Full Text Full Text PDF PubMed Scopus (6083) Google Scholar 9,599 Vascular disease 12–36 12.1 4.9 2.6 CURE 5 CURE Trial InvestigatorsEffects of clopidogrel in addition to aspirin in patients with acute coronary syndromes without ST-segment elevation. N Eng J Med. 2001; 345: 494-502 Crossref PubMed Scopus (6016) Google Scholar 6,259 Non–ST elevation ACS 3–12 5.1 1.2 5.2 PCI-CURE 6 Mehta S.R. Yusuf S. Peters R.J. Bertrand M.E. Lewis B.S. Natarajan M.K. Malmberg K. Rupprecht H. Zhao F. Chrolavicius S. et al. Clopidogrel in Unstable Angina to Prevent Recurrent Events Trial (CURE) InvestigatorsEffects of pretreatment with clopidogrel and aspirin followed by long-term therapy in patients undergoing percutaneous coronary intervention: the PCI-CURE study. Lancet. 2001; 358: 527-533 Abstract Full Text Full Text PDF PubMed Scopus (3022) Google Scholar 1,313 PCI 3–12 2.4 NR 6.0 CREDO 7 Steinhubl S.R. Berger P.B. Mann III, J.T. Fry E.T. DeLago A. Wilmer C. Topol E.J. CREDO InvestigatorsEarly and sustained dual oral antiplatelet therapy following percutaneous coronary intervention: a randomized controlled trial. JAMA. 2002; 288: 2411-2420 Crossref PubMed Scopus (3016) Google Scholar 1,053 Elective PCI 12 1.7 0.9 6.7 COMMIT 8 Chen Z.M. Jiang L.X. Chen Y.P. Xie J.X. Pan H.C. Peto R. Collins R. Liu L.S. COMMIT (Clopidogrel and Metoprolol in Myocardial Infarction Trial) Collaborative GroupAddition of clopidogrel to aspirin in 45,852 patients with acute myocardial infarction: randomised placebo-controlled trial. Lancet. 2005; 366: 1607-1621 Abstract Full Text Full Text PDF PubMed Scopus (1714) Google Scholar 22,961 Acute MI 1 7.1 0.9 1.2 CHARISMA 9 Bhatt D.L. Fox K.A. Hacke W. Berger P.B. Black H.R. Boden W.E. Cacoub P. Cohen E.A. Creager M.A. Easton J.D. et al. CHARISMA InvestigatorsClopidogrel and aspirin versus aspirin alone for the prevention of atherothrombotic events. N Engl J Med. 2006; 354: 1706-1717 Crossref PubMed Scopus (2437) Google Scholar 7,802 High risk plus CAD 11–35 3.1 1.9 1.7 TRITON-TIMI 38 2 Wiviott S.D. Braunwald E. McCabe C.H. Montalescot G. Ruzyllo W. Gottlieb S. Neumann F.J. Ardissino D. De Servi S. Murphy S.A. et al. TRITON-TIMI 38 InvestigatorsPrasugrel versus clopidogrel in patients with acute coronary syndromes. N Engl J Med. 2007; 357: 2001-2015 Crossref PubMed Scopus (5507) Google Scholar 6,795 ACS 6–15 2.4 1.0 9.5 CAD = coronary artery disease; CAPRIE = Clopidogrel Versus Aspirin in Patients at Risk of Ischaemic Events; CHARISMA = Clopidogrel for High Atherothrombotic Risk, Ischemic Stabilization, Management, and Avoidance; CURE = Clopidogrel in Unstable Angina to Prevent Recurrent Events; NR = not reported; PCI = percutaneous coronary intervention. Number of patients in the clopidogrel arm. Open table in a new tab CAD = coronary artery disease; CAPRIE = Clopidogrel Versus Aspirin in Patients at Risk of Ischaemic Events; CHARISMA = Clopidogrel for High Atherothrombotic Risk, Ischemic Stabilization, Management, and Avoidance; CURE = Clopidogrel in Unstable Angina to Prevent Recurrent Events; NR = not reported; PCI = percutaneous coronary intervention." @default.
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- W2059875511 title "Excess Rates of Nonfatal Myocardial Infarction in the Trial to Assess Improvement in Therapeutic Outcomes by Optimizing Platelet Inhibition With Prasugrel (Preventing Clinical Events or Chasing Enzymatic Ghosts?†)†Conflict of interest: Dr. Serebruany is listed as an inventor and received compensation for U.S. Patent Application P-17232, “Method for Treating Vascular Diseases With Prasugrel,” assigned to Eli Lilly and Company, Indianapolis, Indiana. He has received funding for research studies …" @default.
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