New Blood Thinner Promising
Prasugrel Works Better Than Standard Plavix but Carries Bleeding Risk
Prasugrel Benefits People With Diabetes
Further analysis showed that people with diabetes really benefited from the new drug. Those given prasugrel were 30% less likely to have a heart attack or stroke or die of heart disease or stroke, compared with those given Plavix.
But prasugrel proved particularly dangerous for people who had had a previous stroke. That group, which accounted for 4% of study participants, faced a significantly increased risk of having a heart attack or stroke, dying of any cause, or suffering a major bleed if they were given prasugrel.
People 75 and older, or who weighed less than 132 pounds, were neither helped nor harmed by the new drug. "They had less cardiovascular events and more bleeding, so the net benefit was near unity," Antman says.
He says he believes these people, who accounted for 16% of study participants, would benefit from a lower dose of the drug, though that remains to be tested.
Prasugrel More Potent Than Plavix
Prasugrel blocks platelet clumping more rapidly, more consistently, and to a greater degree than Plavix, Antman says.
That's important because some people who get stents develop blood clots and have heart attacks or die despite blood-thinning treatment with Plavix and aspirin, says Sidney Smith, MD, a past president of AHA and a heart doctor at the University of North Carolina in Chapel Hill.
"A more aggressive therapy might lower that risk," he tells WebMD.
Further Study Needed
While generally upbeat about the results, Smith and other experts called for further study to delineate which people would most benefit.
"The additional benefits of prasugrel are very impressive if, as suggested, we can accurately predict the minority of patients who would be at higher risk of bleeding from the drug," Smith says.
Raymond Gibbons, MD, a past president of the AHA and a cardiologist at the Mayo Clinic in Rochester, Minn., tells WebMD that he believes that prasugrel's benefits outweigh its risks.
"If I treat 150 patients, I'll have three fewer heart attacks at a cost of one major bleed. I think it's worth it," he tells WebMD.