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
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
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.
With further study, "we'll be smarter about who should and shouldn't get
the drug," Gibbons says.
Gordon Tomaselli, MD, chairman of the committee that picked which studies to
highlight at the meeting and chief of cardiology at Johns Hopkins University
School of Medicine in Baltimore, tells WebMD that he has concerns about the
bleeding and would like to see more study before the drug is approved.
Prasugrel is being developed by Eli Lilly and Co. and Daiichi Sankyo Co.,
which funded the research.