Reduced dose of prasugrel was as effective and associated with a reduced risk for bleeding compared with a standard dose of ticagrelor for elderly or low-weight patients with acute coronary syndrome (ACS). The trial findings are published in Annals of Internal Medicine.
Two large randomized trials showed that prasugrel and ticagrelor are superior to clopidogrel and aspirin for older patients with ACS, but the dosing algorithm of prasugrel was adjusted after the initial trial because of safety concerns. However, the efficacy and safety of this adjusted treatment strategy have not been widely tested in large randomized trials.
The ISAR-REACT 5 (Intracoronary Stenting and AntiThrombotic Regimen: Rapid Early Action for Coro-nary Treatment 5) trial showed that prasugrel was superior to ticagrelor in reducing the composite end point of death, myocardial infarction, or stroke without increasing the risk for major bleeding in patients with ACS who were managed invasively.
They found that the lower dose of prasugrel maintained anti-ischemic efficacy while protecting this patient population against the excess risk for bleeding.