{"id":1579,"date":"2010-07-12T14:35:50","date_gmt":"2010-07-12T18:35:50","guid":{"rendered":"http:\/\/blogs.nejm.org\/cardioexchange\/clopidogrel-vs-prasugrel-how-effective-how-risky\/"},"modified":"2011-07-19T17:44:17","modified_gmt":"2011-07-19T21:44:17","slug":"clopidogrel-vs-prasugrel-how-effective-how-risky","status":"publish","type":"post","link":"https:\/\/blogs.nejm.org\/cardioexchange\/2010\/07\/12\/clopidogrel-vs-prasugrel-how-effective-how-risky\/","title":{"rendered":"Clopidogrel vs. Prasugrel: How Effective? How Risky?"},"content":{"rendered":"<p>Here are the issues:<\/p>\n<ol>\n<li>The FDA has posted <a href=\"http:\/\/www.fda.gov\/NewsEvents\/Newsroom\/PressAnnouncements\/ucm204253.htm\">a black box warning <\/a>that people with reduced CYP2C19 liver enzyme function (2% to 14% of the U.S. population) cannot effectively convert clopidogrel to its active form, which reduces its effectiveness in ACS patients.\u00a0CYP2C19 function doesn\u2019t influence prasugrel&#8217;s effectiveness.<\/li>\n<li>The <a href=\"http:\/\/content.onlinejacc.org\/cgi\/content\/full\/j.jacc.2010.05.013\">AHA and ACC <\/a>do not support routine CYP2C19 genetic testing (and\u00a0the test is\u00a0not\u00a0readily available).<\/li>\n<li>Prasugrel (10 mg) is \u22482.5 times more potent than clopidogrel (75 mg); in <a href=\"http:\/\/content.nejm.org\/cgi\/content\/abstract\/357\/20\/2001\">TRITON-TIMI 38<\/a>, ACS patients treated with prasugrel had a 50% higher rate of life-threatening hemorrhage and a 4-fold higher rate of fatal hemorrhage than those treated with clopidogrel.<\/li>\n<li>Prasugrel was\u00a0<a href=\"http:\/\/archinte.ama-assn.org\/cgi\/content\/full\/170\/12\/1078\">recently reported<\/a> to be associated with an increase in cancer rates, prompting the authors of the report to recommend that \u00a0\u201cphysicians should consider the potential cancer risks before prescribing prasugrel, especially with prolonged use and in patients with known cancer.\u201d<\/li>\n<\/ol>\n<p><em><strong>So, how do you decide which agent\u00a0to\u00a0prescribe\u00a0for your ACS patients?<\/strong><\/em><\/p>\n","protected":false},"excerpt":{"rendered":"<p>Here are the issues: The FDA has posted a black box warning that people with reduced CYP2C19 liver enzyme function (2% to 14% of the U.S. population) cannot effectively convert clopidogrel to its active form, which reduces its effectiveness in ACS patients.\u00a0CYP2C19 function doesn\u2019t influence prasugrel&#8217;s effectiveness. The AHA and ACC do not support routine [&hellip;]<\/p>\n","protected":false},"author":214,"featured_media":0,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"footnotes":""},"categories":[1],"tags":[],"class_list":["post-1579","post","type-post","status-publish","format-standard","hentry","category-general"],"_links":{"self":[{"href":"https:\/\/blogs.nejm.org\/cardioexchange\/wp-json\/wp\/v2\/posts\/1579","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/blogs.nejm.org\/cardioexchange\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/blogs.nejm.org\/cardioexchange\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/blogs.nejm.org\/cardioexchange\/wp-json\/wp\/v2\/users\/214"}],"replies":[{"embeddable":true,"href":"https:\/\/blogs.nejm.org\/cardioexchange\/wp-json\/wp\/v2\/comments?post=1579"}],"version-history":[{"count":0,"href":"https:\/\/blogs.nejm.org\/cardioexchange\/wp-json\/wp\/v2\/posts\/1579\/revisions"}],"wp:attachment":[{"href":"https:\/\/blogs.nejm.org\/cardioexchange\/wp-json\/wp\/v2\/media?parent=1579"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/blogs.nejm.org\/cardioexchange\/wp-json\/wp\/v2\/categories?post=1579"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/blogs.nejm.org\/cardioexchange\/wp-json\/wp\/v2\/tags?post=1579"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}