Implications of the Antiplatelet Therapy Gap Left With Discontinuation of Prasugrel in Canada.

Abstract

BACKGROUND:

The current Canadian Cardiovascular Society antiplatelet therapy guidelines recommend the use of ticagrelor or prasugrel over clopidogrel as first-line platelet P2Y12 receptor antagonists for treatment of moderate- to high-risk acute coronary syndromes. Recently, Effient (prasugrel [Eli Lilly Canada Inc, Toronto, Canada]) was discontinued by its distributor in Canada.

METHODS:

Five members of the Canadian Cardiovascular Society antiplatelet therapy 2018 guidelines committee undertook an independent, evidence-based review to outline patients for whom prasugrel should be the optimal P2Y12 agent and discuss alternative strategies to consider without prasugrel.

RESULTS:

Several clinical scenarios where prasugrel should be indicated are identified and discussed. Considerations to be undertaken for alternative therapies are summarized, including a review of national and international guidelines for de-escalation of P2Y12 receptor antagonists.

CONCLUSIONS:

The discontinuation of prasugrel poses a challenge for clinicians. Clinicians must consider key factors in determining the best alternate therapy.

• Authors: Marie Lordkipanidzé, Guillaume Marquis-Gravel, Jean-François Tanguay, Shamir R Mehta, Derek Y F So
• Journal: CJC open (CJC Open) Vol. 3 Issue 6 Pg. 814-821 (Jun 2021) ISSN: 2589-790X [Electronic] United States
• PMID: 34169260 (Publication Type: Journal Article)
• Copyright: © 2021 The Authors.