Will prasugrel supersede clopidogrel for acute coronary syndromes?

Graeme J Hankey, John W Eikelboom and Paul E Langton
Med J Aust 2008; 188 (7): . || doi: 10.5694/j.1326-5377.2008.tb01678.x
Published online: 7 April 2008

The benefits are greater efficacy and faster onset of action; the price is increased risk of bleeding . . .

The mainstay of antiplatelet therapy for patients with acute coronary syndromes (ACS), including those undergoing early percutaneous coronary intervention (PCI), is the combination of aspirin and clopidogrel.1-3 Aspirin inhibits platelet thromboxane A2 production and platelet activation, and reduces the relative risk of recurrent ischaemic events in patients at high risk of vascular events by about 22% (absolute risk reduction [ARR], about 2%) at the expense of an increase in the odds of major bleeding events by about 60% (absolute risk increase [ARI], about 0.5%).1 Clopidogrel inhibits ADP-induced platelet activation by blocking the platelet P2Y12 receptor. When added to aspirin therapy in patients with ACS, it reduces the risk of recurrent ischaemic events by a further 20% (ARR, about 2.1%) at the expense of an increase in major bleeding events by approximately 38% (ARI, about 1%).2,3

  • Graeme J Hankey1
  • John W Eikelboom2,3
  • Paul E Langton4,5

  • 1 Department of Neurology, Royal Perth Hospital, Perth, WA.
  • 2 Thrombosis Service, Hamilton General Hospital, Hamilton Health Sciences Corporation, Hamilton, Ontario, Canada.
  • 3 Department of Medicine, McMaster University, Hamilton, Ontario, Canada.
  • 4 Hollywood Private Hospital, Perth, WA.
  • 5 School of Medicine, University of Notre Dame, Fremantle, WA.


Competing interests:

Graeme Hankey has received speaker fees and travel assistance from Sanofi-Aventis to attend scientific meetings.


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