Long Term Efficacy of Prasugrel versus Clopidogrel in Patients undergoing Percutaneous Coronary Intervention and Anticoagulated with Bivalirudin

Aim: Dual-antiplatelet therapy with aspirin and a thienopyridine is a cornerstone of treatment to prevent thrombotic complications of acute coronary syndromes and percutaneous coronary intervention. We studied the long term efficacy of prasugrel compared with clopidogrel loading in patients undergoing percutaneous coronary intervention (PCI), electively or emergently, who were anticoagulated with bivalirudin during the procedure. Methods and Results: This retrospective cohort study included 296 patients (153 prasugrel and 143 clopidogrel) who underwent PCI at our institution from January 2009-December 2012. Time to stroke, non-fatal MI, PCI, CABG, or death (MACE) was assessed in all patients. The mean follow-up was 1198 days (1284 ± 599 days for clopidogrel patients vs. 1119 ± 423 days for prasugrel patients), first MACE occurred in 26 (18.2%) clopidogrel patients vs 17 (11.1%) prasugrel patients (p=0.085). The propensity-adjusted (for key clinical and non-clinical risk factors) Cox model showed no significant difference to time to the first MACE event (Hazard ratio for clopidogrel versus prasugrel [HR]=1.06; 95% confidence interval [CI]: 0.54 to2.04; p=0.860). Likewise the conditional survival model revealed no differences between clopidogrel patients and prasugrel patients in terms of repeated MACE or repeated MI (Repeated MACE: HR=1.37; 95%CI: 0.74, 2.52 and Repeated MI: HR=1.32; 95%CI: 0.71, 2.45). Conclusion: On the long term, there were no significant differences in MACE between patients anticoagulated with bivalirudin and given either clopidogrel or prasugrel during PCI.