Abstract 12618: Dramatic Underuse of Prasugrel in Contemporary Practice: Insights from the Blue Cross Blue Shield of Michigan Cardiovascular Consortium (BMC2)
Background: Prasugrel is a recently approved thienopyridine that has demonstrated a reduction in ischemic events (and increase in bleeding events) in patients with acute coronary syndromes undergoing percutaneous coronary intervention (PCI). There are no data on contemporary use of Prasugrel in routine clinical practice.
Methods: We assessed the temporal trend in prescription of Prasugrel among 8690 patients who underwent PCI from August- December 2009 and survived to hospital discharge at the 31 participating hospitals participating in the Blue Cross Blue Shield of Michigan Cardiovascular Consortium. We further evaluated the proportion of patients who were prescribed Prasugrel despite having a contra-indication to its use based on age, body weight and prior stroke or TIA.
Results: The overall use of Prasugrel in the overall cohort was low (1.82%) but demonstrated a steady rise over the study period. The rate of use in patients with ACS was also low but steadily increased (Figure). Among patients prescribed prasugrel, 34% (54) did not have ACS. Of the patients prescribed Prasugrel, 27.4% (n= 26) had one of the label listed contraindications. Among the 5174 patients with ACS that survived to discharge, 1790 (35%) had a contraindication to prasugrel use.
Conclusions: The use of Prasugrel remained restricted to a very small number of patients in the first few months following the drug's approval. The drug was prescribed to a significant number of patients with label listed contraindications. Further studies are warranted to assess the reasons for a relatively low use of this drug in contemporary practice.
- © 2010 by American Heart Association, Inc.