Abstract 17440: Prasugrel is Commonly Prescribed to Patients with Contraindications; Insights from the Blue Cross Blue Shield of Michigan Cardiovascular Consortium (BMC2)
Background: Prasugrel is a novel thienopyridine approved for use in July 2009 for patients with acute coronary syndromes undergoing percutaneous coronary intervention (PCI). Compared to clopidogrel, prasugrel has improved anti-ischemic efficiacy at the cost of a higher risk of bleeding complications. There are no data on current trends in use of prasugrel in clinical practice.
Methods: We assessed the appropriate and inappropriate use of prasugrel among 55,821 patients who underwent PCI and were discharged alive from January 2010 to December 2011 at 31 hospitals participating in the Blue Cross Blue Shield of Michigan Cardiovascular Consortium.
Results: Of the total, 83% (n=46,574) of patients received clopidogrel and 17% (n=9,247) received prasugrel on discharge. There has been a steady increase in the use of prasugrel over the study period (Figure). Of patients discharged on prasugrel, 10% (n= 953) had one or more known relative contraindications to the drug. Among patients administered prasugrel in the setting of a relative contraindication, 335 (35%) were greater than the age of 75 years, 208 (22%) patients weighed less than 60 kg, and 498 (52%) had a history of cerebro-vascular disease (CVA). Overall, among patients presenting with ACS (n=38,568, 69% of total), one or more contraindications was present in 13,069 (34%) patients.
Conclusion: A significant number of patients received prasgurel with relative contraindications. Given the increasing use of this drug, focused efforts are needed to ensure that prasugrel is avoided in patients with known contraindications. Figure1:
- © 2012 by American Heart Association, Inc.