Prasugrel Plus Aspirin Beyond 12 Months Is Associated With Improved Outcomes After Taxus Liberté Paclitaxel-Eluting Coronary Stent Placement
Background—The Dual Antiplatelet Therapy Study (DAPT) compared 12 and 30 months thienopyridine plus aspirin therapy after drug-eluting stents. The TAXUS Libertē Post Approval Study (TL-PAS) contributed TAXUS Liberté paclitaxel-eluting stent (PES) patients treated with prasugrel.
Methods and Results—Outcomes for 2191 TL-PAS patients enrolled into DAPT were assessed. The DAPT co-primary composite endpoint (death, myocardial infarction [MI] or stroke) was lower with 30 compared with 12 months therapy (3.7% vs 8.8%, HR=0.407, P<0.001). Rates of death and stroke were similar between groups, but MI was significantly reduced with prolonged prasugrel (1.9% vs 7.1%, HR=0.255, P<0.001). The DAPT co-primary endpoint, stent thrombosis (ST), was also lower with longer therapy (0.2% vs 2.9%, HR=0.063, P<0.001). MI related to ST (0% vs 2.6%, P<0.001) and occurring spontaneously (1.9% vs 4.5%, HR=0.407, P=0.007) were both reduced with prolonged prasugrel. Increased MI rates were observed within 90 days of prasugrel cessation after both 12 and 30 months. Composite GUSTO moderate or severe bleeds were modestly increased (2.4% vs 1.7%, HR=1.438, P=0.234) but severe bleeds were not more frequent (0.3% vs 0.5%, HR=0.549, p=0.471) in the prolonged treatment group.
Conclusions—Prasugrel and aspirin continued for 30 months reduced ischemic events for the TAXUS Liberté PES patient subset from DAPT through reductions in MI and ST. Withdrawal of prasugrel was followed by an increase in MI after both 12 and 30 months therapy. The optimal duration of dual antiplatelet therapy with prasugrel following TAXUS Liberté PES remains unknown, but appears to be >30 months.
- Received October 1, 2014.
- Revision received October 16, 2014.
- Accepted October 20, 2014.