Date post: | 18-Dec-2014 |
Category: |
Health & Medicine |
Upload: | heartmeds |
View: | 390 times |
Download: | 2 times |
Focus
• Comfort• Cost• Side Effects
• MI Definition• Cancer• Uric Acid• Serum Creatinine
MI Definition
• CAMI – centrally adjudicated MIs– Someone that is NOT taking care of the patient– Universally increases the event rate
• SRMI – site reported myocardial infarctions– Someone that is taking care of the patient
MI Definition
CAMI
Prasugrel Clopidogrel Difference HR P-value
475 620 145 0.76 <0.001
SRMI
Prasugrel Clopidogrel Difference HR P-value
226 298 72 0.76 0.08
Thromb Haemost 2012; 108: 412–414
TRITON
MI Definition
CAMI
Ticagrelor Clopidogrel Difference HR P-value
504 593 89 0.84 <0.001
SRMI
Ticagrelor Clopidogrel Difference HR P-value
504 548 44 0.92 0.095
Thromb Haemost 2012; 108: 412–414
PLATO
Probability of all 45 undiagnosed MIs belonging to the clopidogrel arm is 0.0000000000002
One in 5 trillion!!
Cancer – Prasugrel
Arch Intern Med. 2010;170(12):1078-1080.
Measure of Impact
Solid Cancer (N) Total (N)
Prasugrel 92 6813
Clopidogrel 64 6795
Prasugrel = 14 events per 1000 patientsClopidogrel = 9 events per 1000 patients
Prasugrel causes 5 events per 1000 patients
Arch Intern Med. 2010;170(12):1078-1080.
Uric Acid
NEJM 2009;361:1045-57.
PLATO
Renal Function
NEJM 2009;361:1045-57.
PLATO
One more thing...
MI, stroke, CV DeathTicagrelor 11.9%, Clopidogrel 9.6%
HR 1.25; 95% CI 0.93-1.67
NEJM 2009;361:1045-57.
Conclusion
• Prasugrel – Causes bleeding, cancer, and didn’t really statistically reduce MI
• Ticagrelor – Causes dyspnea, ventricular pauses, elevated uric acid, elevated SCr, and didn’t really statistically reduce MI
• Clopidogrel is Big Bird