The Midlands Therapeutics Review and Advisory Committee (MTRAC) has reviewed the evidence on prasugrel (Efient®) for acute coronary syndrome (ACS) managed with percutaneous coronary intervention (PCI).

The Committee concluded that prasugrel is suitable for primary care prescribing, after initiation in secondary care. It is considered suitable for a limited number of patients and the benefits must be weighed against the risk of bleeding.

Prasugrel is an anti-platelet agent chemically and pharmacologically related to clopidogrel. It has been compared to clopidogrel in one large randomised controlled trial, involving patients with ACS undergoing planned PCI. Patients considered to be at high risk of bleeding were excluded. There were fewer outcome events (cardiovascular death, or non-fatal MI or stroke) in the prasugrel group compared to the clopidogrel group with a number needed to treat of 45. There were also more instances of major bleeding in the prasugrel group, with a number needed to harm of 167.

MTRAC considered that it should have a lower place in therapy because of concerns over safety; it was also noted that the loading dose of clopidogrel used in the trial was lower than that now commonly used in the UK (300mg vs. 600mg).

The evaluation is available from the MTRAC website, and at time of posting is linked from their Latest News page (see link).

[Editor's note: MTRAC reviews are intended for guidance of GPs in the West Midlands region, but may be of interest elsewhere in the NHS.]