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Prasugrel in all ACS Patients!

Prasugrel in all ACS Patients! . Giuseppe Biondi-Zoccai , MD Sapienza University of Rome , Italy giuseppe.biondizoccai@uniroma1.it. First and foremost : both prasugrel and ticagrelor are lifesaving vs clopidogrel. Biondi-Zoccai et al, Int J Cardiol 2011.

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Prasugrel in all ACS Patients!

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  1. Prasugrel in all ACS Patients! Giuseppe Biondi-Zoccai, MD Sapienza University ofRome, Italy giuseppe.biondizoccai@uniroma1.it

  2. First and foremost: both prasugrel and ticagrelor are lifesaving vs clopidogrel Biondi-Zoccaiet al, Int J Cardiol 2011

  3. Prasugrel hasanestablished and favorablerisk-benefitprofile Wiviottet al, New Engl J Med 2008

  4. Riskstratificationisofcourse key Montalescotet al, Lancet 2009

  5. Short-termregimens are notenough Murphy et al, Eur Heart J 2008

  6. Dose adjustmentispossible Erlingeet al, J Am CollCardiol 2012

  7. Loadingwithboth clopidogrel and prasugrel isnotprohibitive Lohet al, Am J Cardiol 2013

  8. Particularlyrisk-beneficial in diabetics Wiviottet al, Circulation 2008

  9. And even more so in IDDM Wiviottet al, Circulation 2008

  10. Non-CABGbleedingalso ↑ by ticagrelor Wallentinet al, New Engl J Med 2009

  11. And are shortnessofbreath and bradyarrhythmias minor issues? Wallentinet al, New Engl J Med 2009

  12. Last butnotleast • Are youafraidofincreasedneoplastic riskafterassuming prasugrel? • Do youknowhow long doesit take todevelopcancerafteryou are exposedto a nuclearbomb (e.g. Hiroshima)? • Anypurportedassociationbetween prasugrel and cancerrisk in TRITON-TIMI 38 patentlylacksbiologicplausibility

  13. Do you trust plateletresponsivenessassays? Alexopouloset al, J Am CollCardiol 2012

  14. I personally don’t Biondi-Zoccaiet al, BMJ 2008 (butalsoGurbelet al, JAMA 2012; Colletet al, NEJM 2012; Gagliaet al, CardiovascRevascMed 2013; etc)

  15. Evenifyoubelieve… Alexopouloset al, CircCardiovascInterv 2012

  16. Adjustedindirectcomparison Biondi-Zoccaiet al, Int J Cardiol 2011

  17. Adjustedindirectcomparison Biondi-Zoccaiet al, Int J Cardiol 2011

  18. Adjustedindirectcomparison Biondi-Zoccaiet al, Int J Cardiol 2011

  19. Reconciling the evidence Biondi-Zoccaiet al, CurrVascPharmacol 2012

  20. Manythanksforyourattention Fortheseslides and furtherones on similartopicsfeel free tovisit: www.metcardio.org/slides.html Foradditionaldetails or queriesfeel free tocontact me directly: giuseppe.biondizoccai@uniroma1.it

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