View article

To the Editor: Prasugrel significantly decreased cardiovascular death, myocardial infarction (MI), and stroke compared with clopidogrel in TRITON-TIMI 38 (Trial to Assess Improvement in Therapeutic Outcomes by Optimizing Platelet Inhibition with PrasugreldThrombolysis in Myocardial Infarction 38)(1). However, prasugrel use was associated with increased bleeding in patients with a history of previous stroke or transient ischemic attack (TIA) and was not associated with benefit in those 75 years of age. The prasugrel package insert (2) includes a black box warning for patients with previous stroke/TIA and also recommends against its use in patients aged 75 years due to an increased risk of fatal intracranial bleeding and uncertain benefit, except in high-risk situations (age 75 years with history of diabetes or a previous MI). The current American College of Cardiology Foundation/American Heart Association …