Platelet inhibition in STEMI: tirofiban bests cangrelor, and both best chewed prasugrel

  • Circulation

  • curated by Emily Willingham, PhD
  • Clinical Essentials
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Takeaway

  • For inhibition of platelet aggregation in ST-segment elevation myocardial infarction (STEMI), chewed prasugrel is inferior to cangrelor or tirofiban, and tirofiban outperforms cangrelor.

Why this matters

  • The FABOLUS-FASTER trial involved the first pharmacokinetic comparison of parenteral drugs with chewed or integral prasugrel intake in patients with STEMI having primary percutaneous coronary intervention.
  • The authors say that their findings point to parenteral drugs as the appropriate choice for rapid inhibition of platelet aggregation and to deal with the delay to inhibition with oral inhibitors.

Study design

  • Multicenter, open-label, randomized trial.
  • Inhibition of platelet aggregation = maximal percentage of platelet aggregation after agonist stimulation.
  • 122 patients with STEMI, having no history with these drugs, were allocated to cangrelor (n=40), tirofiban (n=40), or prasugrel (chewed, n=21; integral, n=21).
  • Funding: Medicure Inc.

Key results

  • Tirofiban outperformed cangrelor at 30 minutes and all other time points (P<.001>
  • Tirofiban and cangrelor each outperformed chewed prasugrel (each P<.001 with tirofiban continuing to show superior inhibition at other time points.>
  • Cangrelor superiority to chewed prasugrel faded by 2 hours.
  • Chewed prasugrel was no better than integral prasugrel at 1 hour.

Limitations

  • Mechanistic pharmacokinetic study.