CARDIOVASCULAR JOURNAL OF AFRICA • Vol 22, No 3, May/June 2011
168
AFRICA
Prasugrel study addresses timing of thienopyridine loading dose
in NSTEMI patients pre-PCI (the ACCOAST study)
The optimal timing for the administration
of a thienopyridine loading dose of either
clopidogrel or prasugrel is still a matter of
debate in non-ST-segment elevation acute
coronary syndromes (NSTEMI).
Prasugrel has been selected as the
most appropriate drug to investigate this
aspect as it provides enhanced inhibition
of platelet aggregation (IPA) with less
inter-patient variability. The reduced vari-
ability of prasugrel relates to two main
factors: it is more efficiently metabolised
to its active metabolite than clopidog-
rel and its actions are not influenced
by common functional cytochrome P450
genetic variants.
The design and rationale for the
ACCOAST study, a phase III, multi-
centre, parallel-group, double-blind and
event-driven study has recently been
published.
1
The study involving 4 100
patients will randomise patients to either
an initial loading dose of 30 mg of
prasugrel after the diagnosis of NSTEMI,
followed by coronary angiography, with
an additional dose of 30 mg given at
the time of PCI (referred to as the pre-
treatment cohort).
The second group of randomised
patients will be given a loading dose of
60 mg of prasugrel, given only at the
time of PCI (non-pre-treatment group).
For patients who undergo PCI, open-label
10 mg prasugrel will be given until the
30-day visit, whereas patients who are
older than 75 years or weigh less than 60
kg will be given a 5-mg dose. Patients
will be monitored for 90 days.
The study will continue until 400
patients reach one of the primary efficacy
endpoints (CV death, MI, stroke, urgent
revascularisation, or GPIIb/IIIa inhibitor
bale-out). Adjunctive aspirin (75–325 mg
oral or 250–500 mg iv) will be allowed
according to investigator discretion.
An independent clinical endpoint
committee will adjudicate efficacy and
endpoint events as well as TIMI major
bleeding events in a blinded fashion. Lilly
and Daaiichi Sankyo Co, Ltd are co-spon-
sors of the study. This trial will provide
important clinical data and should prove
to be of value to cardiologists worldwide.
J Aalbers, Special Assignments Editor
1.
Montalescot G, Bolognese L, Dudek D,
Goldstein P, Hamm C, Tanguay J-F,
et
al
. A comparison of prasugrel at the time
of percutaneous coronary intervention or
as pretreatment at the time of diagnosis
in patients with non-ST-segment elevation
myocardial infarction: Design and ration-
ale for the ACCOAST study.
Am Heart J
2010;
161
(4): 650–656.e1. DOI:10.1016/j.
ahj.2010.10.017.
It's the
shell that
makes
safer.
R
Safety-Coated
R
81mg
The ORIGINAL low dose aspirin
for optimum cardio-protection
Hp
Each tablet contains Aspirin 81mg. Reg.No.: 29/2.7/0767
Pharmafrica (Pty) Ltd, 33 Hulbert Road, New Centre, Johannesburg 2001
Under licence from Goldshield Pharmaceuticals Ltd. U.K.
From CVJA 21(6): 323
New anti-coagulant therapies set to revitalise clinical
haemotology practice
Annual meeting of the Southern African Society of Thrombosis and
Haemostasis
Prasugrel can however be used for NSTEMI patients and for STEMI patients treated
with PCI.
From CVJA 21(6): 344
Myocardial salvage after myocardial infarction depends
on early therapy
The one-year survival rate of those patients receiving tirofiban within 75 minutes after
diagnosis and primary PCI was 60% higher than those receiving dual anti-platelet
therapy.
Errata
