Prasugrel.

Summary and Recommendations Prasugrel is a third-generation thienopyridine with moreconsistent and efficient metabolism than clopidogrel, thecurrent standard of care. Pharmacodynamic studies haveshown that patients taking prasugrel compared with standardor higher doses of clopidogrel have higher levels of thien-opyridine active metabolite and higher and more consistentlevels of platelet inhibition. Prasugrel appears less susceptibleto genetic variation and drug-drug interactions, which canlimit the antiplatelet activity and clinical effectiveness ofclopidogrel. This pharmacokinetic and pharmacodynamicsuperiority is translated into improved ischemic outcomes butmore bleeding in patients with ACS and planned PCI. Thesedata serve as the first to definitively demonstrate that an agent(or dose of an agent) with higher and more consistent levelsof platelet P2Y 12 inhibition can reduce ischemic events, a keyresearch question in cardiology, and set the stage for furtherresearch on personalized medicine, alternative agents, andalternative platelet targets. These data, however, do notindicate the presence of specific goal levels of plateletinhibition for individual patients. Ticagrelor, a direct, non-thienopyridine P2Y