Prasugrel – a third-generation thienopyridine
Introduction Thienopyridine antiplatelet agents represent a major advance in the care of patients with coronary artery disease, particularly those with acute coronary syndromes (ACS) and those undergoing percutaneous coronary intervention (PCI). Clopidogrel has largely replaced ticlopidine because of better tolerability and fewer side-effects. Despite the significant improvement of dual antiplatelet therapy with aspirin and clopidogrel over aspirin alone, significant limitations of this agent exist; relatively modest inhibition of platelet aggregation, delayed onset of antiplatelet activity, and substantial variability of response among individuals. 1 As a result of these limitations, there may be a role for novel antiplatelet agents, including newer-generation thienopyridines. Prasugrel (CS-747, LY 640315) is the first new agent in this class to undergo clinical testing, and is the subject of this chapter.