Prasugrel in Coronary Intervention in Foreign Patients in Japan

• Published in: Nihon Kanshikkan Gakkaishi Vol. 3; pp. 1 - 5
• Main Authors: Oyakawa, Takuya, Maehira, Naoya, Uechi, Yoichi, Higa, Tomitaka
• Format: Journal Article
• Language: Japanese
• Published: The Japanese Coronary Association 2021; 特定非営利活動法人 日本冠疾患学会
• Subjects: clopidogrel; non-Japanese; percutaneous coronary intervention (PCI); prasugrel; thienopyridine; クロピドグレル; チエノピリジン; プラスグレル; 冠動脈インターベンション; 外国人
• ISSN: 2434-2157
• DOI: 10.32182/njcoron.20-00021

Background: Prasugrel is taken overseas at 10 mg/day (loading dose: 60 mg). However it is taken at 3.75 mg/day (loading dose: 20 mg) in Japan. The Japanese dose is prescribed for the health insurance covered treatment when prasugrel is administered to non-Japanese patients in Japan. The best practice for use of prasugrel in non-Japanese patients in Japan is not clear. Objective: To confirm the efficacy of prasugrel in foreign patients in Japan. Method: Our subjects for this study were European and American patients who received percutaneous coronary intervention (PCI) in our hospital between 2010 and 2018. We retrospectively compared the incidence of major adverse cardiac event (MACE) and bleeding in patients taking prasugrel (3.75 mg/day, loading dose: 20 mg) and patients taking clopidogrel (75 mg/day, loading dose: 300 mg) during the administration period of each drug. Results: Twenty-six patients were treated with prasugrel, and 85 with clopidogrel. Characteristics of patients (prasugrel/clopidogrel) were: age 57/56, body weight 87.4/88.5kg. The incidence rate of MACE was 5 (19.2%) in the prasugrel group, and 4 (4.7%) in the clopidogrel group (RR:4.1, 95%CI:1.18-14.1, p=0.03). The types of MACE (prasugrel/clopidogrel) were revascularization (4/4), nonfatal MI [1(stent thrombosis)/0], cardiovascular death (0/0). There were no differences in bleeding events. Conclusions: The use of the Japanese health insurance mandated dose of prasugrel had a higher incidence of MACE than clopidogrel in PCI for foreign patients. Clopidogrel may be more useful than Japanese doses of prasugrel for foreign patients in Japan.