This post was authored by Ravi S. Hira, MD, and members of the PINNACLE Registry Research and Publications Subcommittee: Paul S. Chan, MD, MSc and Salim S. Virani, MD, PhD, FACC.

Approved for use in patients with acute coronary syndrome undergoing percutaneous coronary intervention in July 2009, prasugrel is a relatively new antiplatelet agent that was shown to decrease cardiovascular death, myocardial infarction (MI) and stroke when compared to clopidogrel in the TRITON-TIMI 38 trial. Despite the proven efficacy, prasugrel has been associated with increased major bleeding in patients with prior stroke or transient ischemic attack, and therefore is contraindicated in these patients. It is also not recommended in patients 75 years of age or older without a history of diabetes or prior MI.

In order to examine the frequency and practice patterns of the inappropriate and non-recommended use of prasugrel, we conducted a study – recently published in the Journal of the American College of Cardiology – which used data from the PINNACLE Registry.

Through our research, we found that almost one in five (18.3 percent) patients captured in the PINNACLE Registry received prasugrel inappropriately or for a non-recommended indication. Within the dataset, we also found significant practice-level variation. After adjusting for patient characteristics, we found that, between two identical patients treated at two randomly selected practices, one patient would be nearly three times as likely to receive prasugrel inappropriately compared with the other, suggesting huge variations in rates of inappropriate prasugrel treatment based solely on where a patient sought care.

Because of the higher risk for major bleeding in patients with a history of stroke or transient ischemic attack who inappropriately receive prasugrel, it is important to understand the extent to which recommendations for prasugrel are followed. Our findings show a need for health care providers to know the recommendations for prasugrel prescribing and for providers and practices to examine and improve their evidence-based use of this therapy.

Learn more about the PINNACLE Registry at NCDR.com/PINNACLE. Also learn more about where the ACC and the PINNACLE Registry are heading in a Leadership Page in the Journal of the American College of Cardiology.

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