Efficacy of prasugrel in the ischemic stroke patients: the phase III PRASTRO trial

Abstract

Prasugrel is a P₂Y₁₂ receptor antagonist with a thienopyridine structure that exhibits a faster, stronger, and more stable antiplatelet action than that of clopidogrel. Prasugrel has been approved in Japan for the treatment of patients with heart disease who have undergone percutaneous coronary intervention. Recently, the efficacy and safety of prasugrel for prevention of recurrence of thrombotic stroke patients have been demonstrated in three multicenter, double–blind studies (PRASTRO–I, PRASTRO–II, and PRASTRO–III) conducted in patients with non–cardioembolic stroke in Japan. The primary efficacy endpoint in thrombotic stroke patients at high risk of ischemic stroke recurrence was similar in the prasugrel and clopidogrel groups, and no major safety issues were identified in the prasugrel group. Combined analysis of these three PRASTRO studies suggests the efficacy of prasugrel in the prevention of stroke recurrence in thrombotic stroke patients with risk factors.