A 64yo female with diabetes presents to the ER with a STEMI. After PCI she should be on:
a. ASA
b. ASA + plavix
c. ASA + prasugrel
d. B or C
Answer: C. Prasugrel was shown to be more effective in Diabetes compared to plavix. While plavix is technically still an acceptable answer per guidelines, the new European guidelines are recommending prasugrel or ticagrelor over plavix in diabetic patients. The Triton-TIMI Trial compared prasugrel to plavix with prasugrel having less ischemic events and in-stent thrombosis. This effect was magnified in diabetics. Ticagrelor is a platelet aggregation inhibitor. The Plato trial compared ticagrelor to plavix showing improved mortality rates (9.8% compared to 11.7%) but higher non-lethal bleeding rates.
Also in December 2012, there was an article in NEJM (Strategies for Multivessel Revascularization in Patients with Diabetes) article comparing PCI with drug eluting stents in the setting of aggressivel medical management vs. CABG in diabetics and as prior studies had suggested patients who underwent CABG had better outcomes.
