{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2024,8,30]],"date-time":"2024-08-30T17:22:47Z","timestamp":1725038567735},"reference-count":17,"publisher":"Wiley","issue":"10","license":[{"start":{"date-parts":[[2016,10,27]],"date-time":"2016-10-27T00:00:00Z","timestamp":1477526400000},"content-version":"vor","delay-in-days":26,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"funder":[{"DOI":"10.13039\/100000968","name":"American Heart Association","doi-asserted-by":"publisher","award":["13POST16340011"],"award-info":[{"award-number":["13POST16340011"]}],"id":[{"id":"10.13039\/100000968","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100007217","name":"Health Services Research and Development","doi-asserted-by":"publisher","id":[{"id":"10.13039\/100007217","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Clinical Cardiology"],"published-print":{"date-parts":[[2016,10]]},"abstract":"<jats:title>ABSTRACT<\/jats:title><jats:sec><jats:title>Background<\/jats:title><jats:p>Prasugrel is more effective than clopidogrel in preventing thrombotic complications after percutaneous coronary intervention (PCI) among patients with acute coronary syndromes (ACS), but it increases the risk of bleeding in subgroups of patients. There is limited data on whether prasugrel use in routine practice is targeted to clinical settings with greatest anticipated patient benefit.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>In a national cohort of 11 617 veterans who underwent PCI between 2010 and 2013 at Veterans Administration hospitals nationwide, we assessed overall trends in the use of prasugrel and the frequency of prasugrel use in patients with contraindications (prior transient ischemic attack or cerebrovascular accident), higher bleeding risk (age \u226575 or weight &lt;60 kg), and nonindicated settings (non\u2013acute coronary syndrome [non\u2010ACS]). We then evaluated the association between prasugrel use and 1\u2010year risk\u2010adjusted mortality, myocardial infarction, and major bleeding rates.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>Overall, 1040 (9.0%) patients who received prasugrel after PCI were included. Prasugrel was infrequently used in contraindicated (2.4%) or higher\u2010bleeding\u2010risk (1.8%) settings. Additionally, 35.8% of patients received prasugrel in settings that lack evidence of clinical benefit (ie, non\u2010ACS). Compared with clopidogrel, there were no significant differences in risk\u2010adjusted mortality, myocardial infarction, or major bleeding outcomes with prasugrel therapy at 1\u2010year follow\u2010up.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>Prasugrel use after PCI in the Veterans Administration is low and prasugrel was rarely used in contraindicated or high\u2010bleeding\u2010risk settings. However, a third of patients received prasugrel for off\u2010label non\u2010ACS indications that lack efficacy data.<\/jats:p><\/jats:sec>","DOI":"10.1002\/clc.22568","type":"journal-article","created":{"date-parts":[[2016,10,27]],"date-time":"2016-10-27T19:15:24Z","timestamp":1477595724000},"page":"578-584","source":"Crossref","is-referenced-by-count":3,"title":["Prasugrel Use Following PCI and Associated Patient Outcomes: Insights From the National VA CART Program"],"prefix":"10.1002","volume":"39","author":[{"given":"Vikas","family":"Aggarwal","sequence":"first","affiliation":[{"name":"Division of Cardiology, Department of Medicine Temple University School of Medicine  Philadelphia Pennsylvania"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ehrin J.","family":"Armstrong","sequence":"additional","affiliation":[{"name":"Department of Cardiology University of Colorado Denver School of Medicine, VA Eastern Colorado Health Care System  Denver Colorado"},{"name":"Department of Cardiology University of Colorado Denver Anschutz Medical Campus  Aurora Colorado"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Wenhui","family":"Liu","sequence":"additional","affiliation":[{"name":"Department of Cardiology University of Colorado Denver School of Medicine, VA Eastern Colorado Health Care System  Denver Colorado"},{"name":"Department of Cardiology University of Colorado Denver Anschutz Medical Campus  Aurora Colorado"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Thomas M.","family":"Maddox","sequence":"additional","affiliation":[{"name":"Department of Cardiology University of Colorado Denver School of Medicine, VA Eastern Colorado Health Care System  Denver Colorado"},{"name":"Department of Cardiology University of Colorado Denver Anschutz Medical Campus  Aurora Colorado"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"P. Michael","family":"Ho","sequence":"additional","affiliation":[{"name":"Department of Cardiology University of Colorado Denver School of Medicine, VA Eastern Colorado Health Care System  Denver Colorado"},{"name":"Department of Cardiology University of Colorado Denver Anschutz Medical Campus  Aurora Colorado"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Evan","family":"Carey","sequence":"additional","affiliation":[{"name":"Department of Cardiology University of Colorado Denver School of Medicine, VA Eastern Colorado Health Care System  Denver Colorado"},{"name":"Department of Cardiology University of Colorado Denver Anschutz Medical Campus  Aurora Colorado"},{"name":"Department of Cardiology Colorado School of Public Health  Aurora Colorado"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Tracy","family":"Wang","sequence":"additional","affiliation":[{"name":"Department of Cardiology Duke Clinical Research Institute, Duke University School of Medicine  Durham North Carolina"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Matthew","family":"Sherwood","sequence":"additional","affiliation":[{"name":"Department of Cardiology Duke Clinical Research Institute, Duke University School of Medicine  Durham North Carolina"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Thomas T.","family":"Tsai","sequence":"additional","affiliation":[{"name":"Department of Cardiology University of Colorado Denver Anschutz Medical Campus  Aurora Colorado"},{"name":"Department of Cardiology Institute for Health Research, Kaiser Permanente  Denver Colorado"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"John S.","family":"Rumsfeld","sequence":"additional","affiliation":[{"name":"Department of Cardiology University of Colorado Denver School of Medicine, VA Eastern Colorado Health Care System  Denver Colorado"},{"name":"Department of Cardiology University of Colorado Denver Anschutz Medical Campus  Aurora Colorado"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Steven M.","family":"Bradley","sequence":"additional","affiliation":[{"name":"Department of Cardiology University of Colorado Denver School of Medicine, VA Eastern Colorado Health Care System  Denver Colorado"},{"name":"Department of Cardiology University of Colorado Denver Anschutz Medical Campus  Aurora Colorado"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"311","published-online":{"date-parts":[[2016,10,27]]},"reference":[{"key":"e_1_2_6_2_1","doi-asserted-by":"publisher","DOI":"10.1517\/17460441.2013.793668"},{"key":"e_1_2_6_3_1","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMoa0706482"},{"key":"e_1_2_6_4_1","doi-asserted-by":"publisher","DOI":"10.5551\/jat.26013"},{"key":"e_1_2_6_5_1","doi-asserted-by":"publisher","DOI":"10.1253\/circj.CJ-14-0266"},{"key":"e_1_2_6_6_1","doi-asserted-by":"publisher","DOI":"10.1002\/clc.22268"},{"key":"e_1_2_6_7_1","unstructured":"Prasugrel [prescribing information package insert]. 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