{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,5,20]],"date-time":"2026-05-20T02:56:59Z","timestamp":1779245819864,"version":"3.51.4"},"reference-count":34,"publisher":"Wiley","issue":"5","license":[{"start":{"date-parts":[[2025,8,4]],"date-time":"2025-08-04T00:00:00Z","timestamp":1754265600000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0\/"}],"funder":[{"DOI":"10.13039\/100020595","name":"National Science and Technology Council","doi-asserted-by":"publisher","award":["NSTC 113\u20102320\u2010B\u2010002\u2010054"],"award-info":[{"award-number":["NSTC 113\u20102320\u2010B\u2010002\u2010054"]}],"id":[{"id":"10.13039\/100020595","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100020595","name":"National Science and Technology Council","doi-asserted-by":"publisher","award":["MOST 111\u20102636\u2010B\u2010002\u2010019"],"award-info":[{"award-number":["MOST 111\u20102636\u2010B\u2010002\u2010019"]}],"id":[{"id":"10.13039\/100020595","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100000049","name":"National Institute on Aging","doi-asserted-by":"publisher","award":["K01AG073651"],"award-info":[{"award-number":["K01AG073651"]}],"id":[{"id":"10.13039\/100000049","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["ascpt.onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Clin Pharma and Therapeutics"],"published-print":{"date-parts":[[2025,11]]},"abstract":"<jats:p>\n                    Prasugrel is recommended for acute coronary syndrome (ACS) patients undergoing percutaneous coronary intervention (PCI). However, East Asians exhibit a stronger antiplatelet response, raising concerns about bleeding risks with standard dosing. This retrospective cohort study evaluated the real\u2010world effectiveness and safety of reduced\u2010dose prasugrel in an East Asian population by emulating the pivotal PRASFIT\u2010ACS trial using Taiwan\u2019s National Health Insurance claims data. In this study, ACS patients were classified into reduced\u2010dose prasugrel or clopidogrel groups post\u2010PCI. We estimated the intention\u2010to\u2010treat effect of initiating reduced\u2010dose prasugrel vs. clopidogrel on the risk of major adverse cardiovascular events (MACE) and the per\u2010protocol effect of treating with reduced\u2010dose prasugrel on major bleeding risk using Cox proportional hazard models. A total of 4833 ACS patients were analyzed, including 977 (20.2%) who received reduced\u2010dose prasugrel. Reduced\u2010dose prasugrel showed comparable effectiveness to clopidogrel in preventing MACE (HR: 0.96, 95% CI: 0.72\u20131.29) and did not increase bleeding risk (HR: 0.82, 95% CI: 0.36\u20131.90), consistent with PRASFIT\u2010ACS results (HR\n                    <jats:sub>MACE<\/jats:sub>\n                    : 0.85, 95% CI: 0.62\u20131.16; HR\n                    <jats:sub>Bleeding<\/jats:sub>\n                    : 0.82, 95% CI: 0.39\u20131.73). A significant reduction in cardiovascular mortality was observed (HR: 0.51, 95% CI: 0.29\u20130.89), differing from PRASFIT\u2010ACS findings (HR: 1.21, 95% CI: 0.48\u20133.06). Our results suggest that reduced\u2010dose prasugrel was effective in preventing thrombotic events in the Taiwanese population without significantly increasing bleeding risk. These findings align with pivotal trial outcomes while highlighting the importance of race\u2010specific dose adjustments to optimize ACS treatment strategies. Further research is needed to evaluate whether these results are applicable to other East Asian populations.\n                  <\/jats:p>","DOI":"10.1002\/cpt.70017","type":"journal-article","created":{"date-parts":[[2025,8,4]],"date-time":"2025-08-04T14:44:32Z","timestamp":1754318672000},"page":"1170-1179","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":1,"title":["Effectiveness and Safety of Reduced\u2010Dose Prasugrel in an East Asian Population:\n                    <scp>PRASFIT<\/scp>\n                    \u2010\n                    <scp>ACS<\/scp>\n                    Emulation Using National Health Insurance Claims Data"],"prefix":"10.1002","volume":"118","author":[{"given":"Li\u2010Wen","family":"Huang","sequence":"first","affiliation":[{"name":"Graduate Institute of Clinical Pharmacy College of Medicine, National Taiwan University  Taipei Taiwan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0009-0009-5675-2811","authenticated-orcid":false,"given":"Yee\u2010Jen","family":"Wu","sequence":"additional","affiliation":[{"name":"Department of Pharmacy National Taiwan University Hospital  Taipei Taiwan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8249-7481","authenticated-orcid":false,"given":"Fang\u2010Ju","family":"Lin","sequence":"additional","affiliation":[{"name":"Graduate Institute of Clinical Pharmacy College of Medicine, National Taiwan University  Taipei Taiwan"},{"name":"Department of Pharmacy National Taiwan University Hospital  Taipei Taiwan"},{"name":"School of Pharmacy, College of Medicine National Taiwan University  Taipei Taiwan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9517-2176","authenticated-orcid":false,"given":"Chien\u2010Chih","family":"Wu","sequence":"additional","affiliation":[{"name":"Department of Pharmacy National Taiwan University Hospital  Taipei Taiwan"},{"name":"School of Pharmacy, College of Medicine National Taiwan University  Taipei Taiwan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4432-1864","authenticated-orcid":false,"given":"Hsin\u2010Yi","family":"Huang","sequence":"additional","affiliation":[{"name":"School of Pharmacy, College of Medicine National Taiwan University  Taipei Taiwan"},{"name":"Department of Population Medicine Harvard Medical School and Harvard Pilgrim Health Care Institute  Boston Massachusetts USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4597-4859","authenticated-orcid":false,"given":"Chi\u2010Chuan","family":"Wang","sequence":"additional","affiliation":[{"name":"Graduate Institute of Clinical Pharmacy College of Medicine, National Taiwan University  Taipei Taiwan"},{"name":"Department of Pharmacy National Taiwan University Hospital  Taipei Taiwan"},{"name":"School of Pharmacy, College of Medicine National Taiwan University  Taipei Taiwan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1305-0846","authenticated-orcid":false,"given":"Xiaojuan","family":"Li","sequence":"additional","affiliation":[{"name":"Department of Population Medicine Harvard Medical School and Harvard Pilgrim Health Care Institute  Boston Massachusetts USA"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"311","published-online":{"date-parts":[[2025,8,4]]},"reference":[{"key":"e_1_2_11_1_1","doi-asserted-by":"publisher","DOI":"10.1161\/CIRCULATIONAHA.109.921502"},{"key":"e_1_2_11_2_1","doi-asserted-by":"publisher","DOI":"10.1001\/jama.2021.0716"},{"key":"e_1_2_11_3_1","doi-asserted-by":"publisher","DOI":"10.1093\/eurheartj\/ehaa575"},{"key":"e_1_2_11_4_1","doi-asserted-by":"publisher","DOI":"10.1007\/s11886-014-0485-4"},{"key":"e_1_2_11_5_1","first-page":"422","article-title":"The East Asian paradox: an updated position statement on the challenges to the current antithrombotic strategy in patients with cardiovascular disease","volume":"121","author":"Kim H.K.","year":"2020","journal-title":"Thromb. 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