Comparative resource utilization and costs for patients with acute coronary syndrome managed with percutaneous coronary intervention and treated with clopidogrel or prasugrel.

ANEMIA diagnosis; DIAGNOSIS of diabetes; HEMORRHAGE diagnosis; HOSPITALS & economics; HEMORRHAGE risk factors; ADVERSE health care events; AGE distribution; ANTICOAGULANTS; ASTHMA; CONFIDENCE intervals; DATABASES; DEMOGRAPHY; ELECTROCARDIOGRAPHY; ETHNIC groups; CARDIAC patients; OBSTRUCTIVE lung diseases; MEDICAL needs assessment; MEDICAL care use; MEDICAL care costs; MYOCARDIAL infarction; MYOCARDIAL revascularization; OSTEOARTHRITIS; PHARMACOLOGY; RACE; RESEARCH funding; TRANSLUMINAL angioplasty; COMORBIDITY; LOGISTIC regression analysis; CENTERS for Medicare & Medicaid Services (U.S.); DATA analysis; ACCESS to information; CLOPIDOGREL; DESCRIPTIVE statistics; ACUTE coronary syndrome; DISEASE complications; DIAGNOSIS

Purpose. Results of a study of bleeding events and other inhospital outcomes with the use of clopidogrel versus prasugrel in patients with acute coronary syndrome (ACS) managed with percutaneous coronary intervention (PCI) are reported. Methods. Demographic and clinical data on adults hospitalized for ACS, managed with PCI, and treated with clopidogrel or prasugrel during a twoyear period were extracted from a large hospital claims database. Bleeding rates, hospital length of stay (LOS), and total hospital costs during the index hospitalization were evaluated. Results. The study sample consisted of 75,297 patients who received clopidogrel and 9,477 who received prasugrel. The unadjusted bleeding rates were 5.7% with clopidogrel use and 3.2% with prasugrel use (p < 0.0001). After propensity score stratification to adjust for selection bias, rates of bleeding events were not significantly different between clopidogrel- and prasugrel-treated patients (odds ratio, 0.90; 95% confidence interval [CI], 0.80-1.02; p = 0.0949). The adjusted mean ± S.D. hospital LOS was 0.22 day lower (95% CI, 0.15-0.28; p < 0.001) with the use of prasugrel versus clopidogrel, and adjusted total mean hospital costs were $375 less for prasugrel-treated patients (p = 0.003). Conclusion. After adjustments for demographic and clinical characteristics, rates of inhospital bleeding in patients who received prasugrel and those who received clopidogrel were not significantly different. The adjusted analyses showed that the mean hospital LOS was shorter and total mean hospital costs were lower for patients treated with prasugrel. [ABSTRACT FROM AUTHOR]