Pretreatment with Prasugrel in Non–ST-Segment Elevation Acute Coronary Syndromes

P2Y 12 inhibitors are effective in non–ST-segment elevation acute coronary syndromes, but the timing of drug dosing is unclear. In this trial, pretreatment with prasugrel, as compared with treatment after coronary angiography, did not improve outcomes and increased the risk of bleeding. Clopidogrel does not become biologically and clinically effective until several hours after administration. 1 , 2 Although a loading dose of clopidogrel is required in patients undergoing percutaneous coronary intervention (PCI), it is uncertain whether pretreatment with clopidogrel (with treatment given early enough before catheterization to be effective) is efficient when the coronary-artery anatomy in a patient with a non–ST-segment elevation (NSTE) acute coronary syndrome is not known. Pretreatment can delay a coronary-artery bypass grafting (CABG) procedure or increase unnecessarily the risk of bleeding in patients who do not need to undergo PCI. Two randomized studies, one involving patients with NSTE acute . . .