Clinical Effectiveness and Safety of Reduced-Dose Prasugrel in Asian Patients: The PROMISE-TW Registry
Year: 2025
Type: article
Study design: Observational Study
Abstract: Background: Reduced-dose prasugrel is widely used in East Asia for acute coronary syndrome (ACS), but real-world data in diverse Asian populations are limited. This study evaluated its effectiveness and safety in Taiwanese patients. Methods: The PROMISE-TW Registry was a multicenter, retrospective study including 1,167 patients with ACS or chronic coronary syndrome (CCS) treated with reduced-dose prasugrel (20 mg loading, 3.75 mg maintenance) across 13 hospitals in Taiwan from 2018 to 2022. The primary endpoint was 1-year major adverse cardiovascular events (MACE: cardiovascular death, non-fatal myocardial infarction, non-fatal stroke). Secondary outcomes included composite ischemic events and major bleeding (BARC 3–5). Results: Among enrolled patients (mean age 63.9 years, 81.2% male, 83% ACS), percutaneous coronary intervention was performed in 90.8%. At one year, MACE occurred in 1.9%, composite ischemic events in 8.2%, and major bleeding in 0.8%. Subgroup analysis identified prior stroke, diabetes, and chronic total occlusion intervention as predictors of bleeding. Male sex, chronic kidney disease, and left circumflex artery intervention predicted higher ischemic risk. Conclusions: Reduced-dose prasugrel provided effective ischemic protection and low bleeding rates in Taiwanese patients, especially those with ACS. These findings support the clinical utility of dose-adjusted prasugrel in East Asian populations and highlight the importance of individualized risk assessment.
Source: Journal of Clinical Medicine
DOI: 10.3390/jcm14165791
Institutions: Asia University, China Medical University, China Medical University Hospital, Asia University Hospital, Chihlee Institute of Technology, Chung Shan Medical University Hospital, Chung Shan Medical University, Far Eastern Memorial Hospital, Yuan Ze University, National Yang Ming Chiao Tung University, Cheng Hsin General Hospital, Tzu Chi Foundation, Hualien Tzu Chi Medical Center, Tainan Municipal Hospital, Tainan Hospital, Chang Gung University, Chang Gung Memorial Hospital, Linkou Chang Gung Memorial Hospital, Kaohsiung Medical University, Kaohsiung Medical University Chung-Ho Memorial Hospital, Kaohsiung Municipal Hsiao-Kang Hospital, National Taiwan University Hospital, Taipei Veterans General Hospital, National Chung Hsing University, Taichung Veterans General Hospital
Language: English
Subfield: Cardiology and Cardiovascular Medicine
Field: Medicine
Domain: Health Sciences
Open Access status: gold
Estimated APC paid: $3,137
OpenAlex ID: W4413340132