Table 9.

—[Sections 3.2.1-3.2.5] Prasugrel Plus Aspirin vs Clopidogrel Plus Aspirin in Patients With a Recent ACS and PCI⁵⁷

Outcomes	Participants (Studies), Follow-up	Quality of the Evidence (GRADE)	Relative Effect (95% CI)	Anticipated Absolute Effects Over 1 y
				Risk With Clopidogrel and Aspirin	Risk Difference With Prasugrel and Aspirin (95% CI)
Vascular mortalitya	13,608 (1 RCT), 14.5 mo	Low due to inconsistencyb and imprecisionc	RR 0.89 (0.70-1.12)	50 per 1,000d	No significant difference; 5 fewer per 1,000 (from 15 fewer to 6 more)
MI nonfatal events	13,608 (1 RCT), 14.5 mo	Moderate due to inconsistencyc	RR 0.76 (0.67-0.85)	70 per 1,000d	17 fewer per 1,000 (from 23 fewer to 10 fewer)
Stroke includes nonfatal ischemic and hemorrhagic strokese	13,608 (1 RCT), 14.5 mo	Low due to inconsistencyb and imprecisionc	RR 1.02 (0.71-1.45)	13 per 1,000d	No significant difference; 0 more per 1,000 (from 4 fewer to 6 more)
Major extracranial bleed	13,608 (1 RCT), 14.5 mo	Low due to inconsistencyb and imprecisionc	RR 1.32 (1.03-1.68)	22 per 1,000d	7 more per 1,000 (from 0 more to 15 more)

See Table 1-3, and 8 legends for expansion of abbreviations.

^aFatal bleeds were 0.4% with prasugrel and 0.1% with clopidogrel.

^bRated down for inconsistency for all outcomes due to credible subgroup analyses showing net harm for composite end point in certain subgroups.

^cRated down for imprecision due to wide CIs suggesting important benefit or harm with prasugrel.

^dControl group risk estimates come from the event rates in the clopidogrel arm of the PLATO study, adjusted to a 1-y time frame.

^eHemorrhagic strokes constituted 0.3% of all strokes in both groups.