Prehospital administration of crushed tablets of prasugrel loading dose in the ambulance while patient is on his way to primary PCI does not improve reperfusion markers compared against uncrushed tablet administration according to the COMPARE CRUSH, presented at the virtual TCT 2020 and simultaneously published in Circulation.

There were no differences in TIMI flow of the infarct related artery or in ST resolution at 60 minutes after PCI. 

These data differ from prior study outcomes which had shown an advantage in prehospital crushed prasugrel administration assuming a faster absorption and therefore faster platelet inhibition. 

The advantage seems to be just another lab result got from measuring platelet aggregation degree, which does not translate in better reperfusion.

The COMPARE CRUSH included 727 patients undergoing ST elevation MI within 6 hours of symptom onset randomized by the emergency service to 60 mg of crushed prasugrel vs uncrushed tablets. The rest of patients received aspirin and 5000 IU of heparin.

Read also: TCT 2020 | Using OCT to Detect Vulnerable Plaque even with Negative FFR.

TIMI flow 3 at initial angiography prior revascularization (primary end point) was 31% with crushed prasugrel vs 32.7% with uncrushed tablets (p=0.64). Complete ST resolution after primary PCI was 59.9% vs 57.3% (p=0.55). ST partial resolution (between 30-70%), minimal resolution (<30%) or >50% resolution rates also resulted similar.

This was similar for all patient subgroups including +75-year olds and prior MI.

The only difference between crushed and uncrushed tablets was platelet reactivity at 45 minutes after administration, which appeared just interesting. 

Original Title: COMPARE CRUSH: a randomized trial of prehospital crushed vs uncrushed prasugrel in STEMI.

Reference: Vlachojannis GJ et al. Circulation. 2020; Epub ahead of print y presentado en el congreso TCT 2020 virtual.

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