prasugrel-hydrochloride and Lung-Neoplasms

Patients are generally required to stop antiplatelet therapy prior to elective invasive procedures. Some patients receive dual antiplatelet therapy for recent vascular procedures such as drug-eluting coronary stenting, and early discontinuation of antiplatelet agents could lead to a significant risk of stent thrombosis. Most bronchoscopic procedures are performed on patients using Aspirin but not on those using Clopidogrel or Prasugrel. In this report, we describe a unique case of a patient with a recent placement of drug-eluting stents, who required endobronchial biopsies for evaluation of lung cancer recurrence. The procedure was performed successfully and safely with no complications.

Topics: Angioplasty, Balloon, Coronary; Aspirin; Biopsy, Needle; Bronchoscopy; Carcinoma, Squamous Cell; Coronary Restenosis; Coronary Stenosis; Drug-Eluting Stents; Follow-Up Studies; Humans; Lung Neoplasms; Male; Middle Aged; Monitoring, Physiologic; Neoplasm Recurrence, Local; Patient Safety; Platelet Aggregation Inhibitors; Pneumonectomy; Prasugrel Hydrochloride; Radiography; Risk Assessment; Treatment Outcome

There was an excess of new solid neoplasms (112 vs. 69), and cancer deaths (24 vs. 15) after prasugrel in the TRITON (Trial to Assess Improvement in Therapeutic Outcomes by Optimizing Platelet Inhibition). These cancers usually occur after 4 months following prasugrel, and women are especially at risk. The hypothesis has been offered that prasugrel, but not aspirin or clopidogrel, causes indirect modulation of tumor growth, and/or enhanced metastatic dissemination due to instability of platelet-tumor cell aggregates via the inability to keep cancer locally within the platelet thrombi due to excessive chronic platelet inhibition.. A 70-year old female diabetic patient underwent drug-eluting stent implantation. The patient received a loading dose of prasugrel (60 mg), followed by prasugrel 10 mg/daily as well as aspirin (81 mg/daily). After 4 months on dual antiplatelet therapy she expectorated blood when coughing. A lung X-ray and CT scan revealed numerous lung nodules later diagnosed as unclassified pleomorphic and spindle cell malignant solid neoplasm. The patient died following multiple brain metastasis.. Female gender, duration of prasugrel exposure, rare unclassified neoplasm pathology type and a tumor of a highly metastatic and aggressive nature in the index patient should be regarded with caution. The effects of novel antiplatelet agents on the onset of cancer should be tested in future mega-trials.

Topics: Aged; Aspirin; Brain Neoplasms; Carcinoma; Clinical Trials, Phase III as Topic; Clopidogrel; Colonic Neoplasms; Coronary Stenosis; Diabetes Mellitus, Type 1; Diabetic Cardiomyopathies; Drug Therapy, Combination; Drug-Eluting Stents; Fatal Outcome; Female; Humans; Lung Neoplasms; Piperazines; Platelet Aggregation Inhibitors; Prasugrel Hydrochloride; Purinergic P2Y Receptor Antagonists; Randomized Controlled Trials as Topic; Risk Factors; Thiophenes; Ticlopidine; Time Factors

Topics: Acute Coronary Syndrome; Angioplasty, Balloon, Coronary; Animals; Colorectal Neoplasms; Humans; Incidence; Lung Neoplasms; Mice; Myocardial Infarction; Neoplasms, Experimental; Piperazines; Prasugrel Hydrochloride; Preoperative Care; Purinergic P2 Receptor Antagonists; Risk Factors; Stroke; Thiophenes; United States