In both treatment groups, patients with at least 1 of these risk factors had higher rates of bleeding than those The FDA approved prasugrel on July 10, 2009, and cited a contraindication against its use in patients with a history of transient ischemic attack or stroke or with active pathological bleeding.8 The FDA labeling information includes a general warning against the use of prasugrel in patients age 75 years because of concerns of an increased risk of fatal and intra- cranial bleeding and uncertain benefit except in high-risk situations (patients with diabetes or a history of prior MI), in which case the net benefit appears to be greater and its use may be considered.8 In focusing specifically on pa- tients with UA/NSTEMI, the rate of the primary efficacy endpoint was significantly reduced in favor of prasugrel The pivotal trial for ticagrelor, PLATO (Study of Platelet Inhibition and Patient Outcomes),9 was a multi- center, international, randomized controlled trial compar- ing ticagrelor with clopidogrel (on a background of aspirin therapy) to determine whether ticagrelor is superior to clopidogrel for the prevention of vascular events and death in a broad population of patients with ACS (see Online Data Supplement). A total of 18 624 patients hospitalized with an ACS were randomized at 862 centers (from 2006 through 2008). Of those, 11 598 patients had UA/NSTEMI (patients with UA and NSTEMI made up 16.7% and 42.7% of the overall population, respectively), whereas 7026 patients had STEMI. The primary efficacy endpoint was the time to first occurrence of the composite of vascular death, MI, or stroke. The primary safety endpoint was the first occur- rence of any major bleeding event. 