Notably:

“But Sid Smith, cardiologist at University of North Carolina at Chapel Hill and a past president of the American Heart Association, has a more optimistic perspective, at least from Lilly’s point of view. In a conversation in Orlando where we’re attending the AHA’s annual science confab, Smith noted that Plavix, the $6 billion drug Lilly hopes to unseat, was approved a decade ago to be combined with aspirin for unstable heart patients after showing a 20% reduction in heart attacks and related events and a 38% increase in serious episodes of bleeding when compared to aspirin alone.

“Those figures are strikingly similar to the 19% decline in heart attacks and strokes and the 32% jump in major bleeding attributed to prasugrel in the just-reported show-down against Plavix. “The question is, how much of an increase in bleeding might be tolerable to achieve the improved outcomes?” he said.”

And some especially surprising and measured comments from the often critical and polarizing Steve Nissen:

“Steve Nissen, chief of cardiovascular medicine at Cleveland Clinic, suggests the new data fall in the tolerable range, providing doctors are willing to apply their own judgment to the pros and cons of prasugrel. “Doctors want to have a magic bullet,” Nissen says. “Unfortunately, medicine doesn’t work that way. It always requires judgment and is about weighing benefits and risks of individual patients.””

I’d say that sentiment sums up this and most every other conversation we have about mediations quite nicely.

Overall, though, judging from the editorial, and comments by Topol and Kaur in the summary at theheart.org, enthusiasm for prasugrel seems tepid at best.