That’s probably not what many expected to hear. But a survey found that 85 high-prescribing clinical and interventional cardiologists were more impressed with prasugrel than Wall Street reaction would justify, according to Catherine Arnold, an analyst at Credit Suisse, which sponsored the poll conducted by ImpactRx. The implications? The Lilly bloodthinner would be used more than some may have predicted. And prasugrel sales may be larger than thought - perhaps as much as $2.5 billion by 2014, Arnold posits.

You may recall that Lilly’s Triton study, released earlier this month, found that prasugrel can lower the risk of cardiovascular death, non-fatal heart attacks or non-fatal strokes when compared with Plavix. But the med caused some patients to experience a statistically significant increase in major bleeding compared to those treated with Plavix, the $7 billion gorilla of blood thinners. Overall, for every 1,000 people treated with prasugrel compared to Plavix, there were 23 fewer heart attacks and an additional six major bleeding complications, suggesting many docs wouldn’t embrace the Lilly drug.

Arnold, however, believes the survey indicates otherwise. “Overall, prasugrel was seen as the future drug of choice in 36 percent of acute coronary syndrome patients who undergo PCI, or angioplasty, and in 40 percent of angioplasty patients receiving a stent or with diabetes,” writes Arnold, in an investor note released last night.

“Perhaps more surprising, these cardiologists said they would be willing to use prasugrel in a significant share of patients outside the PCI setting: medically managed patients following admission for unstable angina (26.1 percent) or a heart attack (25.8 percent), as well as patients with peripheral arterial disease (21.8 percent),” she continues. “These are large segments of the antiplatelet market where there is no data to support the use of prasugrel currently but, based on these results and other research we have conducted, we think prasugrel will generate modest off-label use.”

Among other points Arnold raises, she notes that “cardiologists who work in academic hospitals were less likely to use prasugrel across all of the indications polled…The physicians based at academic centers have most likely been involved in numerous Plavix trials that Bristol-Myers Squibb and Sanofi-Aventis have conducted to date. They are probably more loyal to both the Plavix product and the BMY/SNY alliance so it will take greater effort on the part of Lilly to convince these doctors to use prasugrel.”

And just who were these docs who participated in the survey? Clinical cardiologists amounted to 59 percent and interventionalists accounted for the remaining 41 percent. Almost two-thirds, or 65 percent, work in a private practice setting, while 54 percent actively participate in clinical trials. The number of patients seen per week ranged from just under 70 for those in an academic setting to over 120 for those in private practice.