II. Indications: Prevention of Thrombotic Events

  1. See Platelet ADP Receptor Antagonist
  2. See Antiplatelet Therapy for Vascular Disease
  3. Prevention of thrombotic events following PCI with coronary stenting

III. Contraindications

  1. Active Bleeding
  2. Increased bleeding risk (Prasugrel has higher bleeding risk than other P2Y12 Inhibitors)
    1. Age >75 years
    2. Body weight <60 kg

IV. Mechanism

  1. See Platelet ADP Receptor Antagonist
  2. Bind Platelet ADP receptor irreversibly

V. Dosing

  1. Tablet must be taken whole (do not break)
  2. Impending Percutaneous Coronary Intervention (PCI)
    1. Prasugrel 60 mg orally once
    2. Then initiate standard 10 mg daily oral Prasugrel dose after PCI
  3. Maintenance in coronary stenting thrombosis prevention
    1. Prasugrel 10 mg orally once daily
    2. Consider 5 mg oral daily if weight <60 kg

VI. Efficacy

  1. More effective than Clopidogrel in cardiovascular event reduction

VII. Adverse Effects

  1. Bleeding Risk
    1. Higher risk of bleeding than Clopidogrel in age >75 years, weight <60 kg, CVA history
    2. Avoid in prior Cerebrovascular Accident (CVA) or Transient Ischemic Attack (TIA)
    3. Typically initiated in the catheter lab
      1. Do not initiate in emergency department due to bleeding risk

VIII. Safety

  1. Unknown safety in pregnancy
  2. Unknown safety in Lactation

IX. Drug Interactions

  1. See Platelet ADP Receptor Antagonist
  2. Other antiplatelet agents or Anticoagulants
  3. Agents that reduce Prasugrel activity
    1. Opioids (may reduce absorption of Prasugrel)

X. Management: Reversal

  1. See Platelet ADP Receptor Antagonist
  2. Stop 7 days before elective surgery

XII. References

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Related Studies

Cost: Medications

prasugrel (on 12/21/2022 at Medicaid.Gov Survey of pharmacy drug pricing)
PRASUGREL 10 MG TABLET Generic $0.33 each
PRASUGREL 5 MG TABLET Generic $0.44 each