II. Indications: Prevention of Thrombotic Events
- See Platelet ADP Receptor Antagonist
- See Antiplatelet Therapy for Vascular Disease
- Prevention of thrombotic events following PCI with coronary stenting
III. Contraindications
- Active Bleeding
- Increased bleeding risk (Prasugrel has higher bleeding risk than other P2Y12 Inhibitors)
- Age >75 years
- Body weight <60 kg
IV. Mechanism
- See Platelet ADP Receptor Antagonist
- Bind Platelet ADP receptor irreversibly
V. Dosing
- Tablet must be taken whole (do not break)
- Impending Percutaneous Coronary Intervention (PCI)
- Prasugrel 60 mg orally once
- Then initiate standard 10 mg daily oral Prasugrel dose after PCI
- Maintenance in coronary stenting thrombosis prevention
- Prasugrel 10 mg orally once daily
- Consider 5 mg oral daily if weight <60 kg
VI. Efficacy
- More effective than Clopidogrel in cardiovascular event reduction
VII. Adverse Effects
- Bleeding Risk
- Higher risk of bleeding than Clopidogrel in age >75 years, weight <60 kg, CVA history
- Avoid in prior Cerebrovascular Accident (CVA) or Transient Ischemic Attack (TIA)
- Typically initiated in the catheter lab
- Do not initiate in emergency department due to bleeding risk
VIII. Safety
- Unknown safety in pregnancy
- Unknown safety in Lactation
IX. Drug Interactions
- See Platelet ADP Receptor Antagonist
- Other antiplatelet agents or Anticoagulants
- Agents that reduce Prasugrel activity
- Opioids (may reduce absorption of Prasugrel)
X. Management: Reversal
- See Platelet ADP Receptor Antagonist
- Stop 7 days before elective surgery
XI. Resources
XII. References
- Filler and Lovecchio (2017) Crit Dec Emerg Med 31(7): 24
- Switaj (2017) Am Fam Physician 95(4): 232-40 [PubMed]
- Wiviott (2007) N Engl J Med 357(20):2001-15 [PubMed]
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Related Studies
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 |
Ontology: prasugrel (C1620287)
Definition (NCI) | A novel platelet inhibitor approved for the reduction of thrombotic cardiovascular events in patients with acute coronary syndrome. Prasugrel produces inhibition of platelet aggregation by binding to receptors for ADP on the surface of platelets. |
Concepts | Organic Chemical (T109) , Pharmacologic Substance (T121) |
MSH | C408153 |
SnomedCT | 443312008, 443129001 |
English | Prasugrel (product), Prasugrel, Prasugrel (substance), prasugrel (medication), antiplatelet prasugrel, PRASUGREL, prasugrel |
Spanish | prasugrel (producto), prasugrel, prasugrel (sustancia) |
Ontology: Effient (C2718746)
Concepts | Pharmacologic Substance (T121) , Organic Chemical (T109) |
English | Effient |