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 |