Pharm

Prasugrel

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Prasugrel, Effient

  • See Also
  1. Platelet ADP Receptor Antagonist
  2. Antiplatelet Therapy for Vascular Disease
  3. Clopidogrel
  4. Ticagrelor
  • 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
  • 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
  • Mechanism
  1. See Platelet ADP Receptor Antagonist
  2. Bind Platelet ADP receptor irreversibly
  • 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
  • Efficacy
  1. More effective than Clopidogrel in cardiovascular event reduction
  • 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
  • Safety
  1. Unknown safety in pregnancy
  2. Unknown safety in Lactation
  • 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)
  • Management
  • Reversal
  1. See Platelet ADP Receptor Antagonist
  2. Stop 7 days before elective surgery
  • Resources
  1. Prasugrel (DailyMed)
    1. https://dailymed.nlm.nih.gov/dailymed/drugInfo.cfm?setid=406cc201-89b6-43cc-9e14-a59327a5b4d8
  • References
  1. Filler and Lovecchio (2017) Crit Dec Emerg Med 31(7): 24
  2. Switaj (2017) Am Fam Physician 95(4): 232-40 [PubMed]
  3. Wiviott (2007) N Engl J Med 357(20):2001-15 [PubMed]