PRASUGREL

Prasugrel received approval from the United States Food and Drug Administration (FDA) on July 10, 2009. The 2021 TRITON-TIMI 38 trial evaluated the efficacy and safety of prasugrel relative to clopidogrel in patients with acute coronary syndromes undergoing percutaneous coronary intervention (PCI). The trial showed that prasugrel reduced ischemic event rates, including stent thrombosis, when compared to clopidogrel.

Prasugrel is indicated for reducing thrombotic cardiovascular events, including stent thrombosis, in patients with acute coronary syndrome (ACS) undergoing percutaneous coronary intervention (PCI). It is suitable for patients with unstable angina (UA), non-ST-elevation myocardial infarction (NSTEMI), and ST-elevation myocardial infarction (STEMI). Prasugrel has been shown to lower the rates of cardiovascular death, nonfatal myocardial infarction, and nonfatal stroke compared to clopidogrel. Proper treatment is important, especially in emergency cases, while balancing bleeding risks in patients needing Coronary artery bypass grafting.

Start treatment with prasugrel using a single 60 mg oral loading dose, followed by a maintenance dose of 10 mg daily. Patients should also take aspirin daily at a dose of 75 mg to 325 mg. Prasugrel can be administered with or without food. For patients weighing less than 60 kg, the 10 mg daily maintenance dose may result in increased exposure to the active metabolite and a higher risk of bleeding. Consider reducing the maintenance dose to 5 mg for these patients; however, the effectiveness and safety of this 5 mg dose have not been prospectively evaluated.

Common side effects Bleeding Bruising Nausea Abdominal pain Dizziness Headache Rash or itching Serious side effects Thrombotic thrombocytopenic purpura (TTP) Significant bleeding events Allergic reactions Severe gastrointestinal bleeding

Risk of bleeding: Prasugrel increases the risk of bleeding.Watch for any symptoms of major or minor bleeding, particularly if you’ve recently had procedures like coronary angiography or PCI. Seek medical attention if you experience unusual bruising or bleeding. Older adults: The use of prasugrel is generally not recommended for patients aged 75 years or older due to a higher risk of bleeding and uncertain effectiveness unless they are in high-risk situations. Surgical procedures: Prasugrel should be discontinued at least 7 days before any planned CABG or other surgical procedures to reduce the risk of excessive bleeding. Thrombotic thrombocytopenic purpura (TTP): TTP, a serious condition that can be fatal, has been reported with prasugrel use. Watch for symptoms such as low platelet counts, anaemia, and neurological changes, and seek urgent medical care if they occur. Weight considerations: For patients weighing less than 60 kg, consider a lower maintenance dose due to increased bleeding risk. Regular monitoring may be necessary.

Before starting prasugrel, consider these important precautions. Avoid using this medication if you have active bleeding, a history of stroke, or TIA. Discuss any previous bleeding issues with your healthcare provider. If you have kidney or liver problems, inform your doctor, as they may need to monitor your condition closely. Be aware that prasugrel can cause gastrointestinal issues; maintain proper hydration and report any severe symptoms. Provide your healthcare provider with a complete list of all medications you are taking to avoid potential interactions, particularly with medicines that increase bleeding risk. Regular follow-ups are required to make sure the therapy is effective and to manage any side effects.

Inform your doctor if you have a history of kidney or liver disease, as these conditions may require close monitoring during treatment. Monitor regularly for gastrointestinal symptoms and maintain adequate hydration to prevent dehydration. Report any skin reactions or symptoms of low blood cell counts to your healthcare provider immediately. Disclose all other medications you are taking to your doctor to avoid potential interactions. Use prasugrel during pregnancy only when necessary and monitor for allergic reactions; report any concerns without delay.

Ticagrelor or Prasugrel for Patients With Acute Coronary Syndrome Treated With Percutaneous Coronary Intervention: A Prespecified Subgroup Analysis of a Randomized Clinical Trial | Acute Coronary Syndromes | JAMA Cardiology | JAMA Network https://www.accessdata.fda.gov/drugsatfda_docs/label/2010/022307s002lbl.pdf https://www.ema.europa.eu/en/medicines/human/EPAR/efient https://www.ncbi.nlm.nih.gov/books/NBK557427/