Prasugrel: antiplatelet used around coronary stenting

Prasugrel is indicated to prevent atherothrombotic events, meaning clots that form on diseased artery walls, in people with acute coronary syndrome who are having a percutaneous coronary intervention, such as a stent. It is given alongside aspirin.

For people with unstable angina or NSTEMI the SmPC says the loading dose is given at the time of the procedure, so the decision usually sits with the cardiology team. A daily tablet follows. The leaflet lists it as a prescription-only medicine.

Prasugrel binds irreversibly to a receptor on platelets called P2Y12. That blocks the signal that tells platelets to clump when ADP is released, so the platelets stay inactive for their lifetime. The SmPC describes maximum inhibition of platelet aggregation of about 83 percent.

Because the binding is irreversible, the effect on a platelet does not simply fade as the medicine leaves the blood. That is why the SmPC asks for careful thought about timing around surgery.

According to the SmPC, the standard approach is a 60mg loading dose followed by 10mg once a day. For people aged 75 years or older, and for those weighing under 60kg, the daily dose is lowered to 5mg because bleeding is more common in these groups.

For UA/NSTEMI the loading dose is given at the time of PCI, not earlier. Your cardiology team sets the dose and duration, and you should not adjust tablets yourself.

Prasugrel must not be used in people with active bleeding, a previous stroke or transient ischaemic attack, or severe liver impairment. The SmPC stresses that major and minor bleeding occurred more often with prasugrel than with clopidogrel, with a particularly raised risk, including fatal bleeding, in people aged 75 and over.

Tell the team about any recent injuries, stomach ulcers, bleeding conditions or operations, and report black stools, vomiting blood, severe nosebleeds, or sudden severe headache. Seek urgent help for those.

The SmPC points out that morphine can reduce the effect of prasugrel by slowing its absorption from the gut, and that anti-inflammatory painkillers and warfarin need care because of added bleeding risk. Always give your pharmacist a full medicine list.

If you need surgery, the SmPC advises careful consideration when it falls within 7 days after stopping prasugrel, because bleeding can be worse. Always tell surgeons and dentists you are on it, and let them decide on any pause.

The patient leaflet for Efient states that suspected side effects can be reported through the MHRA Yellow Card scheme. It explains pregnancy, breastfeeding, driving and alcohol precautions, and the advice on stopping treatment, so read the leaflet that comes with your pack.

Do not stop prasugrel early after a stent without speaking to your cardiology team, because the plan for how long to continue is set around your procedure.