What is the role and dosage of Effient (prasugrel) in reducing the risk of heart disease and stroke?

From the Guidelines

Effient (prasugrel) is an antiplatelet medication that should be prescribed at a loading dose of 60 mg followed by a maintenance dose of 10 mg once daily, taken with aspirin (75-325 mg daily), to reduce the risk of heart attack, stroke, and cardiovascular death in patients with acute coronary syndrome who undergo percutaneous coronary intervention (PCI). For patients weighing less than 60 kg or those aged 75 and older, a reduced maintenance dose of 5 mg daily may be recommended due to increased bleeding risk 1. Prasugrel works by preventing platelets from sticking together to form blood clots by irreversibly blocking the P2Y12 receptor on platelets. The medication is typically prescribed for at least 12 months after PCI, though some patients may require longer treatment based on their specific cardiovascular risk factors.

• Key considerations for prasugrel use include:
  • Increased bleeding risk, particularly in patients with a history of stroke or TIA, or those weighing less than 60 kg or aged 75 and older 1
  • Contraindication in patients with active pathological bleeding or a history of TIA or stroke 1
  • Potential for increased risk of fatal and intracranial bleeding in patients aged 75 and older, except in high-risk situations such as diabetes or prior myocardial infarction 1
  • Recommendation to discontinue prasugrel at least 7 days before any surgery 1 Patients should be aware that prasugrel carries a higher bleeding risk compared to some other antiplatelet medications, so any signs of unusual bleeding should be reported to a healthcare provider immediately. It should not be stopped without medical consultation as this could increase the risk of serious cardiac events, particularly in patients with coronary stents. According to the most recent guidelines, prasugrel is not recommended for "upfront" therapy in patients with non-ST-elevation acute coronary syndromes (NSTE-ACS) 1. The use of prasugrel in patients undergoing PCI is addressed in the guidelines, and it is recommended to be given for at least 12 months after PCI, unless the risk of bleeding outweighs the anticipated net benefit afforded by a P2Y12 receptor inhibitor 1.

From the FDA Drug Label

Prasugrel tablets are indicated to reduce the rate of thrombotic CV events (including stent thrombosis) in patients with acute coronary syndrome (ACS) who are to be managed with percutaneous coronary intervention (PCI) as follows: Patients with unstable angina (UA) or non-ST-elevation myocardial infarction (NSTEMI) Patients with ST-elevation myocardial infarction (STEMI) when managed with primary or delayed PCI.

Prasugrel tablets have been shown to reduce the rate of a combined endpoint of cardiovascular death, nonfatal myocardial infarction (MI), or nonfatal stroke compared to clopidogrel The difference between treatments was driven predominantly by MI, with no difference on strokes and little difference on CV death

Effient (prasugrel) is a medication used to reduce the risk of heart disease and stroke in patients with acute coronary syndrome (ACS) who are managed with percutaneous coronary intervention (PCI).

• The dosage of Effient is a single 60 mg oral loading dose, followed by 10 mg orally once daily.
• Effient is used to lower the chance of having another serious problem with the heart or blood vessels, such as another heart attack, a stroke, blood clots in the stent, or death.
• It works by preventing platelets from sticking together and forming a clot that can block an artery or a stent.
• The medication should be taken with aspirin (75 mg to 325 mg) daily.
• Patients taking Effient should be aware of the increased risk of bleeding and report any unanticipated, prolonged, or excessive bleeding to their doctor. 2 2 2

From the Research

Overview of Effient (Prasugrel)

• Effient, also known as prasugrel, is an antiplatelet drug used to reduce the risk of heart disease and stroke in patients with acute coronary syndromes undergoing percutaneous coronary intervention (PCI) 3, 4, 5.
• It is a thienopyridine analog that inhibits platelet aggregation by irreversibly inhibiting the binding of adenosine diphosphate to the purinergic P2Y12 receptor on the platelet surface 4.

Role of Effient in Reducing Heart Disease and Stroke

• Effient has been shown to be a potent antiplatelet agent with a faster, more consistent, and greater inhibition of platelet aggregation compared to clopidogrel 4, 6.
• The results of the TRITON-TIMI 38 trial demonstrated a significant reduction in ischemic events, including stent thrombosis, with prasugrel compared to clopidogrel, but with an increased risk of major bleeding 4.
• Current guidelines recommend the use of prasugrel or ticagrelor instead of clopidogrel in patients with acute coronary syndromes undergoing PCI 3, 6.
• Emerging data have shown that prasugrel is more efficient than ticagrelor in reducing the incidence of nonfatal myocardial infarction, stroke, or cardiovascular death, without increased risk of major bleeding 6.

Dosage of Effient

• The dosage of Effient is typically 60 mg loading dose, followed by a maintenance dose of 10 mg once daily 5, 7.
• It is recommended to be used in combination with aspirin to reduce the rate of thrombotic cardiovascular events in patients with acute coronary syndromes being managed with PCI 5.

Safety and Efficacy

• Prasugrel has been shown to be safe and effective in reducing the risk of heart disease and stroke in patients with acute coronary syndromes undergoing PCI 3, 4, 6, 7.
• However, it is associated with an increased risk of major bleeding, and the risk-benefit ratio should be carefully considered when selecting patients for treatment with prasugrel 4, 7.