From the Guidelines
**Prasug
From the FDA Drug Label
If possible, prasugrel should be discontinued at least 7 days prior to CABG. Before having any surgery, you should talk to your doctor about stopping prasugrel tablets. If possible, prasugrel tablets should be stopped at least 1 week (7 days) before any surgery, as instructed by the doctor who prescribed prasugrel tablets for you
Stopping Prasugrel before Non-Cardiac Surgery:
- Prasugrel should be stopped at least 7 days before any surgery, if possible.
- The decision to stop prasugrel should be made by the doctor who prescribed it.
- Patients should inform their doctor about any upcoming surgery or invasive procedure. 1 1
From the Research
Perioperative Management of Prasugrel
To determine how long before non-cardiac surgery Prasugrel should be stopped, several factors must be considered, including the type of surgery, the patient's risk of bleeding, and the risk of stent thrombosis.
- The general recommendation for stopping Prasugrel before non-cardiac surgery is based on the time necessary for platelet function recovery, which is typically around 7-10 days 2, 3.
- This recommendation is part of a broader strategy for managing dual antiplatelet therapy (DAPT) in patients undergoing non-cardiac surgery, which also includes considering the continuation of aspirin during the perioperative period 2, 4.
- For patients at high risk of bleeding, such as those undergoing intracranial surgery, alternative strategies like bridge therapy with short-acting antiplatelet agents may be considered 2.
- The decision to stop Prasugrel should be made on a case-by-case basis, taking into account the individual patient's risk factors and the specific surgical procedure planned 2, 4, 3.
- It's also important to note that the management of antiplatelet therapy in the perioperative period is evolving, with ongoing research aimed at balancing the risks of bleeding and thrombosis 4, 5.
Key Considerations
- The risk of coronary thrombosis after antiplatelet drug withdrawal is higher than the risk of surgical bleeding if these drugs are continued 4.
- Aspirin should be continued throughout the perioperative period, except in cases where the risk of bleeding is very high 2, 4.
- The use of prasugrel and other antiplatelet agents requires careful management to minimize the risk of bleeding and thrombotic complications 3, 6.
Clinical Evidence
- Studies have shown that prasugrel is effective in reducing the risk of thrombotic events, but it also increases the risk of bleeding 6.
- The optimal timing for stopping prasugrel before surgery is not universally agreed upon, but most guidelines recommend stopping it 7-10 days before elective non-cardiac surgery 2, 3.