From the Guidelines
You should not take prasugrel and clopidogrel at the same time. These medications are both P2Y12 inhibitors that work in the same way to prevent blood clots by stopping platelets from sticking together. Taking both simultaneously would significantly increase your risk of dangerous bleeding without providing additional therapeutic benefit, as noted in the 2009 ACC/AHA guidelines for the management of patients with ST-elevation myocardial infarction 1.
Key Considerations
- The use of prasugrel and clopidogrel as part of a dual-antiplatelet therapy regimen is not recommended for patients with a prior history of stroke and transient ischemic attack for whom primary PCI is planned, due to the increased risk of bleeding 1.
- Prasugrel was associated with a significant increase in the rate of bleeding, notably TIMI major hemorrhage, which was observed in 2.4% of patients taking prasugrel and in 1.8% of patients taking clopidogrel (HR for prasugrel versus clopidogrel 1.32; 95% CI 1.03 to 1.68, P 0.03) 1.
- The 2011 ACCF/AHA focused update of the guidelines for the management of patients with unstable angina/non-ST-elevation myocardial infarction also notes that prasugrel is potentially harmful as part of a dual-antiplatelet therapy regimen in patients with a prior history of stroke and/or TIA for whom PCI is planned 1.
Clinical Implications
- If you're currently on one of these medications and have been prescribed the other, you should contact your healthcare provider immediately for clarification.
- Typically, a doctor might switch you from one medication to the other due to side effects or effectiveness concerns, but this requires stopping the first medication before starting the second.
- Both prasugrel (Effient) and clopidogrel (Plavix) are commonly prescribed after heart procedures like stent placement or for conditions like acute coronary syndrome, but they should be used as alternatives to each other, not in combination.
- Always follow your doctor's specific instructions regarding these blood-thinning medications.
From the Research
Combination Therapy with Prasugrel and Clopidogrel
- There is no direct evidence to suggest that patients should be on both prasugrel and clopidogrel at the same time 2, 3, 4, 5, 6.
- Prasugrel and clopidogrel are both antiplatelet agents used to prevent blood clots in patients with acute coronary syndrome (ACS) 2, 3.
- Studies have compared the efficacy and safety of prasugrel and clopidogrel, with prasugrel showing greater inhibition of platelet aggregation and a reduction in ischemic outcomes compared to clopidogrel 3, 5.
- However, prasugrel is also associated with a higher risk of bleeding complications, particularly in elderly patients or those with a history of stroke or transient ischemic attack 2, 3, 4.
Clinical Implications
- The choice of antiplatelet agent should be made on an individual patient basis, taking into account the patient's risk factors and medical history 4.
- Current evidence suggests that prasugrel or ticagrelor plus aspirin should be the dual antiplatelet therapy (DAPT) of choice in patients with ACS undergoing percutaneous coronary intervention (PCI), unless they are at particularly high risk of bleeding 4.
- There is no evidence to support the use of both prasugrel and clopidogrel in combination, and this approach may increase the risk of bleeding complications 2, 3, 4, 5, 6.