What is the dosage regimen of prasugrel in the treatment of non-ST-elevation acute coronary syndrome (unstable angina and NSTEMI), and when is it contraindicated?

Updated: May 07, 2019
  • Author: A Maziar Zafari, MD, PhD, FACC, FAHA; Chief Editor: Eric H Yang, MD  more...
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A loading dose of prasugrel 60 mg is recommended, followed by a maintenance dose of 10 mg daily.

Because of the unique metabolic conversion pathways of prasugrel, it has a more rapid and more consistent platelet inhibition than clopidogrel, which was demonstrated in the Therapeutic Outcomes by Optimizing Platelet Inhibition with Prasugrel–Thrombolysis in Myocardial Infarction (TRITON–TIMI) 38 trial. However, there was a concern of an increased bleeding risk in individuals treated with prasugrel. [93, 94, 95] Therefore, major contraindication to the use of prasugrel are a previous history of stroke or transient ischemic attack (TIA), age over 75 years, and low body weight (93</ref>

Current clinical practice guidelines have different recommendations with regard to the use of prasugrel upfront in patients with NSTE-ACS. The American College of Cardiology/American Heart Association (ACC/AHA) guidelines do not recommend the use of prasugrel in this setting; however, its use can be considered for those undergoing PCI. [96]  The ESC guidelines, however, recommend the use of prasugrel upfront in patients treated for NSTE-ACS—provided there is no contraindication to its use. [3]

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