Prasugrel is contraindicated after any prior stroke or transient ischaemic attack because of excess intracranial bleeding. In patients aged 75 or over, it is generally not recommended; if used, the maintenance dose is 5 mg. In patients under 60 kg, the maintenance dose is also 5 mg.
These checks matter to anyone who reviews a medication list after an acute coronary syndrome, not only cardiologists: the GP renewing a prescription, the physician admitting an older patient, the surgeon planning an operation.
- Check for any prior stroke or TIA before continuing prasugrel.
- Confirm the maintenance dose is 5 mg in patients aged 75 or more or weighing under 60 kg.
- Before elective surgery, prasugrel is usually stopped 7 days ahead, longer than ticagrelor or clopidogrel; confirm with cardiology.
- Never stop a P2Y12 inhibitor early after a recent stent without speaking to the cardiology team.
Why it matters
Most antiplatelet prescriptions are renewed by someone other than the cardiologist who started them.
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