Prasugrel – Cardiology MCQ

Wrong statement about prasugrel:
a) Not influenced by CYP inhibitors
b) Higher bleeding risk in those with previous cerebrovascular events
c) Use in acute coronary syndrome is better restricted to the cathlab
d) Recommended in those above 75 years
Correct answer: d) Recommended in those above 75 years
Prasugrel has a higher bleeding risk in those above 75 years and in those with body weight less than 60 Kg. Prasugrel is not interfered with by CYP inhibitors, CYP2C19 gene variants or proton pump inhibitors, unlike clopidogrel. Rapid onset of action enables its use in the cathlab after coronary angiography if percutaneous intervention is the option. This avoids the bleeding risk after an initial loading dose which could be significant in case the option after angio is for early coronary artery bypass grafting. Prasugrel is better in diabetic patients and in moderate to high risk non ST segment elevation acute coronary syndromes.