Prasugrel

Amber-G

Brand Name(s):Efient

Indication:Prevention of atherothrombotic events in patients with acute coronary syndrome

Rationale:

Considered:Oct-08

Review Date:Jan-25

Comments:
NICE TA 317

1.1 Prasugrel 10 mg in combination with aspirin is recommended as an option within its marketing authorisation, that is, for preventing atherothrombotic events in adults with acute coronary syndrome (unstable angina [UA], non-ST segment elevation myocardial infarction [NSTEMI] or ST segment elevation myocardial infarction [STEMI]) having primary or delayed percutaneous coronary intervention.

July 2014

MHRA Drug Safety Update Incresed risk of bleeding – information on timing of loading dose when used in the acute management of patients experiencing unstable angina or NSTEMI and undergoing coronary angiography within 48hours of admission.
http://www.mhra.gov.uk/Safetyinformation/DrugSafetyUpdate/CON364156

January 2014

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Yorkshire & the Humber Cardiovascular Strategic Clinical Network (South) Guidance can be found on the Medicines Management Webside under Guidelines – local at:
http://medicinesmanagement.doncasterpct.nhs.uk/page.asp?cpath=103#
February 2014

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NICE CG 172
MI Secondary Prevention
details at: http://www.nice.org.uk/nicemedia/live/14302/65691/65691.pdf
Issued November 2013
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Treatment with Prasugrel should be initiated in secondary care. It is then appropriate for continued prescribing in primary care. The duration of treament should be specified by secondary care in the original communication.

Prasugrel may be suitable for a limited number of patients (e.g. patients who require immediate percutaneous coronary intervention or patients who have experienced stent thrombosis despite previous clopidogrel treatment). However, for each individual, the potential benefits of prasugrel must be carefully balanced against the risk of bleeding.

Prasugrel is not recommended for patients over the age of 75 years or patients weighing less then 60kg because these patients have a high risk of bleeding.

It is contraindicated in patients with a history of stroke or transient ischaemic attack.

Prasugrel (Efient) for acute coronary syndrome managed with percutaneous coronary intervention
MTRAC Verdict & Summary February 2010