WARNING: BLEEDING RISK
Effient can cause significant, sometimes fatal, bleeding
[see Warnings and Precautions (5.1 and 5.2) and Adverse Reactions ].
Do not use Effient in patients with active pathological bleeding or a history of transient ischemic attack or stroke
[see Contraindications (4.1 and 4.2)].
In patients ≥ 75 years of age, Effient is generally not recommended, because of the increased risk of fatal and intracranial bleeding and uncertain benefit, except in high-risk situations (patients with diabetes or a history of prior MI) where its effect appears to be greater and its use may be considered
[see Use in Specific Populations ].
Do not start Effient in patients likely to undergo urgent coronary artery bypass graft surgery (CABG). When possible, discontinue Effient at least 7 days prior to any surgery.
Additional risk factors for bleeding include:
body weight < 60 kg
propensity to bleed
concomitant use of medications that increase the risk of bleeding (
, warfarin, heparin, fibrinolytic therapy, chronic use of non-steroidal anti-inflammatory drugs [NSAIDS])
Suspect bleeding in any patient who is hypotensive and has recently undergone coronary angiography, percutaneous coronary intervention (PCI), CABG, or other surgical procedures in the setting of Effient.
If possible, manage bleeding without discontinuing Effient. Discontinuing Effient, particularly in the first few weeks after acute coronary syndrome, increases the risk of subsequent cardiovascular events
[see Warnings and Precautions].
WARNING: BLEEDING RISK
Effient contains prasugrel, a thienopyridine class inhibitor of platelet activation and aggregation mediated by the P2Y12 ADP receptor.
Acute Coronary Syndrome
Effient is indicated to reduce the rate of thrombotic cardiovascular (CV) events (including stent thrombosis) in patients with acute coronary syndrome (ACS) who are to be managed with percutaneous coronary intervention (PCI) as follows:
Patients with unstable angina (UA) or non-ST-elevation myocardial infarction (NSTEMI).
Patients with ST-elevation myocardial infarction (STEMI) when managed with primary or delayed PCI.
Effient has been shown to reduce the rate of a combined endpoint of cardiovascular death, nonfatal myocardial infarction (MI), or nonfatal stroke compared to clopidogrel. The difference between treatments was driven predominantly by MI, with no difference on strokes and little difference on CV death [see Clinical Studies ].
It is generally recommended that antiplatelet therapy be administered promptly in the management of ACS because many cardiovascular events occur within hours of initial presentation. In the clinical trial that established the efficacy of Effient, Effient and the control drug were not administered to UA/NSTEMI patients until coronary anatomy was established. For the small fraction of patients that required urgent CABG after treatment with Effient, the risk of significant bleeding was substantial [see Warnings and Precautions]. Because the large majority of patients are managed without CABG, however, treatment can be considered before determining coronary anatomy if need for CABG is considered unlikely. The advantages of earlier treatment with Effient must then be balanced against the increased rate of bleeding in patients who do need to undergo urgent CABG.
Published Studies Related to Effient (Prasugrel)
A comparative evaluation of prasugrel and clopidogrel in patients with acute
coronary syndrome undergoing percutaneous coronary intervention. 
patients were also assessed for safety of the drugs... CONCLUSION: This study suggests that prasugrel is more effective than clopidogrel
Concomitant administration of clopidogrel with statins or calcium-channel
blockers: insights from the TRITON-TIMI 38 (trial to assess improvement in
therapeutic outcomes by optimizing platelet inhibition with
prasugrel-thrombolysis in myocardial infarction 38). 
blockers (CCBs) may attenuate the pharmacodynamic effects of clopidogrel... CONCLUSIONS: In patients with ACS undergoing PCI, the use of statins or CCBs was
Gastrointestinal adverse events after dual antiplatelet therapy: clopidogrel is
safer than ticagrelor, but prasugrel data are lacking or inconclusive. 
Current guidelines offer a choice of P2Y12 receptor antagonist among clopidogrel,
prasugrel or ticagrelor on top of aspirin (ASA) for dual antiplatelet therapy
(DAPT) in patients after acute coronary syndromes (ACS). However, the comparative
risks of gastrointestinal (GI) adverse events during DAPT are not clear...
Effects of prasugrel on platelet inhibition during systemic endotoxaemia: a
randomized controlled trial. 
P2Y(12) receptor antagonists have become a mainstay for the treatment of CVD
(cardiovascular diseases). However, they have rarely been evaluated under
pathophysiological conditions apart from arterial diseases... However, vWF release may reduce prasugrel's
effects under high-shear conditions.
Efficacy and safety of intensive antiplatelet therapy with prasugrel from TRITON-TIMI 38 in a core clinical cohort defined by worldwide regulatory agencies. [2011.10.01]
TRITON-TIMI 38 showed that in patients with acute coronary syndrome undergoing percutaneous coronary intervention prasugrel decreased ischemic events compared to standard clopidogrel, but with more bleeding. The United States Food and Drug Administration and the European Medicines Agency approved prasugrel but provided contraindications in patients with previous stroke or transient ischemic attack and recommended limited use or reduced dose in patients >/=75 years old and weighing <60 kg...
Clinical Trials Related to Effient (Prasugrel)
A Study of Prasugrel in Healthy Participants [Completed]
The purpose of this study is to evaluate the amount of drug available in the body when given
to healthy participants as two different formulations with or without a meal. In addition,
this study will evaluate how much of the drug gets into the blood stream and how long the
body takes to get rid of it. Information about any side effects that may occur will also be
collected. Each participant will receive a total of five different treatments. Each
treatment is given by mouth, once a day. The treatment period lasts for five consecutive
The Influence of Smoking Status on Prasugrel and Clopidogrel Treated Subjects Taking Aspirin and Having Stable Coronary Artery Disease [Completed]
This study is being conducted to determine if smoking will influence the platelet
aggregation inhibition ability of clopidogrel and prasugrel. It will also determine if
smoking has any effect on the plasma concentrations of the active metabolite of prasugrel
and the active and inactive metabolites of clopidogrel.
The primary hypothesis is that smoking status will influence the antiplatelet effects and
active metabolite concentrations of clopidogrel but will have no impact on prasugrel's
antiplatelet effects or active metabolite concentrations.
A Relative Bioavailability Study of a Prasugrel Orally Disintegrating Tablet [Completed]
This study compares the clinical tablet formulation of prasugrel taken orally with an orally
disintegrating tablet (ODT) taken orally. The study will evaluate the amount of prasugrel
active metabolite circulating in the blood for each treatment.
Prasugrel With Lower Dose - Loading Dose [Completed]
Although prasugrel, recently available thienopyridine derivative, exhibits rapid and potent
platelet inhibition, concerns of low on-treatment platelet reactivity have been suggested
especially in East Asian ethnicities. The investigators compared the effect of lower loading
dose of prasugrel with conventional loading dose of clopidogrel and prasugrel.
Clopidogrel to Prasugrel in Acute Coronary Syndrome (ACS) Patients [Completed]
This study will evaluate the use of a prasugrel 60 mg loading dose (LD) administered during
percutaneous coronary intervention (PCI) with and without a prior LD of clopidogrel on
platelet inhibition in patients presenting with acute coronary syndrome (ACS). Platelet
inhibition following a prasugrel LD in clopidogrel pretreated patients' will be determined
in a time-dependent manner for two different prasugrel loading doses (30 mg and 60 mg).
Understanding the effects of this combination on platelet inhibition will provide guidance
to physicians on the use of prasugrel in patients who have already been pretreated with
Reports of Suspected Effient (Prasugrel) Side Effects
Thrombosis in Device (77),
Acute Myocardial Infarction (36),
Chest Pain (33),
in-Stent Coronary Artery Restenosis (29),
Haemorrhage Intracranial (28),
Drug Dose Omission (26),
Myocardial Infarction (26), more >>
Page last updated: 2014-11-30