PT  - JOURNAL ARTICLE
AU  - Jinu John
AU  - Santhosh K. G. Koshy
TI  - Current Oral Antiplatelets: Focus Update on Prasugrel
AID  - 10.3122/jabfm.2012.03.100270
DP  - 2012 May 01
TA  - The Journal of the American Board of Family
                Medicine
PG  - 343--349
VI  - 25
IP  - 3
4099  - http://www.jabfm.org/content/25/3/343.short
4100  - http://www.jabfm.org/content/25/3/343.full
SO  - J Am Board Fam Med2012 May 01; 25
AB  - Platelet activation and aggregation plays an integral role in the pathogenesis of acute coronary syndrome (ACS). The mainstay of ACS treatment revolves around platelet inhibition. It is known that greater platelet inhibition results in better ischemic outcomes; hence, focus in drug development has been to create more potent inhibitors of platelet aggregation. Prasugrel, a potent, third-generation thienopyridine, was approved by the US Food and Drug Administration in July 2009 for its use in ACS and percutaneous coronary intervention. The addition of prasugrel to aspirin for dual antiplatelet therapy has been shown to reduce the ischemic outcomes compared with clopidogrel and aspirin in combination. However, being a more potent antiplatelet agent, prasugrel increases the risk of bleeding, especially in those patients who are at a higher risk of bleeding complications. Elderly patients ≥75 years, patients who weigh ≥60 kg, and patients with a history of stroke or transient ischemic attack are at a higher risk of bleeding complications when prasugrel is used in combination with aspirin. Newer antiplatelets currently are being clinically evaluated to assess their efficacy in reducing ischemic events without increasing the bleeding risk.