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Pragrel also has a stronger performance than clopidogrel in interventional surgery for stable angina pectoris and acute coronary syndrome, but the stronger the antiplatelet effect is, the more likely it is to cause bleeding. The key question now is how we can identify patients at high risk of thrombosis and how we can identify those at high risk of bleeding in the clinic, so that pragrel and clopidogrel can be used differently in the two high-risk groups, both to reduce coronary thrombosis and avoid major bleeding.
Drug | Onset | Bleeding Risk | Best For |
---|---|---|---|
Prasugrel | 30 min | High | ACS with PCI |
Clopidogrel | 6+ hrs | Moderate | Stroke history |
Ticagrelor | 30 min | High | NSTEMI |
In vitro study of Prasugrel.
Prasugrel, a novel orally active thiophenyl pyridinium, has faster, higher and more reliable platelet aggregation inhibition than clopidogrel, indicating that it is metabolized in vivo as an active metabolite with selective P2Y(12) antagonistic activity.
FAQs
Q: How long must I take prasugrel?
A: Typically 12 months post-stent – DO NOT STOP without doctor approval.
Q: What if I miss a dose?
A: Take ASAP if <12 hrs late; otherwise skip. Never double dose.
Q: Can I take NSAIDs?
A: Avoid – increases bleeding risk (ibuprofen, aspirin >100mg).
Q: Why is prasugrel stronger?
A: More consistent CYP enzyme metabolism vs. clopidogrel.
Q: Signs of bleeding emergency?
A: Black stools, vomiting blood, severe headache → seek ER care.
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