Side Effects of prasugrel: A Synthesis of Findings from 30 Studies

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Original Abstract of the Article

Major Research Findings

Studies on prasugrel have shown that it can reduce the risk of ischemic events in patients with acute coronary syndrome (ACS) undergoing percutaneous coronary intervention (PCI). 21 However, prasugrel use has also been shown to be associated with an increased risk of bleeding. 23 This side effect was particularly pronounced in older patients and those with a lower body weight. 17 Furthermore, prasugrel use can increase the risk of bleeding when combined with other antiplatelet agents. 12

Reasons for Side Effects

The side effects of prasugrel are believed to stem from its mechanism of action. Prasugrel works by inhibiting ADP receptors (P2Y12 receptors), thereby reducing platelet aggregation. This effect reduces the risk of ischemic events but also increases the risk of bleeding.

Common Side Effects

Bleeding

The most common side effect of prasugrel is bleeding. 23 Bleeding can occur to varying degrees, from mild nosebleeds to severe intracranial hemorrhage. 7 The risk of bleeding varies depending on the patient's age, weight, concurrent medications, and other health conditions. 17

Gastrointestinal Symptoms

Prasugrel side effects can include gastrointestinal symptoms. 25 These symptoms include nausea, vomiting, abdominal pain, and diarrhea. 25

Skin Reactions

Prasugrel side effects can also include skin reactions. 25 These reactions include rash, itching, and hives. 25

Other

Other side effects of prasugrel include dizziness, headache, and fatigue. 25

Side Effects Management

Bleeding Management

To reduce the risk of bleeding associated with prasugrel use, patients at high risk for bleeding should be closely monitored. 11 Patients with a high risk of bleeding may require adjustments to their prasugrel dosage or a switch to another antiplatelet agent. 17 If bleeding occurs, appropriate treatment should be provided. 11

Gastrointestinal Symptom Management

If gastrointestinal symptoms develop, medication therapy such as antiemetics and antacids can be effective. 25

Skin Reaction Management

If skin reactions develop, medication therapy such as antihistamines and steroids can be effective. 25

Comparison Across Studies

Commonalities

Multiple studies have shown that prasugrel use reduces the risk of ischemic events in ACS patients. 21 Studies have also shown that prasugrel use is associated with an increased risk of bleeding. 23

Differences

The bleeding risk of prasugrel has been shown to vary across studies. 23 This variation can be explained by factors such as study design, patient characteristics, and concurrent medications. 17

Implications for Real-Life Application

Prasugrel use can reduce the risk of ischemic events. 21 However, prasugrel use also increases the risk of bleeding. 23 Therefore, the use of prasugrel should be carefully evaluated on a case-by-case basis, considering the risks and benefits for each patient. 17

Limitations of Current Research

Further research is needed on the long-term safety and efficacy of prasugrel. 19

Future Research Directions

Large-scale clinical trials are needed to evaluate the long-term safety and efficacy of prasugrel. 19 Development of new strategies to mitigate the bleeding risk associated with prasugrel use is also needed. 11

Conclusion

Prasugrel use can reduce the risk of ischemic events. 21 However, prasugrel use also increases the risk of bleeding. 23 The use of prasugrel should be carefully evaluated on a case-by-case basis, considering the risks and benefits for each patient. 17 Further research is expected to provide additional information on the safety and efficacy of prasugrel. 19

Keywords
Benefit Keywords
Antiplatelet activity
4
Costum made DAPT
Prevent atherothrombotic events
6
Ischemic event reduction
7
DAPT effectiveness
8
Antiplatelet treatment
10
Reduced ischemic events
11
Anticoagulation
12
Faster platelet inhibition
Improved ACS treatment
13
Atherothrombosis treatment
15
Arterial thrombosis prevention
16
Improved heart health
17
Peripheral arterial disease treatment
18
Reduced MI risk
Reduced bleeding risk
19
Control of platelet function
20
Cardiovascular events
Faster onset
Platelet inhibition
21
Antiplatelet activity
Antithrombotic effects
Faster onset
23
Antiplatelet activity
Antithrombotic effects
Faster onset of action
24
Antithrombotic agent
25
Improved anticoagulation
26
Drug metabolism
27
Coronary artery disease treatment
28
Antithrombotic effect
29
Faster platelet inhibition
30
Risk Keywords
Antithyroid drug side effects
1
Drug interactions
Potential complications
2
Angioedema
3
Bleeding
Toxicity
4
Bradycardia
Dyspnea
5
Bleeding risk
Side effects
6
Hemorrhagic risk
7
Acute coronary syndrome
8
Antibiotic resistance
Fungemia
Hepatotoxicity
Increased risk of malignancies
Meningioma
QT prolongation
9
Thrombotic complications
10
Bleeding complications
11
Hemorrhagic side effects
Triple oral anticoagulation
12
Bleeding
13
Bleeding events
Death
Myocardial infarction
Stent thrombosis
14
Bleeding risk
15
Hemorrhagic side effects
16
Bleeding
Stent thrombosis
17
Bleeding risk
Drug interactions
18
Side effects
20
Increased risk of MI
Increased risk of death
Increased risk of stroke
22
Hemorrhagic risk
23
Hemorrhagic side effects
24
Cerebral ischemia
Hemorrhagic side effects
25
Bleeding risk
Unexpected side effects
26
Toxic metabolites
27
Bone marrow toxicity
Major bleeding
28
Bleeding
30
Literature analysis of 30 papers
Positive Content
23
Neutral Content
3
Negative Content
4
Article Type
4
0
0
14
27
1.

Hepatotoxicity and cutaneous reactions after antithyroid drug administration.

Author: OtsukaFumiko, NohJaeduk Y, ChinoToshiko, ShimizuTaeko, MukasaKoji, ItoKunihiko, ItoKoichi, TaniyamaMatsuo

Antithyroid drug side effects

This study investigated side effects associated with the first and second antithyroid drugs (ATDs) used in patients. The study highlights the high frequency of side effects associated with thiamazole (MMI) and propylthiouracil (PTU).

Journal ArticleAn article published in an academic or professional journal that reports original research or scholarly analysis.
Randomized Controlled TrialA clinical trial that randomly assigns participants to treatment and control groups to evaluate the effects of an intervention.

Language : English

2.

Structural characterization of the optical isomers esomeprazole and omeprazole using the JADER and FAERS databases.

Author: NeishiMami, HamanoHirofumi, NiimuraTakahiro, DendaMasaya, YagiKenta, MiyataKoji, LinTsung-Jen, HigashionnaTsukasa, GodaMitsuhiro, ZamamiYoshito, IshizawaKeisuke, NawaHideki

Drug interactions
Potential complications

This study assessed the potential complications of esomeprazole (EPZ) and omeprazole (OPZ) when combined with cilostazol, clopidogrel, and prasugrel, medications frequently used concomitantly. The study aimed to determine whether the s (-) form of esomeprazole has an improved safety profile compared to its racemic form.

Journal ArticleAn article published in an academic or professional journal that reports original research or scholarly analysis.

Language : English

5.

A rare but serious complication of ticagrelor therapy: a case report.

Author: AriotiManfredi, SirianniGiovanni, LaudisaMaria Luisa, De CesareNicoletta Bianca

Bradycardia
Dyspnea

Ticagrelor is a drug that helps prevent blood clots, which is important for patients with heart problems. The most common side effects are shortness of breath and a slow heart rate, but the slow heart rate is usually not serious.

Case ReportsIn the medical field, a report that describes in detail a unique case, an unusual medical condition, or the effect of a treatment. Provides new insights and possibilities for treatment through individual patient cases.

Language : English

10.

Incidence, Predictors, and Clinical Impact of Early Prasugrel Cessation in Patients With ST-Elevation Myocardial Infarction.

Author: KoskinasKonstantinos C, ZanchinThomas, KlingenbergRoland, GencerBaris, TemperliFabrice, BaumbachAndreas, RoffiMarco, MoschovitisAris, MullerOliver, TüllerDavid, StorteckyStefan, MachFrancois, LüscherThomas F, MatterChristian M, PilgrimThomas, HegDik, WindeckerStephan, RäberLorenz

Antiplatelet treatment
Thrombotic complications

Early cessation of prasugrel, an antiplatelet medication, after percutaneous coronary intervention for ST-segment elevation myocardial infarction increases the risk of thrombotic complications.

Journal ArticleAn article published in an academic or professional journal that reports original research or scholarly analysis.
Multicenter StudyResearch conducted in collaboration with multiple research institutions. It aims to collect a wide range of data and obtain more generalizable results.
Randomized Controlled TrialA clinical trial that randomly assigns participants to treatment and control groups to evaluate the effects of an intervention.

Language : English

11.

[Management of the bleeding risk associated with antiplatelet agents].

Author: MartinA-C, Houssany-PissotS, ZlotnikD, TaylorG, GodierA

Reduced ischemic events
Bleeding complications

This paper reviewed the bleeding risk associated with antiplatelet agents, particularly the newer agents prasugrel and ticagrelor, which have increased the risk of major bleeding. It discusses the importance of platelet function monitoring and the optimal management of bleeding complications, including the challenging issue of reversing antiplatelet therapy, especially for ticagrelor.

Journal ArticleAn article published in an academic or professional journal that reports original research or scholarly analysis.
ReviewAn article that critically examines existing research on a particular topic and summarizes the current state of knowledge in the field.

Language : French

13.

[Platelet inhibitors in clinical practice].

Author: GebhardC, BeerJ

Faster platelet inhibition
Improved ACS treatment
Bleeding

Cardiovascular disease is a leading cause of death. Antiplatelet agents, such as aspirin and clopidogrel, are used to prevent blood clots. This study reviewed new antiplatelet agents, including prasugrel and ticagrelor. These agents offer faster and more consistent platelet inhibition but carry an increased risk of bleeding. This review highlights the importance of tailoring antiplatelet treatment to individual patient needs.

Comparative StudyResearch that compares multiple groups/interventions to determine differences/similarities in outcomes/characteristics.
Journal ArticleAn article published in an academic or professional journal that reports original research or scholarly analysis.
ReviewAn article that critically examines existing research on a particular topic and summarizes the current state of knowledge in the field.

Language : German

14.

Oral antiplatelet therapy after drug-eluting stent implantation: adherence and side-effects.

Author: RossiniRoberta, BaroniMatteo, MusumeciGiuseppe, GavazziAntonello

Bleeding events
Death
Myocardial infarction
Stent thrombosis

This review examines the importance of prolonged dual antiplatelet therapy after drug-eluting stent implantation and the potential risks and side effects of premature discontinuation. It also highlights new antiplatelet drugs and management strategies for patients undergoing surgery.

EditorialAn article in which the editor or publisher expresses their opinion or perspective on a particular topic or issue. Its purpose is to convey a specific message or idea to the reader.

Language : English

17.

Residual platelet reactivity, bleedings, and adherence to treatment in patients having coronary stent implantation treated with prasugrel.

Author: ParodiGuido, BellandiBenedetta, VendittiFrancesco, CarrabbaNazario, ValentiRenato, MiglioriniAngela, GrasselliniSilvia, RamazzottiErica, AntoniucciDavid

Improved heart health
Bleeding
Stent thrombosis

This study evaluated the bleeding rates and adherence to treatment in patients treated with prasugrel, a medication used to prevent blood clots. The study found that bleeding rates in real-world patients were comparable to those reported in clinical trials, and that minimal bleeding events did not appear to affect adherence to treatment.

Clinical Trial, Phase IIIA Phase III trial is a trial that further rigorously verifies the efficacy and safety of a new drug or treatment, whose efficacy and safety have been confirmed in a Phase II trial, in a large number of patients, and evaluates whether it is superior to existing treatments.
Comparative StudyResearch that compares multiple groups/interventions to determine differences/similarities in outcomes/characteristics.
Journal ArticleAn article published in an academic or professional journal that reports original research or scholarly analysis.
Randomized Controlled TrialA clinical trial that randomly assigns participants to treatment and control groups to evaluate the effects of an intervention.
Research Support, Non-U.S. Gov'tResearch funding provided by government agencies outside the United States.

Language : English

18.

Antiplatelet and anticoagulant drugs in interventional radiology.

Author: AltenburgAlexander, HaagePatrick

Peripheral arterial disease treatment
Bleeding risk
Drug interactions

Antiplatelet and anticoagulant therapies are important in the treatment of peripheral arterial disease. Aspirin is the first-line agent for antiplatelet therapy, with clopidogrel added for dual antiplatelet therapy. Unfractionated heparin is the preferred anticoagulant for use during procedures, with low molecular-weight heparins suitable for post-interventional treatment.

Journal ArticleAn article published in an academic or professional journal that reports original research or scholarly analysis.
ReviewAn article that critically examines existing research on a particular topic and summarizes the current state of knowledge in the field.

Language : English

19.

The importance of high-quality evidence of the long-term impact of nonfatal events used in randomized controlled trials: a case study of prasugrel.

Author: LuC Y, KarnonJ, SorichM J

Reduced MI risk
Reduced bleeding risk

This article discusses the importance and challenges of using evidence from randomized controlled trials (RCTs) for clinical and policy decisions. It focuses on the case study of prasugrel and its effects on nonfatal myocardial infarction (MI) and nonfatal bleeding.

Journal ArticleAn article published in an academic or professional journal that reports original research or scholarly analysis.
Research Support, Non-U.S. Gov'tResearch funding provided by government agencies outside the United States.

Language : English

20.

Pharmacochemistry of the platelet purinergic receptors.

Author: JacobsonKenneth A, DeflorianFrancesca, MishraShilpi, CostanziStefano

Control of platelet function
Side effects

Platelets contain purinergic G protein-coupled receptors that are involved in platelet function. New pharmacological tools are being developed to control platelet function.

Journal ArticleAn article published in an academic or professional journal that reports original research or scholarly analysis.

Language : English

21.

Ticagrelor: from concept to clinical evaluation.

Author: ShandJames A, MenownIan B A, StoreyRobert F

Cardiovascular events
Faster onset
Platelet inhibition

Ticagrelor, a novel P2Y(12) receptor blocker, demonstrates faster onset, faster offset, greater maximal inhibition of platelet aggregation, and less variability in response compared to clopidogrel. In the PLATO trial, ticagrelor reduced the risk of cardiovascular death, myocardial infarction, or stroke by 16% compared to clopidogrel in patients with acute coronary syndrome.

Journal ArticleAn article published in an academic or professional journal that reports original research or scholarly analysis.
Research Support, Non-U.S. Gov'tResearch funding provided by government agencies outside the United States.
ReviewAn article that critically examines existing research on a particular topic and summarizes the current state of knowledge in the field.

Language : English

22.

Review article: combination of clopidogrel and proton pump inhibitors: implications for clinicians.

Author: TranMarie, TafreshiJavad, PaiRamdas G

Increased risk of MI
Increased risk of death
Increased risk of stroke

This paper reviews the existing literature on a potential drug-drug interaction between clopidogrel and proton pump inhibitors (PPIs). The paper concludes that there may be a detrimental interaction, but further research is needed. Clinicians should consider discontinuing PPI use if there is no clear indication and alternative options should be considered.

Journal ArticleAn article published in an academic or professional journal that reports original research or scholarly analysis.
ReviewAn article that critically examines existing research on a particular topic and summarizes the current state of knowledge in the field.

Language : English

23.

Prasugrel: a novel platelet ADP P2Y(12) receptor antagonist.

Author: MousaShaker A, JeskeWalter P, FareedJawed

Antiplatelet activity
Antithrombotic effects
Faster onset
Hemorrhagic risk

Novel adenosine diphosphate (ADP) P2Y(12) antagonists, such as prasugrel, ticagrelor, cangrelor, and elinogrel, are being developed to improve antiplatelet activity, faster onset of action, and antithrombotic effects compared to clopidogrel. Prasugrel is more potent and has a faster onset of action than clopidogrel, but it is also associated with an increased risk of bleeding.

Journal ArticleAn article published in an academic or professional journal that reports original research or scholarly analysis.
ReviewAn article that critically examines existing research on a particular topic and summarizes the current state of knowledge in the field.

Language : English

24.

Antiplatelet therapy prasugrel: a novel platelet ADP P2Y12 receptor antagonist.

Author: MousaShaker A, JeskeWalter P, FareedJawed

Antiplatelet activity
Antithrombotic effects
Faster onset of action
Hemorrhagic side effects

This study reviewed novel adenosine diphosphate (ADP) P2Y(12) antagonists under investigation for improved antiplatelet activity, faster onset of action, and/or greater antithrombotic effects than clopidogrel. Prasugrel was highlighted as being more efficacious but with an increased risk of bleeding.

Journal ArticleAn article published in an academic or professional journal that reports original research or scholarly analysis.
ReviewAn article that critically examines existing research on a particular topic and summarizes the current state of knowledge in the field.

Language : English

25.

Advances in antiplatelet therapy for stroke prevention: the new P2Y12 antagonists.

Author: GiossiA, PezziniA, Del ZottoE, VolonghiI, CostaP, FerrariD, PadovaniA

Antithrombotic agent
Cerebral ischemia
Hemorrhagic side effects

P2Y12 antagonists, such as clopidogrel, are used to prevent blood clots. Several novel P2Y12 antagonists, including prasugrel, ticagrelor, cangrelor, and PRT060128, are being investigated for their potential to improve antithrombotic effects and reduce side effects.

Journal ArticleAn article published in an academic or professional journal that reports original research or scholarly analysis.
ReviewAn article that critically examines existing research on a particular topic and summarizes the current state of knowledge in the field.

Language : English

26.

[Update on new antithrombotic treatments].

Author: BoehlenF, Tirefort-DimitrovaY, de MoerlooseP, FontanaP

Improved anticoagulation
Bleeding risk
Unexpected side effects

This article provides an update on new antithrombotic treatments, highlighting the emergence of new anticoagulants like fondaparinux, rivaroxaban, and dabigatran. It also discusses new antiplatelet agents like prasugrel, ticagrelor, and cangrelor, emphasizing the need for individualized prescriptions due to their varying bleeding risks and side effects.

English AbstractA summary of a research paper/publication written in English for a wider audience.
Journal ArticleAn article published in an academic or professional journal that reports original research or scholarly analysis.

Language : French

27.

Drug metabolism for the perplexed medicinal chemist.

Author: TestaBernard

Drug metabolism
Toxic metabolites

Oxidoreductases are the main enzymes responsible for the formation of toxic or active metabolites, whereas transferases play a major role in producing inactive and nontoxic metabolites.

Journal ArticleAn article published in an academic or professional journal that reports original research or scholarly analysis.
ReviewAn article that critically examines existing research on a particular topic and summarizes the current state of knowledge in the field.

Language : English

29.

New P2Y12 antagonists.

Author: MichelsonAlan D

Antithrombotic effect

This article reviews the current status of the P2Y12 antagonist clopidogrel and other new P2Y12 antagonists. While clopidogrel has been a valuable antithrombotic agent, new antagonists have been developed to address the limitations of clopidogrel.

Journal ArticleAn article published in an academic or professional journal that reports original research or scholarly analysis.
ReviewAn article that critically examines existing research on a particular topic and summarizes the current state of knowledge in the field.

Language : English

30.

Switching directly to prasugrel from clopidogrel results in greater inhibition of platelet aggregation in aspirin-treated subjects.

Author: PayneChristopher D, LiYing G, BrandtJohn T, JakubowskiJoseph A, SmallDavid S, FaridNagy A, SalazarDaniel E, WintersKenneth J

Faster platelet inhibition
Bleeding

This study investigated the safety and efficacy of switching directly from clopidogrel to prasugrel in patients on aspirin. The results demonstrated that switching directly to prasugrel, either with a loading dose or maintenance dose, was well tolerated and resulted in significantly greater levels of platelet inhibition than clopidogrel alone.

Journal ArticleAn article published in an academic or professional journal that reports original research or scholarly analysis.
Randomized Controlled TrialA clinical trial that randomly assigns participants to treatment and control groups to evaluate the effects of an intervention.
Research Support, Non-U.S. Gov'tResearch funding provided by government agencies outside the United States.

Language : English

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