Prasugrel (Effient) — what you need to know

If you or someone you care for was told to take prasugrel, the key point is simple: it prevents platelets from clumping and cutting the risk of clots after a heart attack or stent procedure. That payoff comes with a real trade-off — higher bleeding risk — so you should know when it helps and when it doesn’t.

How prasugrel works and when it's used

Prasugrel is an oral antiplatelet agent often given to patients with acute coronary syndrome (ACS) who are going for percutaneous coronary intervention (PCI) with stent placement. After a loading dose, it keeps platelets less sticky so clots are less likely to form on a new stent. Compared with older drugs like clopidogrel, prasugrel acts faster and tends to reduce some types of heart attacks — but it also raises bleeding risk.

Typical dosing: a 60 mg loading dose before PCI, then 10 mg once daily. For patients under about 60 kg, doctors often cut the maintenance dose to 5 mg daily. If you have had a stroke or transient ischemic attack (TIA), prasugrel is usually avoided — it’s contraindicated because of bleeding risk.

Practical safety tips and common side effects

Bleeding is the main side effect. That includes easy bruising, nosebleeds, prolonged bleeding from cuts, or more serious internal bleeding. Tell every doctor, dentist, or nurse you see that you’re on prasugrel. They’ll want to know before any procedures or surgeries. Most teams ask you to stop prasugrel about 7 days before planned surgery to lower bleeding risk.

Other common effects include stomach upset and rare allergic reactions. Watch for sudden severe headache, fainting, heavy bleeding, dark stools, or coughing/vomiting blood — these need emergency care. If you miss a dose, take it as soon as you remember that day; don’t double up the next day.

Drug interactions matter. Combining prasugrel with NSAIDs (ibuprofen, naproxen), SSRIs, or other blood thinners (warfarin, DOACs) increases bleeding risk. Always tell your cardiologist about all medicines and supplements you use, including aspirin — aspirin is typically continued with prasugrel but follow your doctor’s plan for dose and duration.

There’s a big trial called TRITON-TIMI 38 that compared prasugrel to clopidogrel in ACS patients. It showed fewer ischemic events with prasugrel but more major bleeding. That’s why doctors pick prasugrel when the benefit seems to outweigh bleeding risk — for example, in certain high-risk PCI cases — and avoid it in people with prior stroke or high bleeding risk.

Final practical point: don’t stop prasugrel on your own after a stent without talking to your cardiologist. Stopping early raises the chance of a clot forming on the stent. Ask your doctor about how long you should stay on it and what to do if you need surgery or have a bleeding problem.