An antiplatelet
Prasugrel
A potent antiplatelet taken with aspirin to prevent clots after a heart attack or coronary stent.
What is Prasugrel?
Prasugrel is a strong antiplatelet (anti-clotting) medicine that stops platelets sticking together to form clots. It is usually taken alongside low-dose aspirin after a heart attack or after a stent is placed in a coronary artery. Because it thins the blood powerfully, its main trade-off is a higher chance of bleeding and bruising.
Education and reference only. This is a plain-language guide to Prasugrel — it deliberately contains no doses. Doses depend on the person, the brand and the reason for treatment, and belong with your prescriber. Always check the BNF, the product labelling (SmPC) and follow medical advice.
What it is
Prasugrel is a potent antiplatelet medicine used mainly after a heart attack (acute coronary syndrome) and after a stent has been fitted to open up a narrowed heart artery. It belongs to a group of drugs that block a platelet receptor called P2Y12, and it is normally prescribed together with low-dose aspirin — a combination known as dual antiplatelet therapy. The aim is to keep the treated artery and stent clear of clots during the higher-risk period after the procedure.
How it works
Platelets are tiny blood cells that clump together to form clots. Prasugrel blocks a key receptor on the platelet surface (the P2Y12 receptor) that platelets use to activate and stick to one another. By switching off this signal, prasugrel makes platelets much less able to form a clot, which helps stop a stent or damaged artery from blocking off again. Its effect lasts for the life of each platelet, so the blood stays thinner for several days after the last dose.
Company & origin
Originated / developed by: Developed by Daiichi Sankyo and Eli Lilly..
Introduced in the late 2000s, prasugrel was approved in Europe and the UK around 2009 for use after coronary stenting.
Practical use
How to take Prasugrel
General, dose-free guidance — always follow your prescriber's and the leaflet's specific instructions.
- Take it once a day at about the same time, with or without food, together with your low-dose aspirin.
- Swallow the tablet whole with water; do not stop it just because you feel well.
- Do not stop before dental treatment, surgery or other procedures unless your cardiologist or surgeon tells you to.
- Tell every doctor, dentist and pharmacist that you take prasugrel before any treatment.
- If a dose is missed, take it as soon as you remember the same day, but skip it if your next dose is near — never take two at once.
Weighing it up
Advantages & disadvantages of Prasugrel
Advantages
- A strong, reliable antiplatelet that protects a freshly placed stent from clotting off.
- Works consistently between people and starts acting quickly, which is useful after a heart attack.
- Taken as a simple once-a-day tablet alongside aspirin.
Disadvantages
- Carries a higher bleeding risk than some alternatives, so bruising and minor bleeds are common.
- Not suitable for people who have had a stroke or mini-stroke (TIA) because of bleeding in the brain.
- Needs extra care, and sometimes an alternative, in older or lighter-built people who bleed more easily.
Practical use
Good to know
Prasugrel is usually taken once a day, with or without food, alongside aspirin for a set period decided by your cardiology team. It is a powerful blood thinner, so bruising, nosebleeds and longer bleeding from cuts are common, and any heavy, unusual or unstoppable bleeding should be reported. Very importantly, do not stop it before dental work, surgery or other procedures without specialist advice — stopping early can let a clot form in the stent. Tell any healthcare professional that you take it, and carry this information with you.
Who should not take it / use with caution
- People with active bleeding, such as a bleeding stomach ulcer or bleeding in the brain.
- Anyone who has previously had a stroke or transient ischaemic attack (TIA).
- People with severe liver disease, and used with extra caution in those who are elderly or of low body weight.
Monitoring
- Watching for signs of bleeding or unusual bruising
- Review of how long dual antiplatelet therapy should continue
- Full blood count if bleeding or low platelets are suspected
Side effects
- Easier bruising, nosebleeds and bleeding that takes longer to stop after cuts.
- More serious bleeding, including from the stomach or gut — report black or bloody stools, vomiting blood, or any heavy or unstoppable bleeding urgently.
- Occasional rash; rarely a drop in platelet counts.
Key interactions
- Other blood thinners and anticoagulants (such as warfarin or apixaban) and other antiplatelets raise bleeding risk.
- Anti-inflammatory painkillers (NSAIDs such as ibuprofen) add to the risk of stomach bleeding.
- Tell your team about all medicines and any herbal remedies before starting or stopping anything.
Available as: Tablets.
Answers
Prasugrel: frequently asked questions
Why am I taking prasugrel with aspirin?
Using two antiplatelets together (dual antiplatelet therapy) gives stronger protection against a clot forming in a new stent or damaged artery than either alone. Your cardiology team decides how long to continue the combination.
Can I stop prasugrel before an operation or dental work?
Not on your own. Stopping early can let a clot block the stent, which can be very dangerous. Always check with your cardiologist or surgeon first — they will advise whether and when to pause it.
I bruise much more easily now — is that normal?
Yes, easier bruising and longer bleeding from small cuts are expected because the medicine thins the blood. Report heavy, unusual or unstoppable bleeding, blood in your urine, or black stools urgently.
What is the difference between prasugrel and Efient?
They are the same medicine. Prasugrel is the generic (active-ingredient) name and Efient is a brand name; both contain the identical active ingredient.
Why is prasugrel avoided after a stroke?
People who have had a stroke or mini-stroke (TIA) have a higher risk of bleeding in the brain on prasugrel, so a different antiplatelet is usually chosen for them.
The wider class
About Antiplatelets
Prasugrel belongs to the antiplatelets class. For how the class as a whole works, its shared safety principles and monitoring, see the full guide.
Browse by body system
Authoritative sources
- BNF: Prasugrel.
- NICE CKS: Antiplatelet medicines.
Building a medicines information resource?
We create evidence-led, dose-free drug and formulary references for teams.