Prasugrel Use in Patients with Liver Disease

Bleeding Risk and Contraindications

• The American College of Cardiology notes that prasugrel carries inherent bleeding risks, including TIMI major hemorrhage in 2.4% of patients, life-threatening bleeding in 1.4%, and fatal bleeding in 0.4%, compared to clopidogrel 1, 2
• Prasugrel is absolutely contraindicated in patients with active pathological bleeding, as stated by the American College of Cardiology and the American Heart Association 1, 2, 3, 4, 5, 6, 7
• The European Society of Cardiology recommends that patients with body weight <60 kg should have their maintenance dose reduced to 5 mg daily, due to increased bleeding risk 1, 3, 2, 4, 5, 6, 7, 9
• The American College of Cardiology advises that prasugrel should be avoided in patients aged ≥75 years, except in high-risk situations like diabetes or prior MI, due to increased bleeding risk 1, 3, 2, 4, 5, 6, 7, 10

Dosing and Monitoring

• The American Heart Association recommends that patients with liver disease requiring prasugrel should be assessed for severity of hepatic impairment using Child-Pugh classification, and those with Class C should avoid prasugrel due to lack of safety and efficacy data 1, 8
• The European Heart Journal suggests that patients with liver disease should be closely monitored for bleeding complications, with regular clinical assessment for signs of bleeding and counseling on bleeding symptoms and medication compliance 8
• The American College of Cardiology states that prasugrel should be discontinued at least 7 days before any planned surgery, including procedures for portal hypertension complications, to minimize bleeding risk 1, 3, 2, 4, 5, 6, 7, 8