Prasugrel Weight-based Dosing — EECC MCQ

Correct answer: A — Reduce prasugrel to 5 mg daily

Prasugrel (a third-generation thienopyridine P2Y12 inhibitor) requires dose adjustment in two populations: (1) body weight <60 kg: reduce to 5 mg daily (increased bleeding risk from higher drug exposure per kg); (2) age ≥75 years: 5 mg daily generally recommended (though not explicitly required in the ESC guidelines, the TRITON-TIMI 38 subgroup showed net harm in ≥75 years at full dose). Additionally, prasugrel is CONTRAINDICATED in patients with prior stroke/TIA (increased intracranial haemorrhage — TRITON-TIMI 38 showed net harm). The 2023 ESC ACS Guidelines recommend: prasugrel 60 mg loading then 10 mg daily (or 5 mg if <60 kg or ≥75 years) as a preferred potent P2Y12 inhibitor for ACS patients undergoing PCI (Class I), alongside ticagrelor as an alternative.

Reference: ESC (2023): ACS Guidelines; TRITON-TIMI 38: https://bnf.nice.org.uk/