Implications of the Antiplatelet Therapy Gap Left With Discontinuation of Prasugrel in Canada
Related Experiment Video
Updated: Nov 1, 2025
Microfluidics in Assessing Platelet Function
Published on: November 8, 2024
Marie Lordkipanidzé1,2, Guillaume Marquis-Gravel1,3, Jean-François Tanguay1,3
1Montreal Heart Institute, Montreal, Quebec, Canada.
Insights
The discontinuation of prasugrel in Canada necessitates a review of antiplatelet therapy guidelines. Clinicians must identify optimal P2Y12 receptor antagonist alternatives for acute coronary syndromes.
Area of Science:
- Cardiology
- Pharmacology
Background:
- Current Canadian Cardiovascular Society guidelines favor ticagrelor or prasugrel over clopidogrel for acute coronary syndromes.
- Prasugrel (Effient) has recently been discontinued in Canada, impacting treatment options.
Purpose of the Study:
- To review clinical scenarios where prasugrel was optimal.
- To discuss alternative P2Y12 receptor antagonist strategies in the absence of prasugrel.
Main Methods:
- An evidence-based review by Canadian Cardiovascular Society guidelines committee members.
- Analysis of clinical scenarios and alternative therapy considerations.
Main Results:
- Identified specific clinical situations favoring prasugrel use.
- Summarized alternative therapy considerations, including de-escalation strategies.
Conclusions:
- Prasugrel discontinuation presents a clinical challenge for managing acute coronary syndromes.
- Key factors must be considered when selecting alternative P2Y12 receptor antagonists.
Background:
The current Canadian Cardiovascular Society antiplatelet therapy guidelines recommend the use of ticagrelor or prasugrel over clopidogrel as first-line platelet P2Y12 receptor antagonists for treatment of moderate- to high-risk acute coronary syndromes. Recently, Effient (prasugrel [Eli Lilly Canada Inc, Toronto, Canada]) was discontinued by its distributor in Canada.
Methods:
Five members of the Canadian Cardiovascular Society antiplatelet therapy 2018 guidelines committee undertook an independent, evidence-based review to outline patients for whom prasugrel should be the optimal P2Y12 agent and discuss alternative strategies to consider without prasugrel.
Results:
Several clinical scenarios where prasugrel should be indicated are identified and discussed. Considerations to be undertaken for alternative therapies are summarized, including a review of national and international guidelines for de-escalation of P2Y12 receptor antagonists.
Conclusions:
The discontinuation of prasugrel poses a challenge for clinicians. Clinicians must consider key factors in determining the best alternate therapy.
More Related Videos
10:28Interventional Diagnostic Procedure: A Practical Guide for the Assessment of Coronary Vascular Function
Published on: March 15, 2022
09:13Turbidimetry on Human Washed Platelets: The Effect of the Pannexin1-inhibitor Brilliant Blue FCF on Collagen-induced Aggregation
Published on: April 6, 2017
Related Concept Videos
01:20Antiplatelet Drugs: Prostaglandin Synthesis, P2Y12 and Glycoprotein IIb/IIIa Inhibitors
Prostaglandin synthesis inhibitors, exemplified by the widely known aspirin, wield their power by irreversibly acetylating...
01:22Formation of the Platelet Plug
As the injured blood vessel contracts, endothelial cells undergo contraction, revealing collagen fibers in the basement membrane and underlying connective tissue. Furthermore, the plasma membrane of endothelial cells becomes adhesive, preparing the site for platelet adhesion. Platelets...
01:27Coronary Artery Disease V: Interprofessional Care
01:27Peripheral Artery Disease III: Interprofessional Care
01:23Treatment for Pulmonary Arterial Hypertension: Prostacyclin Receptor Agonists
These agonists bind to the IPR receptor situated on the plasma membrane of the pulmonary artery smooth muscle cells. This binding triggers a cascade of reactions known as the GS-AC-cAMP-PKA pathway. This pathway results in the relaxation of smooth muscle...
01:16Clot Retraction and Fibrinolysis