Some prasugrel prescribing runs counter to labeling

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Prescribing patterns for the anticoagulant prasugrel suggest that there is ample room for improvement. 

Prasugrel (Effient, Eli Lilly/Daiichi Sankyo), while effective in decreasing the risk of MI, stroke and cardiovascular death, has warnings about its use in patients at risk for increased bleeding. A research letter published online July 1 in the Journal of the American College of Cardiology reviewing data from the National Cardiovascular Data Registry PINNACLE database found that of the 27,533 patients receiving prasugrel, 3,824 patients fell under an “inappropriate use” indication while 1,210 patients were taking prasugrel in a way that was not recommended by the manufacturer.

The definition of “inappropriate” includes patients with a history of stroke or transient ischemic attack, while prasugrel was “nonrecommended” for patients 75 years of age or older.

The research team led by Ravi S. Hira, MD, from Baylor College of Medicine in Houston, wrote that in addition to nearly one fifth of patients prescribed prasugrel being defined as inappropriate or nonrecommended, 15.4 percent of patients were receiving a trifecta of aspirin, warfarin and prasugrel, potentially increasing bleeding risks. They expressed concerns that any anti-ischemic benefit may be offset, even if appropriately prescribed in these cases. However, 319 and 677 of those patients receiving the triple therapy were inappropriately or nonrecommendedly prescribed prasugrel, respectively.

Hira et al noted that as some of the data was self-reported and the numbers of patients may be skewed. In the end, they expressed a recommendation for clinicians to increase their awareness of drug contraindications before prescribing.