What are the potential disadvantages of using prasugrel in triple therapy?
Prasugrel produce a greater degree of platelet inhibition than clopidogrel and are associated with greater rates of bleeding. These are important potential disadvantages in patients requiring triple therapy, a group in which the inherent risks of bleeding are significantly increased. Overall bleeding risk was not increased with ticagrelor, although there was increased bleeding in certain subgroups on this drug. Because there are no well-established therapies to reverse the anticoagulant effects of the newer oral antiplatelet agents, caution is required when considering the use of these agents in patients who require triple therapy and are at significantly increased risk of bleeding. This admonition is especially important in elderly patients, a group in which bleeding risk is inherently increased.