Limited Use Note(s)

Government of Ontario Logo
Reason For Use CodeClinical Criteria
449In combination with ASA for patients with: ST-elevated myocardial infarction (STEMI) undergoing primary percutaneous coronary intervention (PCI) who have not received antiplatelet therapy prior to arrival in the catheterization lab. OR Acute coronary syndrome who failed on optimal clopidogrel and ASA therapy as defined by definite stent thrombosis (see note 1), or recurrent STEMI, or NSTEMI or UA after prior revascularization via PCI. Treatment must be initiated in hospital. Funding approval is for up to 1 year. Notes: 1. Definite stent thrombosis, according to the Academic Research Consortium, is a total occlusion originating in or within 5mm of the stent OR is a visible thrombus within the stent OR is within 5mm of the stent in the presence of an acute ischemic clinical syndrome within 48 hours. Definite stent thrombosis must be confirmed by angiography or by pathologic evidence of acute thrombosis. 2. As per the product monograph, prasugrel is contraindicated in patients with a known history of transient ischemic attack or stroke; those with active pathological bleeding such as gastrointestinal bleeding or intracranial hemorrhage; and those with severe hepatic impairment (Child-Pugh Class C). 3. As per the product monograph, prasugrel is not recommended in patients greater than or equal to 75 years of age because of the increased risk of fatal and intracranial bleeding; or those with body weight less than 60kg because of increased risk of major bleeding due to an increase in exposure to the active metabolite of prasugrel.
LU Authorization Period: 1 year