Last reviewed 2026-04-22 · How we verify

prasugrel/bivalirudin

Prasugrel and bivalirudin are combined to provide dual antiplatelet and anticoagulant activity for acute coronary syndrome management.

Prasugrel and bivalirudin are combined to provide dual antiplatelet and anticoagulant activity for acute coronary syndrome management. Used for Acute coronary syndrome (ACS) in patients undergoing percutaneous coronary intervention (PCI).

At a glance

Mechanism of action

Prasugrel is a P2Y12 platelet receptor antagonist that irreversibly inhibits platelet aggregation, while bivalirudin is a direct thrombin inhibitor that prevents thrombin-mediated coagulation. Together, they provide complementary antithrombotic effects—prasugrel blocks platelet activation and aggregation, and bivalirudin inhibits the coagulation cascade—reducing thrombotic complications in acute coronary syndromes.

Approved indications

• Acute coronary syndrome (ACS) in patients undergoing percutaneous coronary intervention (PCI)

Common side effects

• Bleeding
• Thrombocytopenia
• Dyspnea

Key clinical trials

• Downstream Versus Upstream Strategy for the Administration of P2Y12 Receptor Blockers (PHASE4)
• Effect of Prasugrel Versus Clopidogrel on Platelet Function After Bivalirudin Cessation (PHASE4)
• Rapid Activity of Platelet Inhibitor Drugs Study (PHASE4)
• Rapid Activity of Platelet Inhibitor Drugs Study 2 (PHASE4)
• Efficacy Study of Combined Prasugrel and Bivalirudin Versus Clopidogrel and Heparin in Myocardial Infarction (PHASE4)
• FIT (Fast Infarction Treatment): Complete Revascularization During Primary Percutaneous Coronary Intervention (PCI) Can be Achieved Safely With an Improved Clinical Outcome During the Indexed Hospitalization. (PHASE3)
• Bivalirudin/Prasugrel Versus Abciximab/Clopidogrel in Patients Presenting With STEMI (PHASE4)

Primary sources

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