Prasugrel is contraindicated in patients with which history?

• A. Diabetes
• B. History of stroke
• C. Prior MI
• D. Age >75

Answer: (B)

Prasugrel is a potent P2Y12 inhibitor used with aspirin in acute coronary syndrome, especially around PCI. The key safety concern with this drug is the risk of bleeding, particularly intracranial hemorrhage. In patients who have had a prior stroke or transient ischemic attack, this risk is markedly higher, and using prasugrel in that group has been shown to cause more harm than benefit. That's why a history of stroke is a contraindication for prasugrel.

Diabetes, prior myocardial infarction, and advanced age alone do not place a patient in a contraindicated category for prasugrel. Diabetes and prior MI are common contexts where prasugrel is beneficial, and while age over 75 increases bleeding risk, treatment is not outright ruled out; guidelines recommend using a lower dose (or approaching with caution) rather than declaring it contraindicated.