Current prescribing information cautions clearly Prasugrel should not be used in TIA or recent stroke (Even in ischemic strokes -Embolic included !)
The warning is perplexing and illogical to me.
What is your take ?
I would imagine the following could be the reasons.
Prasugrel as an antiplatlet agent is many fold powerful and could convert all strokes into hemorrhagic one .
Does Prasugrel convert a TIA into stroke instead of curing it ?
Prasugrel may worsen the stroke in case the TIA is going to end up as stroke.
Is there any thing called hemorrhagic TIA ?
Since we do not have any mechanism to diagnose Ischemic TIA from hemorrhagic TIA , it is better to avoid Prasugrel . It is still a mystery , why clopidogrel which acts on the same receptor and can be safely given for TIA ( pro actively)
After thought
I think Neuro physicians must answer this question . ( Cardiologists better limit their extended geographical terrain ! )
Dr.S.Venkatesan MD 