Risk increases in patients receiving prasugrel who undergo coronary artery bypass graft surgery (CABG)(do not start prasugrel in patients likely to undergo urgent CABG; suspect bleeding in any patient who is hypotensive and has recently undergone coronary angiography, PCI, CABG, or other surgical procedures in the setting of prasugrel). Premature discontinuation of prasugrel increases risk of stent thrombosis, MI, and death (if possible, manage bleeding without discontinuing treatment). Do not use prasugrel in patients with active pathological bleeding or history of transient ischemic attack or stroke. In patients ≥75 years of age, prasugrel is generally not recommended because of the increased risk of intracranial and fatal bleeding and uncertain benefit, except in high-risk patients (diabetes or prior MI), where its effect appears to be greater and its use may be considered. When possible, discontinue treatment at least 7 days prior to any surgery. Additional risk factors for bleeding include body weight <60 kg, propensity to bleed, and concomitant use of medications that increase risk of bleeding. Thrombotic thrombocytopenic purpura (TTP) has been reported with the use of other thienopyridines, sometimes after a brief exposure (<2 weeks).