antiplatelet agent
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Indications
- prevention of myocardial infarction
- prevention of ischemic stroke[2]
- prevention of transient ischemic attack
- vascular stents
- percutaneous coronary intervention
- prevention of arterial thrombosis associated with coronary stent[5]
- percutaneous coronary intervention
- atherectomy[9]
- secondary prevention in patients with cardiovascular disease
- thrombocytosis[9]
- hypercoagulability
- intermittent claudication
- pulmonary hypertension
- myocardial perfusion scintigraphy
- platelet aggregation inhibition[9]
Contraindications
- bleeding
- chronic kidney disease ?
- lack of clear efficacy in reducing cardiovascular morbidity & mortality
- risk of bleeding may exceed benefit[7]
- hemophilia
- malaria[8]
Dosage
- proton pump inhibitors should be considered for patients on long-term antiplatelet therapy if:[3]
- history of peptic ulcer or gastrointestinal bleeding
- dual antiplatelet therapy or concomitant anticoagulation
- additional risk factors (age >= 60, steroid use, dyspepsia, or gastroesophageal reflux).
- in patients with a history of ulcer histories who are starting chronic antiplatelet therapy, test for & eradicate H pylori[3]
Adverse effects
- increased risk of bleeding, including upper GI bleed
| drug(s) | odds ratio |
|---|---|
| aspirin 81 mg | 1.8 |
| dipyridamole | 1.9 |
| clopidogrel | 1.1 |
| aspirin + clopidogrel | 7.4 |
| aspirin + dipyridamole | 2.3 |
| aspirin + warfarin | 5.3 |
- platelet transfusion not indicated for GI bleed
- increased mortality, no reduction of risk for rebleed[11]
- increased risk of bleeding increases with age[12]*
* proton pump inhibitor should be given to patients > 75 years of age[12]
- drug adverse effects of antiplatelet agents
- drug adverse effects of antithrombotic agent(s)
Mechanism of action
- prevents platelet thrombi 'white clots'
More general terms
More specific terms
- anagrelide (Agrylin)
- aspirin (Ecotrin, Empirin, Bayer aspirin, Vazalore, ASA)
- aspirin/dipyridamole (Aggrenox)
- cangrelor (Kengreal)
- cilostazol (Pletal)
- dipyridamole (Persantine)
- glycoprotein IIb/IIIa inhibitor
- iloprost (Ventavis, ciloprost)
- P2Y12-receptor inhibitor
- revacept
- ticlopidine (Ticlid)
- vorapaxar (Zontivity)
References
- ↑ Hallas J et al, Use of single and combined antithrombotic therapy and risk of serious upper gastrointestinal bleeding: Population based case-control study. BMJ 2006, 333:726 PMID: https://www.ncbi.nlm.nih.gov/pubmed/16984924
Sung JJY Combining aspirin with antithrombotic agents. BMJ 2006, 333:712 PMID: https://www.ncbi.nlm.nih.gov/pubmed/17023437 - ↑ 2.0 2.1 Thijs V et al, Network meta-analysis: Simulatneous meta-analysis of common antiplatelet regimens after transient ischaemic attack or stroke. Eur Heart J 2008, 29:1086 PMID: https://www.ncbi.nlm.nih.gov/pubmed/18349026
- ↑ 3.0 3.1 3.2 Bhatt DL et al. ACCF/ACG/AHA 2008 expert consensus document on reducing the gastrointestinal risks of antiplatelet therapy and NSAID use. Am J Gastroenterol 2008 Nov; 103:2890.
Bhatt DL et al, ACCF/ACG/AHA 2008 expert consensus document on reducing the gastrointestinal risks of antiplatelet therapy and NSAID use: a report of the American College of Cardiology Foundation Task Force on Clinical Expert Consensus Documents. J Am Coll Cardiol. 2008 Oct 28;52(18):1502-17. PMID: https://www.ncbi.nlm.nih.gov/pubmed/19017521
Bhatt DL et al. ACCF/ACG/AHA 2008 expert consensus document on reducing the gastrointestinal risks of antiplatelet therapy and NSAID use: A report of the American College of Cardiology Foundation Task Force on Clinical Expert Consensus Documents. Circulation 2008 Oct 28; 118:1894. PMID: https://www.ncbi.nlm.nih.gov/pubmed/18836135 - ↑ McMorran BJ et al. Platelets kill intraerythrocytic malarial parasites and mediate survival to infection. Science 2009 Feb 6; 323:797. PMID: https://www.ncbi.nlm.nih.gov/pubmed/19197068
- ↑ 5.0 5.1 Prescriber's Letter 18(9): 2011 Discontinuing Antiplatelet Agents Detail-Document#: http://prescribersletter.com/(5bhgn1a4ni4cyp2tvybwfh55)/pl/ArticleDD.aspx?li=1&st=1&cs=&s=PRL&pt=3&fpt=25&dd=270919&pb=PRL (subscription needed) http://www.prescribersletter.com
- ↑ Prescriber's Letter 18(10): 2011 Detail-Document#: http://prescribersletter.com/(5bhgn1a4ni4cyp2tvybwfh55)/pl/ArticleDD.aspx?li=1&st=1&cs=&s=PRL&pt=3&fpt=25&dd=271020&pb=PRL Comparison of Oral Anticoagulants and Antiplatelets (subscription needed) http://www.prescribersletter.com
- ↑ 7.0 7.1 Palmer SC Effects of Antiplatelet Therapy on Mortality and Cardiovascular and Bleeding Outcomes in Persons With Chronic Kidney Disease: A Systematic Review and Meta-analysis Ann Intern Med March 20, 2012 156:445-459 <PubMed> PMID: https://www.ncbi.nlm.nih.gov/pubmed/22431677 <Internet> http://www.annals.org/search?author1=Suetonia+C.+Palmer&sortspec=date&submit=Submit
- ↑ 8.0 8.1 Eikelboom JW, Hirsh J, Spencer FA, Baglin TP, Weitz JI. Antiplatelet drugs: Antithrombotic Therapy and Prevention of Thrombosis, 9th ed: American College of Chest Physicians Evidence-Based Clinical Practice Guidelines. Chest. 2012 Feb;141(2 Suppl):e89S-119S PMID: https://www.ncbi.nlm.nih.gov/pubmed/22315278
- ↑ 9.0 9.1 9.2 9.3 Deprecated Reference
- ↑ Prescriber's Letter 21(9): 2014 Comparison of Oral Antiplatelets Detail-Document#: http://prescribersletter.com/(5bhgn1a4ni4cyp2tvybwfh55)/pl/ArticleDD.aspx?li=1&st=1&cs=&s=PRL&pt=3&fpt=25&dd=300909&pb=PRL (subscription needed) http://www.prescribersletter.com
- ↑ 11.0 11.1 Zakko L, Rustagi T, Douglas M, Laine L. No benefit from platelet transfusion for gastrointestinal bleeding in patients taking antiplatelet agents. Clin Gastroenterol Hepatol 2016 Jul 24; PMID: https://www.ncbi.nlm.nih.gov/pubmed/27464591
- ↑ 12.0 12.1 12.2 Li L, Geraghty OC, Mehta Z et al Age-specific risks, severity, time course, and outcome of bleeding on long-term antiplatelet treatment after vascular events: a population-based cohort study. Lancet. Jun 13, 2017 <PubMed> PMID: https://www.ncbi.nlm.nih.gov/pubmed/26227434 Free full text <Internet> http://www.thelancet.com/journals/lancet/article/PIIS0140-6736(17)30770-5/fulltext
Diener HC Preventing major gastrointestinal bleeding in elderly patients. Lancet. Jun 13, 2017 <PubMed> PMID: https://www.ncbi.nlm.nih.gov/pubmed/28622952 Free Article <Internet> http://www.thelancet.com/journals/lancet/article/PIIS0140-6736(17)31507-6/fulltext