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antiplatelet agent

Indications: - prevention of myocardial infarction - unstable angina - prevention of ischemic stroke [2] - prevention of transient ischemic attack - vascular stents - percutaneous coronary intervention - prevention of arterial thrombosis associated with coronary stent [5] - atherectomy [9] - secondary prevention in patients with cardiovascular disease - thrombocytosis [9] - myeloproliferative disorders - hypercoagulability - thromboembolism - 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] a) history of peptic ulcer or gastrointestinal bleeding b) dual antiplatelet therapy or concomitant anticoagulation c) 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] Mechanism of action: - prevents platelet thrombi 'white clots'

Interactions

drug interactions drug adverse effects (more general classes)

Related

antiplatelet agent contraindications

Specific

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)

General

antithrombotic agent

References

  1. 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: 16984924 - Sung JJY Combining aspirin with antithrombotic agents. BMJ 2006, 333:712 PMID: 17023437
  2. 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: 18349026
  3. 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: 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: 18836135
  4. McMorran BJ et al. Platelets kill intraerythrocytic malarial parasites and mediate survival to infection. Science 2009 Feb 6; 323:797. PMID: 19197068
  5. Prescriber's Letter 18(9): 2011 Discontinuing Antiplatelet Agents Detail-Document#: 270919 (subscription needed) http://www.prescribersletter.com
  6. Prescriber's Letter 18(10): 2011 Detail-Document#: 271020 Comparison of Oral Anticoagulants and Antiplatelets (subscription needed) http://www.prescribersletter.com
  7. 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 PMID: 22431677 http://www.annals.org/search?author1=Suetonia+C.+Palmer&sortspec=date&submit=Submit
  8. 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: 22315278
  9. Deprecated Reference
  10. Prescriber's Letter 21(9): 2014 Comparison of Oral Antiplatelets Detail-Document#: 300909 (subscription needed) http://www.prescribersletter.com
  11. 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: 27464591
  12. 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 PMID: 26227434 Free full text 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 PMID: 28622952 Free Article http://www.thelancet.com/journals/lancet/article/PIIS0140-6736(17)31507-6/fulltext