Antiplatelets
1) Antiplatelet Drugs
- COX Inhibitors
- Prostaglandin Analogues (PGI2)
- Treprostinil (Remoodulin)
- Combos
- Aspirin + Clopidogrel
- 4 weeks after bare metal stent
- 6 months after drug eluting stent
- Unstable angina
- Aspirin + Prasugrel
A) COX Inhibitors
- Acetylsalicylic Acid (Aspirin)
- COX1 Inhibition (Thromboxane A2)
- COX2 Inhibition at high doses
- Overdose:
- Gastric Lavage, Activated Charcoal
- Alkalinization of the urine (IV Sodium Bicarb)
- Goal of urine pH ≥7.5
- Dialysis if Salicylate levels ≥90-100 with acute intoxication or ≥60 ng/mL in chronic administration
- Reye Syndrome
- Use of aspirin after a URI
- Symptoms
- Acute encephalopathy w/hepatic dysfunction occurring days after recovery
- Heavy vomiting, delirium, fatty liver, seizures, coma
- Liver failure with elevated AST, ALT
- Increased PT, elevated ammonia, and hypoglycemia
- ± Renal and heart failure, Increased ICP
B) PDE Inhibitors/Thromboxane Inhibitors
- Cyclic AMP Interference
- Dipyridamol (Persantine)
- Blocks AMP BD, inhibit Platelet activation
C) PARI
- Thrombin Receptor Interference, PAR-1 Antagonist
- Vorapaxar (Zontivity)
D) P2Y12
- ADP Receptor Antagonists (P2Y12 Inhibitors)
- Binds platelet ADP receptor
- Inhibits platelet aggregation
- Used in aspirin intolerant or in coronary stents
- Thienopyridine (IR)
- Require CYP450 activation
- Clopidogrel (Plavix)
- Prasugrel (Effient)
- 10x stronger, more rapid
- More bleeding risk than clopidogrel
- CI in ≥75 y/o, renal impaired, CVD
- Ticlopidine (Ticlid)
- Nucleotide/side analog (R)
- Reversible, no activation needed to work
- Ticagrelor (Brilinta)
- More rapid onset, ≥ than clopidogrel
- SE: Dyspnea MC
- Cangrelor
E) GIIb/IIIa Receptor Inhibitors
- GP IIb/IIIa antagonists
- Abciximab (ReoPro)
- PCI w/o ADPRA, not renally cleared
- Monoclonal antibody
- Eptifibatide (Integrilin)
- Tirofiban (Aggrastat)
- High risk unstable angina- Eptifibutide (Integrilin)
F) PDE3 Inhibitors
- Cilostazole (Pletal)
- Only indicated in symptomatic claudication
- CI: HF