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Anti-Platelet Agents (Aspirin (MOA
Irreversible, non-selective COX…
Anti-Platelet Agents
Aspirin
MOA
Irreversible, non-selective COX inhibitor
→ ↓ plat TxA2 →
- ↓ plat activation
- ↓ platelet adhesion, aggregation
Relatively platelet-specific @ low dose
-
CI<16yrs (Reyes syn.)
- except in Kawasaki’s
Active PUD
Bleeding disorders
Gout
R (if GFR < 10ml/min)
P, B
Caution:
Interactions
↑ risk of bleeding with other
anti-coagulants and antiplatelets:
W+
↑s fx of
- sulphonylureas
- methotrexate
-
-
Clopidogrel (Plavix)
Thienopyridine
Irreversible adenosine R antagonist
- inhibits ADP-induced fibrinogen binding
to GPIIb/IIIa
Used following bare metal or drug eluting
stents.
SE
Bleeding
- esp. GI or intracranial
GI upset
Dyspepsia / PU
TTP (rare)
Blood dyscrasias (rare)
-
-
-
-
Indications for Anti-Platelet Therapy
Secondary prevention
Primary prevention
- 10yr CVD risk >20% + controlled BP
Tissue heart valve replacements
Recommendations
- Clopidogrel is preferred over aspirin + DP-MR for secondary prevention after stroke
- Aspirin + DP-MR is preferred over clopi following a TIA.
- Clopidogrel + aspirin is given in the emergent Mx of STEMI and NSTEMI
- Continue clopi for 12mo in NSTEMI or 1mo in STEMI
- Clopi + aspirin not beneficial following stroke