Lecture Antiplatelets and Thrombolytics Flashcards
antiplatelet drugs include:
Aspirin
P2Y12_ADP receptor blockers - clopidogrel (Plavix)
Glycoprotein IIb/IIIa inhibitors - abciximab
Antiplatelet drugs prevent clot formation. They should not be ___.
stopped abruptly as there is a high risk of thrombus formation.
Aspirin ASA
used for: ischemic stroke, TIAs, chronic stable angina, unstable angina, coronary stenting, acute MI, previous MI, MI prevention
Great for these!!
AE: Risk of GI bleed & hemorrhagic stroke
Dose
- 81 mg/day – shown to be most effective, no increase efficacy at a higher dose; effects last up to 1 week
- 325 mg – used for acute events (MI), have pt CHEW IT!!
clopidogrel (Plavix)
P2Y12_ADP receptor antagonist
Uses: prevent blockage of coronary artery stents, reduce thrombotic events in acute coronary syndromes (ACS) or atherosclerosis
Risk of GI bleed & hemorrhagic stroke
Cousins
prasugrel [Effient] - used for thrombotic events, greater risk for bleeding
ticagrelor [Brilinta] - used for MI/stent stenosis/CV death after new ACS, greater risk for bleeding
ticlopidine - about like ASA, but much more expensive
abciximab
Glycoprotein (GP) IIb/IIIa Receptor Antagonists used for ACS & percutaneous coronary interventions (PCI)
“Super aspirin”, but $$ so only used in these situations
Given short-term via IV, with ASA & low-dose heparin (all given together)
a. can accelerate revascularization
b. works 24-48 hrs after infusion
c. doubles risk of major bleeding
Glycoprotein (GP) IIb/IIIa Receptor Antagonists
abciximab
eptifibatide
tirofiban
PCI (Percutaneous Coronary Intervention)
KNOW THIS
Give:
Anticoagulant (IV heparin) AND 2 Antiplatelets
1. Aspirin AND
2. P2Y12ADP receptor agonist OR Glycoprotein IIb/IIIa receptor antagonist
P2Y12ADP receptor agonist – clopidagrel
Glycoprotein IIb/IIIa receptor antagonist – abciximab, eptifibatide, and tirofiban
ie heparin + aspirin + either: clopidagrel abciximab eprifibatide tirofivan)
alteplase [tPA]
used for MI, Ischemic stroke, massive PE
EMERGENCY!!
Give IV Bolus, then infuse over 90 minutes
Give as quick as possible – w/in 2-4 hours after symptom onset (MI or stroke)
note: Cathflow Activase is used to clear a clot in a central line catheter
AE: bleeding
if bleed -> apply pressure, give blood, aminocaproic acid
tenecteplase [TNKase]
cousin to tPA
used for acute MI
easier to use
single IV bolus (5 sec)
Hemophilia
Deficiency in a factor in the coagulation cascade
Treatment:
- Primary: replace clotting factor
- Desmopressin for minor bleeds
If someone has too much clot buster on board give Antifibrinolytic Agents
- aminocaproic acid [Amicar] - IV/PO
- tranexamic acid [Cyklokapron] - IV
Hemophilia A “Classic Hemophilia”
Lack clotting Factor VIII
Treatment:
- Primary Tx is Factor VIII Concentrate, IV; Watch for allergic reactions
- Tx for minor bleeds (like nosebleeds) - Desmopressin
Desmopressin
treatment for minor bleeds
VTE usually presents as ___.
DVT or PE
Treatment:
i. Oxygen (O2)
ii. Anticoagulation
iii. IVC filter: filter in vein
Afib
Cardiac arrhythmia
Usually associated with some underlying heart disease (HTN, coronary disease, valvular heart disease)
Patient is at an increased risk of death, heart failure, hospitalization, and thromboembolic events
Blood often pools in the heart and a blood clot forms
Causes ischemic stroke – usually first sign
Treatment: different options
i. Anticoagulation (risk vs benefit)
ii. Rate versus rhythm control to improve symptoms
CVA
either hemorrhagic or ischemic stroke (Ischemic is more common than hemorrhagic)
ACT F.A.S.T. Face drop - 1 sided Arms - drift Speech - slurred Time to CALL 911!
Treatment:
CAT scan to determine
If ischemic: IV aTP, aspirin
If hemorrhagic: dc antiplatelets and anticoagulants, give antidotes (Vit K, Protamine, Factors)
