Patients on Antiplatelet Therapy Flashcards
What are ADP receptor inhibitors?
Clopidogrel, prasugrel, ticagrelor, ticlopidine
These are medications that inhibit the ADP receptor to prevent platelet aggregation.
Which ADP receptor inhibitor is first-line for patients following ischaemic stroke?
Clopidogrel
Clopidogrel is also indicated for patients with peripheral arterial disease.
What is the mechanism of action (MOA) of ADP receptor inhibitors?
Prevent platelet aggregation and stabilization of plaques
ADP is one of the main platelet activation factors.
What is the recommended antiplatelet regimen for patients with ACS undergoing PCI?
Aspirin (75-100mg daily) + either prasugrel, ticagrelor, or clopidogrel for 12 months
After 12 months, aspirin alone is recommended.
What side effect is associated with ticagrelor?
Shortness of breath (SOB)
This is a notable side effect that some patients may experience.
What caution should be taken with clopidogrel?
Caution with PPIs
PPIs can reduce the antiplatelet effect of clopidogrel.
What are the absolute contraindications for prasugrel?
History of stroke or TIA, high risk of bleeding, prasugrel hypersensitivity
These contraindications must be considered before prescribing prasugrel.
What conditions contraindicate the use of ticagrelor?
High risk of bleeding, history of intracranial hemorrhage, severe hepatic dysfunction
Caution is also advised in patients with COPD or acute asthma.
What is the first-line treatment for acute coronary syndrome?
Aspirin (lifelong) & ticagrelor (12 months)
If aspirin is contraindicated, clopidogrel is used lifelong.
What is the MOA of aspirin?
COX inhibitor that blocks thromboxane A2 in platelets
This action reduces platelet aggregation.
What is the indication for aspirin in patients under 16 years of age?
Not for use unless for Kawasaki disease treatment
The benefits must outweigh the risks due to Reye’s syndrome.
What is the typical antiplatelet and anticoagulation therapy for patients with stable CVD?
All patients on antiplatelet; anticoagulant monotherapy without antiplatelet if indicated
This is to manage risks effectively.
What is the recommended therapy duration for triple therapy after acute coronary syndrome/PCI?
4-6 weeks
This consists of 2 antiplatelets and 1 anticoagulant.
What is the recommended therapy duration for dual therapy after acute coronary syndrome/PCI?
Up to 12 months
This consists of 1 antiplatelet and 1 anticoagulant.
What should be done if a patient on antiplatelets develops venous thromboembolism?
Prescribe anticoagulants for 3-6 months
The ORBIT score should be calculated to assess bleeding risk.
If the ORBIT score indicates low bleeding risk, what should be done regarding antiplatelets when managing a VTW?
Continue on antiplatelets alongside addition of anticoagulant
If the risk is intermediate or high, consider stopping antiplatelets.
