Current and future antiplatelet therapies: emphasis on preserving haemostasis

Antiplatelet drugs, such as aspirin, P2Y12 antagonists, and glycoprotein (GP) IIb/IIIa inhibitors, have proved to be successful in reducing the morbidity and mortality associated with arterial thrombosis. These agents are, therefore, the cornerstone of therapy for patients with acute coronary syndromes. However, these drugs all carry an inherent risk of bleeding,..

Comparison of Common Antiplatelet Agents

Antiplatelet agents can be classified by which stage of platelet function they affect...

Antiplatelet Therapy in Stroke: The Old and the New

The landmark CHANCE and POINT trials demonstrate that DAPT with clopidogrel and aspirin reduces the risk of stroke and vascular events in patients with high-risk TIA or minor stroke compared to aspirin alone and the benefit is confined to the early period. This may explain why longer-term trials of DAPT (MATCH, SPS3 and CHARISMA) found no benefit. The SOCRATES trial found that DAPT with ticagrelor and aspirin is not superior to aspirin in reducing vascular events, although ticagrelor shows a strong trend toward reduced stroke in the acute setting and is more efficacious in patients with large artery disease or patients already taking aspirin.

Medications After a Heart Attack| Why Dual Anti Platelet Therapy Is So Important

DAPT is composed of two medications. The first is aspirin and the second is either Plavix (Clopidogrel), Brilinta (Ticagrelor), or Effient (Prasugrel). They are supremely important after a having a stent placed in the heart because they keep the stent open. DAPT keeps stents open by preventing clots from forming inside the stents.

Plavix (clopidogrel), step aside, and prasugrel (Effient), watch your back: Ticagrelor proves that some"me-too" drugs are truly superior

Regardless, it is refreshing to see that the industry is indeed designing drugs with demonstrable benefits over existing agents... I will rarely be using either of these drugs or Plavix because I rarely treat AMI or patients undergoing PCI. My interest in this trial and that of prasugrel stems from the fact that in the cases of these two agents, the sponsoring company indeed succeeded in making what is in essence a "me-too" drug that is superior to an earlier-to-market agent(s). They did not monkey around with this non-inferiority trial crap like anidulafungin and gefitinib and just about every antihypertensive that has come to market in the past 10 years, they actually took Plavix to task and beat it, legitimately. For this, and for the sheer size of the trial and its superb design, they deserve to be commended. One take-home message here, and from other posts on this blog is "beware the non-inferiority trial".

Antiplatelet Therapy Use Before PCI Declining

The timing of antiplatelet medication administration is changing in individuals undergoing cardiac procedures.

Antiplatelet therapy with aspirin, clopidogrel, and dipyridamole versus clopidogrel alone or aspirin and dipyridamole in patients with acute cerebral ischaemia (TARDIS)

Among patients with recent cerebral ischaemia, intensive antiplatelet therapy did not reduce the incidence and severity of recurrent stroke or TIA, but did significantly increase the risk of major bleeding. Triple antiplatelet therapy should not be used in routine clinical practice.

Comparing Antiplatelet Therapy in STEMI: The FABOLUS-FASTER Trial

We have seen many studies based on cangrelor, on glycoprotein (GP) IIb/IIIa inhibitors, including tirofiban and many studies based on prasugrel, but we have never had a comparative assessment of the capability of these 3 drugs, which was the main goal in setting up this study.

Current State and Novel Approaches of Antiplatelet Therapy

An unresolved problem with clinical use of antiplatelet therapy is that a significant number of individuals either still get thrombosis or run the risk of life-threatening bleeding. Antiplatelet drugs are widely used clinically, either chronically for people at risk of athero/thrombotic disease or to prevent thrombus formation during surgery. However, a subpopulation may be resistant to standard doses, while the platelet targets of these drugs are also critical for the normal hemostatic function of platelets.

Dual antiplatelet therapy after stenting

Although dual antiplatelet therapy has benefits, it also has drawbacks. Because antiplatelet drugs prevent blood from clotting, they can cause bruising and internal bleeding. Surgery for any reason becomes risky, since bleeding can be hard to stop. For these reasons, the less time antiplatelet therapy is needed, the better.

How Aspirin Works Its Magic

Aspirin is one of the rare magic bullets in medicine when it works against thromboxane: even tiny doses completely and irreversibly stop thromboxane production. People who take a baby aspirin a day for 10 days have no thromboxane at all left in their platelets. Although their blood will still coagulate normally, their platelets do not stick together well, and they may bleed a little more from a cut or scratch than usual. It takes a full 10 days for aspirin's effects to wear off after a person stops taking it.

Understanding Your Options When Taking Aspirin and Other Antiplatelet Drugs

Many heart attack and stroke patients – and people seeking to avoid those events – are treated with what’s known as dual antiplatelet therapy. Simply put, that means taking aspirin along with a second drug to prevent blood clotting. Dual antiplatelet therapy, referred to as DAPT, often is prescribed for patients who have had heart attacks, are treated with stents in their coronary arteries, and some patients who undergo coronary artery bypass surgery.

Wallets rejoice as Plavix goes generic

Despite its contribution to the treatment of heart disease, clopidogrel is not ideal for everyone who needs it. It can cause unwanted and sometimes serious or fatal bruising and bleeding. Also, an estimated one in three users lack the gene that allows their body to metabolize the drug, rendering it ineffective as a clot preventer.