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Antiplatelet drugs - P2Y12 inhibitors

Blood thinners - clopidogrel; Antiplatelet therapy - clopidogrel; Thienopyridines

 

Platelets are small cells in your blood that your body uses to form clots and stop bleeding. If you have too many platelets or your platelets stick together too much, you are more likely to form clots. This clotting can take place on the inside of your arteries and lead to heart attack or stroke.

Antiplatelet drugs work to make your platelets less sticky and thereby help prevent blood clots from forming in your arteries.

  • Aspirin is an antiplatelet drug that may be used.
  • P2Y12 receptor blockers are another group of antiplatelet drugs. This group of drugs includes: clopidogrel, ticlopidine, ticagrelor, prasugrel, and cangrelor.

Who Should Take Antiplatelet Drugs

 

Antiplatelet drugs may be used to:

  • Prevent heart attack or stroke for those with PAD.
  • Clopidogrel (Plavix, generic) may be used in place of aspirin for patients who have narrowing of the coronary arteries or who have had a stent inserted.
  • Sometimes two anti-platelet drugs (one of which is almost always aspirin) are prescribed for patients with unstable angina, acute coronary syndrome (unstable angina or early signs of heart attack), or those who have received a stent during PCI.
  • For heart disease primary and secondary prevention, daily aspirin is generally the first choice for antiplatelet therapy. Clopidogrel is prescribed instead of aspirin for patients who are aspirin allergic or who cannot tolerate aspirin.
  • Clopidogrel and aspirin is recommended for patients who are undergoing angioplasty with or without stenting.
  • Prevent or treat heart attacks.
  • Prevent stroke or transient ischemic attacks (TIAs are early warning signs of stroke. The are also called "mini-strokes.")
  • Prevent clots from forming inside stents put inside your arteries to open them.
  • Acute coronary syndrome.
  • After bypass graft surgery that uses a man-made or prosthetic graft performed on arteries below the knee.

Your health care provider will choose which one of these drugs are best for your problem. At times, you may be asked to take low dose aspirin along with one of these drugs.

 

Side Effects

 

Side effects of this medicine may include:

  • Diarrhea
  • Itching
  • Nausea
  • Skin rash
  • Stomach pain

Before you start taking these medicines, tell your health care provider if:

  • You have bleeding problems or stomach ulcers.
  • You are pregnant, plan to become pregnant, or are breastfeeding.

There are a number of other possible side effects, depending on which drug you are prescribed. For example:

  • Ticlopidine may lead to a very low white blood cell count or an immune disorder that destroys platelets.
  • Ticagrelor may worsen kidney function and cause episodes of shortness of breath.

 

Taking P2Y12 Inhibitors

 

This medicine is taken as a pill. Your provider may change your dose from time to time.

Take this medicine with food and plenty of water to reduce side effects. You may need to stop taking clopidogrel before you have surgery or dental work. DO NOT just stop taking your medicine without first talking with your health care provider.

Talk with your provider before taking any of these drugs:

  • Heparin and other blood thinners, such as warfarin (Coumadin)
  • Pain or arthritis medicine (such as diclofenac, etodolac, ibuprofen, indomethacin, Advil, Aleve, Daypro, Dolobid, Feldene, Indocin, Motrin, Orudis, Relafen, or Voltaren)
  • Phenytoin (Dilantin), tamoxifen (Nolvadex, Soltamox), tolbutamide (Orinase), or torasemide (Demadex)

DO NOT take other drugs that may have aspirin or ibuprofen in them before talking with your provider. Read the labels on cold and flu medicines. Ask what other medicines are safe for you to take for aches and pains, colds, or the flu.

If you have any type of procedure scheduled, you may need to stop these drugs 5 to 7 days before hand. However, always check with your provider first about whether it is safe to stop.

Tell your provider if you are pregnant or planning to become pregnant, or breastfeeding or planning to breastfeed. Women in the later stages of pregnancy should not take clopidogrel. Clopidogrel can be passed to infants through breast milk.

Talk with your provider if you have liver or kidney disease.

If you miss a dose:

  • Take it as soon as possible, unless it is time for your next dose.
  • If it is time for your next dose, take your usual amount.
  • DO NOT take extra pills to make up for a dose you have missed, unless your doctor tells you to.

Store these drugs and all other medicines in a cool, dry place. Keep them where children cannot get to them.

 

When to Call the Doctor

 

Call if you have any of these side effects and they do not go away:

  • Any signs of unusual bleeding, such as blood in the urine or stools, nosebleeds, any unusual bruising, heavy bleeding from cuts, black tarry stools, coughing up blood, heavier than usual menstrual bleeding or unexpected vaginal bleeding, vomit that looks like coffee grounds
  • Dizziness
  • Difficulty swallowing
  • Tightness in your chest or chest pain
  • Swelling in your face or hands
  • Itching, hives, or tingling in your face or hands
  • Wheezing or difficulty breathing
  • Very bad stomach pain
  • Skin rash

 

 

References

Abraham NS, Hlatky MA, Antman EM, et al. ACCF/ACG/AHA 2010 expert consensus document on the concomitant use of proton pump inhibitors and thienopyridines: a focused update of the ACCF/ACG/AHA 2008 expert consensus document on reducing the gastrointestinal risks of antiplatelet therapy and NSAID use: a report of the American College of Cardiology Foundation Task Force on Expert Consensus Documents. J Am Coll Cardiol. 2010; 56(24);2051-2066. PMID: 21126648 www.ncbi.nlm.nih.gov/pubmed/21126648.

Biller J, Ruland S, Schneck MJ. Ischemic cerebrovascular disease. In: Daroff RB, Jankovic J, Mazziotta JC, Pomeroy SL, eds. Bradley's Neurology in Clinical Practice. 7th ed. Philadelphia, PA: Elsevier; 2016:chap 65.

Fihn SD, Gardin JM, Abrams J, et al. 2012 ACCF/AHA/ACP/AATS/PCNA/SCAI/STS guideline for the diagnosis and management of patients with stable ischemic heart disease: a report of the American College of Cardiology Foundation/American Heart Association task force on practice guidelines, and the American College of Physicians, American Association for Thoracic Surgery, Preventive Cardiovascular Nurses Association, Society for Cardiovascular Angiography and Interventions, and Society of Thoracic Surgeons. Circulation. 2012;126(25):3097-3137. PMID: 23166210 www.ncbi.nlm.nih.gov/pubmed/23166210.

Goldstein LB. Prevention and management of ischemic stroke. In: Mann DL, Zipes DP, Libby P, Bonow RO, Braunwald E, eds. Braunwald's Heart Disease: A Textbook of Cardiovascular Medicine. 10th ed. Philadelphia, PA: Elsevier Saunders; 2015: chap 59.

January CT, Wann LS, Alpert JS, et al. 2014 AHA/ACC/HRS guideline for the management of patients with atrial fibrillation: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines and the Heart Rhythm Society. J Am Coll Cardiol. 2014;64(21):e1-e76. PMID: 24685669 www.ncbi.nlm.nih.gov/pubmed/24685669.

Lansberg MG, O'Donnell MJ, Khatri P, et al. Antithrombotic and thrombolytic therapy for ischemic stroke: Antithrombotic Therapy and Prevention of Thrombosis, 9th ed: American College of Chest Physicians Evidence-Based Clinical Practice Guidelines. Chest. 2012;141(2 Suppl):e601S-e36S. PMID: 22315273 www.ncbi.nlm.nih.gov/pubmed/22315273.

Meschia JF, Bushnell C, Boden-Albala B, et al. Guidelines for the primary prevention of stroke: a statement for healthcare professionals from the American Heart Association/American Strok Association. Stroke. 2014;45(12):3754-3832. PMID: 25355838 www.ncbi.nlm.nih.gov/pubmed/25355838.

Smith SC Jr, Benjamin EJ, Bonow RO, et al. AHA/ACCF secondary prevention and risk reduction therapy for patients with coronary and other atherosclerotic vascular disease: 2011 update: a guideline from the American Heart Association and American College of Cardiology Foundation endorsed by the World Heart Federation and the Preventive Cardiovascular Nurses Association. J Am Coll Cardiol. 2011;58(23):2432-2446. PMID: 22055990 www.ncbi.nlm.nih.gov/pubmed/22055990.

Vandvik PO, Lincoff AM, Gore JM, et al. Primary and secondary prevention of cardiovascular disease: Antithrombotic Therapy and Prevention of Thrombosis, 9th ed: American College of Chest Physicians Evidence-Based Clinical Practice Guidelines. Chest. 2012;141(2 Suppl):e637S-e668S. PMID: 22315274 www.ncbi.nlm.nih.gov/pubmed/22315274.

 
  • Plaque buildup in arteries

    Plaque buildup in arteries - illustration

    A heart attack or stroke may occur when an area of plaque (atherosclerosis) ruptures and a clot forms over the location, blocking the flow of blood to the organ's tissues.

    Plaque buildup in arteries

    illustration

    • Plaque buildup in arteries

      Plaque buildup in arteries - illustration

      A heart attack or stroke may occur when an area of plaque (atherosclerosis) ruptures and a clot forms over the location, blocking the flow of blood to the organ's tissues.

      Plaque buildup in arteries

      illustration

    A Closer Look

     

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      Review Date: 8/2/2016

      Reviewed By: Michael A. Chen, MD, PhD, Associate Professor of Medicine, Division of Cardiology, Harborview Medical Center, University of Washington Medical School, Seattle, WA. Also reviewed by David Zieve, MD, MHA, Isla Ogilvie, PhD, and the A.D.A.M. Editorial team.

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