PEBC: What You Need to Know: Antiplatelet Agents

Focus: Conary Artery Disease and Myocardial Infarction (Secondary Prevention)

Examples:

Acetylsalicylic acid (aspirin), clopidogrel and ticagrelor (note: prasugrel is now discontinued in Canada)

Dual Antiplatelet Therapy Dosing:

-Clopidogrel 75 mg once daily x 1 year with indefinite aspirin 81 mg once daily

-Ticagrelor 90 mg twice daily x 1 year with indefinite aspirin 81 mg once daily (can continue ticagrelor at 60 mg twice daily afterwards if risk is still high)

Adverse Effects:

-BLEEDING: minor bleeds such as cuts and nosebleeds may take longer to stop. Major bleeds such as blood in stool or continous bleeds will need to be assessed. Higher bleeding rates with dual antiplatelet therapy > single agent. Higher bleeding with ticagrelor > clopidogrel.

-Stomach irritation and bleeds: some patients may require stomach protectants such as proton pump inhibitors

-Nausea, diarrhea, rash: clopidogrel

-Dyspnea and increased uric acid: ticagrelor

Drug Interactions:

All agents: caution for bleeding when combined with anticoagulants (apixaban, rivaroxaban) and NSAIDs.

Ticagrelor: 3A4 substrate, so watch for inhibitors which can increase the risk of bleeding