Newer anti platelet drugs
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Newer antiplatelet drugs like prasugrel and ticagrelor have shown better outcomes than clopidogrel in reducing heart attacks and deaths in ACS patients. Prasugrel reduced risk by 24% compared to clopidogrel but increased bleeding risk, so it is not recommended for those over 75, under 60kg, or with stroke history. Ticagrelor provided faster, more consistent platelet inhibition than clopidogrel and reduced deaths and heart attacks in the PLATO trial, though it increased non-CABG bleeding and dyspnea. Guidelines recommend aspirin plus a P2Y12 inhibitor like clopidogrel, prasugrel or ticagrelor for ACS patients
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This document summarizes various antiplatelet drugs used to treat thrombotic diseases. It discusses the pathophysiology of thrombosis and hemostasis, focusing on the interplay between the vessel wall, coagulation proteins, and platelets. Older antiplatelet drugs such as aspirin, clopidogrel, and GP IIb/IIIa inhibitors are described along with newer agents like ticagrelor, elinogrel, and cangrelor that inhibit the P2Y12 receptor on platelets. Other drug classes discussed include thromboxane receptor antagonists, thrombin receptor antagonists, and GPVI receptor antagonists. The challenges of preventing thrombosis without increased bleeding risks are also noted.
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Antiplatelet agents such as aspirin and clopidogrel work by preventing platelet activation and aggregation to reduce clot formation. Anticoagulants like heparin and warfarin slow down the clotting process by inhibiting coagulation factors. These drugs are used to prevent conditions caused by clots such as heart attacks, strokes, and deep vein thrombosis. Common side effects include bleeding and gastrointestinal issues. The choice of antiplatelet or anticoagulant depends on the medical condition being treated.
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This document summarizes various trials that have evaluated antiplatelet drugs like aspirin, clopidogrel, prasugrel, ticagrelor, as well as oral anticoagulants in patients with acute coronary syndromes or those undergoing percutaneous coronary intervention. It discusses major trials such as ISIS-2, CURE, TRITON, PLATO and others that helped establish the efficacy and safety of these antiplatelet and anticoagulant drugs. It also summarizes recent trials that have evaluated shorter durations of dual antiplatelet therapy compared to longer durations.
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Class antiplatele tand fibinolytics
This document discusses various antiplatelet and antithrombotic drugs. It describes the mechanisms and uses of aspirin, clopidogrel, ticlopidine, abciximab, tirofiban, dipyridamole, cilostazol, prasugrel, ticagrelor, streptokinase, urokinase, anistreplase, tPA, reteplase, tenecteplase for conditions like myocardial infarction, unstable angina, stroke prevention and treatment. It also lists the contraindications for thrombolytics like intracranial hemorrhage and recent closed head injury.
Anti coagulants
This document discusses antiplatelet agents used for cardiovascular disease. It describes the mechanisms of action, indications, dosing, side effects, and perioperative management of various antiplatelet drugs including aspirin, clopidogrel, ticlopidore, ticagrelor, prasugrel, cangrelor, abciximab, eptifibatide, tirofiban, dipyridamole, vorapaxar, and atopaxar. It also discusses the use of antiplatelet therapy for primary and secondary prevention of cardiovascular events such as cardiovascular death, stroke, and myocardial infarction, as well as for peripheral artery disease.
Can newer antiplatelets replace clopidogrel
- Clopidogrel is still the standard antiplatelet for many patients with stable IHD or ACS managed conservatively, as well as for primary PCI within 3 hours of chest pain onset, as prasugrel and ticagrelor have certain limitations for these groups.
- For PCI, a 600 mg loading dose of clopidogrel is recommended based on evidence from RCTs showing benefit compared to lower doses.
- Newer antiplatelets like ticagrelor have advantages over clopidogrel but also drawbacks like increased dyspnea and renal issues, while prasugrel requires caution in certain groups due to bleeding risks.
- Cangrelor's IV formulation
Choosing antiplatelet therapy before during and after hosp for acs
- The document discusses guidelines for antiplatelet therapy before, during, and after hospitalization for acute coronary syndrome (ACS).
- It recommends aspirin for all patients without contraindications, and ticagrelor over clopidogrel or prasugrel due to its greater effectiveness in reducing ischemic events, stent thrombosis, and death for up to one year.
- For patients undergoing percutaneous coronary intervention (PCI), pretreatment with a P2Y12 inhibitor such as clopidogrel is recommended to reduce complications, with higher loading doses for those who have not received previous treatment.
Last power 11 dic.52 mb pptx
This document discusses primary hemostasis, which is the initial response to vascular injury mediated by platelets. It involves platelet adhesion to the subendothelium through interactions with glycoprotein Ib and von Willebrand factor, activation of platelet granules to recruit more platelets, and aggregation of additional platelets through glycoprotein IIb/IIIa and fibrinogen binding to form the initial clot. This triggers secondary hemostasis, or coagulation. The document also discusses factors that maintain the balance of hemostasis, such as substances released by endothelial cells like nitric oxide, prostacyclin, and ADPase.
Trials on oral anti platelet agents
1) Multiple trials have evaluated various oral antiplatelet agents for reducing mortality in patients with acute coronary syndromes. The ISIS-2 trial showed aspirin reduces mortality in STEMI patients with no increased bleeding risk.
2) Clopidogrel, prasugrel, ticagrelor, and cangrelor are P2Y12 receptor antagonists used in addition to aspirin. They differ in reversibility, activation pathway, onset and offset of action, and drug interactions. Trials have shown these agents reduce ischemic events when added to aspirin.
3) Later trials evaluated higher doses of antiplatelet agents or administering them in alternative ways like crushing tablets. While some strategies led
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1) The ISAR-REACT 5 trial compared the efficacy and safety of ticagrelor versus prasugrel for dual antiplatelet therapy in patients with acute coronary syndrome (ACS) who were undergoing invasive management.
2) 4018 patients presenting with ACS were randomly assigned to receive either ticagrelor or prasugrel.
3) At 1 year follow up, the primary outcome of death, myocardial infarction, or stroke occurred less frequently in the prasugrel group compared to the ticagrelor group (6.9% vs 9.3%), driven mainly by a lower rate of myocardial infarction in the prasugrel group. Major bleeding occurred more often in the
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Antiplatelet agents in acute coronary syndrome
This document summarizes antiplatelet agents used in acute coronary syndrome. It discusses 3 oral P2Y12 inhibitors approved by the FDA - Clopidogrel, Prasugrel, and Ticagrelor. Clopidogrel was shown to reduce cardiovascular events in CURE trial but has slow onset and offset. Prasugrel provided greater platelet inhibition than Clopidogrel in TRITON trial but increased bleeding. Ticagrelor had faster, greater platelet inhibition than Clopidogrel and reduced mortality compared to Clopidogrel in PLATO trial. The document also discusses the IV P2Y12 inhibitor Cangrelor, which has very rapid onset and offset, and was shown to reduce periproced
Antiplatelets in IHD, Dose Duration, DAPT vs SAPT
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Antiplatelet drugs (antithrombotics)
A PowerPoint Presentation on " Antiplatelet Drugs (Antithrombotic Drugs)" suitable for UG MBBS studrents
Antiplatelet Drugs
This ppt is important for UG MBBS, PG Pharmacology and any other healthcare person interested in Antiplatelet drugs.
Anticoagulanta and regional anesthesia.ppt draft 3
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The document discusses the risks and management of neuraxial anesthesia in patients receiving anticoagulant or antiplatelet medications. It states that while neuraxial techniques can reduce thromboembolic risks, anticoagulants are still often needed and precautions must be taken with neuraxial blocks. The timing of medication discontinuation, monitoring of coagulation parameters, and catheter management varies depending on the specific agent and dosing regimen. Neurological monitoring is important when combining these techniques due to the rare but serious risk of spinal hematoma.Dr pratap journal reading 1
This document summarizes a randomized controlled trial that compared clopidogrel to ticagrelor or prasugrel in 1002 patients aged 70 years or older with non-ST-elevation acute coronary syndrome. Patients were randomly assigned to receive clopidogrel or ticagrelor/prasugrel. The primary outcome was major or minor bleeding, while the co-primary outcome included mortality, myocardial infarction, stroke, and bleeding. The results found clopidogrel was associated with fewer bleeding events compared to ticagrelor/prasugrel without increasing the risk of the combined clinical outcome. The conclusion is that clopidogrel could be an alternative P2Y12 inhibitor, especially for elderly patients
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Newer anti platelet drugs
- 6. CLOPIDOGREL- MOST WIDELY USED –causes irreversible alterations in p2y12 receptor mediated platelet inhibition. It has addictive effects when combined with aspirin due to different mechanism of actions. Now used commonly in ACS with aspirin. Drawbacks- prodrug- delayed onset of action(4-6 hours),irreversible platelet inhibition (increased hemmorhage)and has marked interindividual variability in anti-platelet action called clopidogrel resistance( increased stent thrombosis and MI) Also has interaction with PPI , hence lead to reduced clinical effects,PANTOPRAZOLE IS SAFE, because no interaction with CYP2C19 cytochrome enzyme.
- 7. PRASUGREL THEINOPYRIDINE group Acts through P2Y12 receptor. Prodrug- but acts more rapidly in 30 mins. TRITOM-TIMI trial compared prasugrel and clopidogrel in 13608 patients.All patients received aspirin. One group received Prasugrel 60 mg loading and f/b 10 mg and other 300 mg clopi loading dose and 75 daily for 15 months. Prasugrel had 24 % risk reduction.
- 8. BLEEDING risk is MORE. HENCE NOT RECOMMENDED IN - Elderly >75 years < 60 kgs History of previous strokes Planned for urgent surgery. Should only be given to patients whose coronary anatomy is known after PCI, ONLY WHEN decision to proceed to PTCA is made. NOT RECOMMENDED FOR PATIENTS MANAGED MEDICALLY.
- 9. TICAGRELOR- NOVEL directly acting oral platelet p2y12 receptor antagonist and REVERSIBLE ACTION. FASTEST AND GREATER AND CONSISTENT anti- platelet action. PLATO Trial-compared ticagrelor and clopitab , decreased deaths and MI in the Ticagrelor group. However NON-CABG and Intra-cranial bleeding higher. Increased Dyspnea. Increased Ventricular Phase of Holter Monitoring. Recommended in ALL PATIENTS BEING MANAGED COSERVATIVELY OR WITH INTERVENTIONS.
- 10. CANGRELOR- Intravenous Platelet inhibitor. Rapid onset and offset. Reversible action and platelet function becomes normal within 30- 60 minutes of stopping cangrelor. Used in patient who need to undergo CABG,Sinc it acts for less time with rapid offfset.
- 11. PROTEASE ACTIVATED RECEPTOR 1(PAR1) INHIBITORS- Acts against THROMBIN induced Platelet aggregation. VORAPAXOR AND ATOPAXAR selective and potent. Reduces the risk of MI and death, but with significant risk of bleeding.
- 12. GUIDELINES- • Aspirin PLUS • Clopitab, prasugrel or ticagrelor Acs with planned intervention • Aspirin plus Clopidogrel or ticagrelor Medically managed ACS • Aspirin plus clopidgrel ELECTIVE PCI
- 14. UNSTABLE ANGINA OR NSTEMI Aspirin PLUS BEFORE PCI- C/T/ OR IV GP 2B3A- Eptifibatide or tirofiban At the time of PCI- Prasugrel /ticagrelor/clopidogrel or iv gp 2b3a Without stenting-aspirin for lifelong and C OR T upto 12 months.
- 15. ESC GUIDELINES- Ticagrelor is recommended in all patients at moderate to high risk ischaemic events (elevated troponins ) irrespective of initial strategy. Prasugrel only in whom coronary anatomy is known proceeding to PTCA Clopidogrel in all whom P OR T cant be given
- 16. STEMI • Aspirin loading • Plus clopidogrel 300 or prasugrel 60 or ticagrelor 180 Undergoing Pami • Aspirin plus clopidogrel 300 mg loading if <75 years Undergoing Thrombolysising • If pci performed within 24 hours clopidogrel 300 mg loading and if performed after 24hours- 600 mg clopidogrel Undergoing PCI after Thrombolysis
- 17. CLASS 1- FOR ACS/NON STEMI /UA/ STEMI managed medically- Clopidogrel or ticagrelor- upto 12 months. ACS undergoing PCI with stents-(bms or des) clopidogrel or prasugrel or ticagrelor- upto 2- 3 years ASPIRIN to be continued lifelong. DURATION
- 18. CONCLUSION NEWER anti-platelets like prasugrel and ticagrelor have shown promising results better than clopidogrel. Other agents have shown reduction in clinical events but increased risk of bleeding , hence still under evaluation. Not recmommended in cerebrovascular or other peripheral vascular illnesses.