Managing adverse effects and drug–drug interactions of antiplatelet agents

Abstract

Antiplatelet therapies have reduced the frequency of adverse events associated with plaque rupture in several clinical situations. These therapies include established antiplatelet agents (such as aspirin, clopidogrel, or glycoprotein IIb/IIIa inhibitors) as well as new agents (such as prasugrel and ticagrelor). In this Review, we address the most important adverse events of antiplatelet therapy, including hemorrhage, hematologic reactions, and dyspnea. We discuss strategies to reduce the incidence of complications and outline potential methods to manage adverse reactions. Interactions between antiplatelet agents and other drugs--such as proton-pump inhibitors, calcium-channel blockers, statins, warfarin, or NSAIDs--are also addressed, as well as specific issues relating to the use of antiplatelet therapies in elderly patients.

Hemorrhagic complications after prasugrel (Effient) therapy for vascular neurointerventional procedures

“…For this reason, it has been recommended by some authorities that patients at increased risk of bleeding from prasugrel be treated with a lower maintenance dose (5 mg orally daily) 21. Notably, the majority of patients who experienced major hemorrhagic complications from prasugrel therapy in our series had few, if any, of these risk factors.…”

“…Data from subgroup analyses comparing the efficacy of aspirin/clopidogrel with aspirin/prasugrel DAPT in patients with acute coronary syndrome demonstrate that age (>75 years), prior thromboembolic events, bleeding propensity, body weight (<60 kg) and various concomitant medication usage may increase the risk of hemorrhage from thienopyridine therapy 21. For this reason, it has been recommended by some authorities that patients at increased risk of bleeding from prasugrel be treated with a lower maintenance dose (5 mg orally daily) 21.…”

Aortic thrombosis in dogs: Presentation, therapy, and outcome in 26 cases

“…35,38 Co-administration of antiplatelet drugs is known in humans to increase the risk of both minor and serious hemorrhage due to cumulative effects on hemostasis. 39 In fact, the pharmacodynamic interaction of aspirin with warfarin has the potential to increase the risk of bleeding without altering the patient's INR. 35 Most dogs in this report were treated with heparin or low molecular weight heparin as a short-term strategy prior to initiation of definitive therapy.…”

Therapeutic Effects of Water Soluble Danshen Extracts on Atherosclerosis

“…The mechanisms of aspirin and clopidogrel, which are two common medicines used in the treatment of atherosclerotic cardiovascular diseases, have various pathways affecting the vascular endothelium, VSMC, and platelets. However, these drugs have the potential for serious adverse reactions including hemorrhage and hematologic adverse reactions [20]. Furthermore, issues regarding resistance to aspirin and clopidogrel have led to the need for the development of newer agents.…”