Newer Pharmacotherapy in Patients Undergoing Percutaneous Coronary Interventions: A Guide for Pharmacists and Other Health Care Professionals

Abstract

Significant advances in pharmacotherapy for patients undergoing percutaneous coronary intervention (PCI) have occurred during the past decade, including the introduction and approval of new antithrombin and antiplatelet therapies, as well as modifications in dosing, administration, and/or duration of older pharmacotherapy regimens. Also, off-label (i.e., not approved by the United States Food and Drug Administration) use of certain agents has become common. Given the novel nature of these agents and the nuances of therapy, the pharmacist and other health care professionals should play an integral role in collaboration with interventional cardiologists in development of hospital protocols, determination of appropriate agent selection, assessment of patient renal function and hematologic status, dosing, and monitoring for adverse effects. In this guide, the newer antiplatelet and antithrombin drugs that may be used during PCI are reviewed, and recommendations regarding the proper administration of these agents are provided.

2011 ACCF/AHA/SCAI Guideline for Percutaneous Coronary Intervention

“…298,299,779,780 Medications that require dosage adjustments in patients with CKD include eptifibatide, tirofiban, bivalirudin, enoxaparin, and fondaparinux. 781 …”

Variable Platelet Response to Aspirin and Clopidogrel in Atherothrombotic Disease

“…62 Both are selective noncompetitive inhibitors of the P2Y 12 receptor. The active metabolites of ticlopidine and clopidogrel induce a permanent defect that involves a single platelet-signaling pathway for the lifetime of the cell via cumulative inhibition at low doses in a manner similar to the pharmacodynamics of aspirin.…”

“…64 Poor tolerance of larger loading doses (Ͼ500 mg) precludes this approach to achieve earlier platelet inhibition. 62 Diarrhea, nausea, and vomiting are common side effects (30% to 50%). Skin rash is also a frequent problem.…”

Antiplatelet therapy in acute coronary syndromes: current agents and impact on patient outcomes

“…Clinically relevant antiplatelet activity at the standard dose (250 mg twice daily, oral) occurs at 24–48 h, peaking at 3–5 days. The unacceptably high incidence of GI side effects (30%–50% vomiting, nausea, and diarrhea) precluded the use of a higher loading dose (500 mg daily, oral) 16,17. Neutropenia as a side effect of ticlopidine was first noted in phase III trials and was subsequently shown to be as high as 2.4% 18.…”