Ticagrelor
The risk of stopping ANTIplatelet drugs too soon
As a cardiovascular pharmacist, you may be asked about the risk of stopping aspirin, clopidogrel, or other antiplatelet drugs too soon. This applies to the many patients with cardiovascular disease taking aspirin to prevent a recurrent event, or aspirin plus clopidogrel for acute coronary syndrome or after a stent. Stopping these t…
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Surgery
How to manage ANTIplatelets around surgery
As a clinical pharmacist, you will be asked how to manage dual antiplatelet therapy (DAPT) around surgery in patients with a recent coronary stent. It’s a balancing act between risk of thrombosis and bleeding. American College of Cardiology guidelines still prefer at least 6 to 12 months of DAPT after most stent placements, but suggest shorter durations as an opti…
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Myocardial Infarction
Aspirin for PRIMARY prevention is different story
As a cardiovascular pharmacist, you will be asked whether "an aspirin a day" is still good for the heart, based on new U.S. Preventive Services Task Force recommendations. Help patients sort out the facts. This is a case of guidance catching up with the evidence... Recommend aspirin 81 mg/day for SECONDARY prevention , such as…
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Stroke
Clinical pharmacology of DOACs
Mechanism of action ㅡ Direct Oral Anticoagulants (DOACs) or Non-Vitamin K Antagonist Oral Anticoagulant (NOACs) are Direct Thrombin Inhibitors (e.g., Dabigatran) and Factor Xa Inhibitors (e.g. Rivaroxaban, Apixaban, Edoxaban) with prothrombinase activity, thus inhibiting the conversion of prothrombin to thrombin, see figure 1 . Thrombin c…
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Dual Antiplatelet Therapy
Limit bleeding risk in patients on triple antithrombotic therapy
How to manage patients on an anticoagulant (warfarin, etc) who also need antiplatelet medications ( aspirin , etc)? ㅡ Many patients end up on " triple antithrombotic therapy " such as warfarin for atrial fibrillation PLUS clopidogrel ( Plavix ) and aspirin after a stent. But bleeding risk is high. One in 50 patients will have a serious bleed in the first…
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Surgery
Management of minor bleeding from antithrombotics
Patients using an antithrombotic may be alarmed by "nuisance bleeding" OR nosebleeds, prolonged bleeding from a small cut, etc. This isn't typically serious or a reason to stop therapy. Share tips to prevent bleeding, such as using a saline spray to keep the nasal passages moist, an electric razor to avoid nicks while shaving and a soft toothbrush to pr…
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PPIs
The interaction between PPI (omeprazole) and clopidogrel, what is your recommendations?
PRODIGY has published a guideline on antiplatelet treatment. This contains a scenario on the management of gastrointestinal adverse effects. This scenario discusses how to manage a patient at high risk of gastrointestinal bleeds. Ensure that general measures to reduce risk of gastrointestinal (GI) adverse effects have been taken... Prescribing …
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Direct Oral Anticoagulants
Antiplatelets for arterial clots and anticoagulants for venous clots
It can be tricky to know when to recommend an antiplatelet, an anticoagulant, or both... These are some important questions to know the difference between antiplatelet and anticoagulant, and when to use each other... What Are Antiplatelets and Anticoagulants? Antiplatelets : Medications like aspirin, clopidogrel (Plavix), and ticagrelor (Briliq…
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Stroke
Using TWO antiplatelets short-term after a minor stroke or transient ischemic attack
More patients will be discharged on a SHORT course of aspirin plus clopidogrel ( Plavix ) after a minor ischemic stroke or high-risk Transient Ischemic Attack (TIA). We know aspirin alone is generally used to prevent another stroke. But you'll see growing acceptance of DUAL antiplatelet therapy in these patients. It's already an option in guidelines based on …
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Myocardial Infarction
Use "ABCDs" to optimize medications for stable coronary artery disease
Recent evidence suggests coronary stents don't improve chest pain more than optimal medications in patients with stable coronary artery disease. Remember these "ABCDs: A- antiplarelet; B- blood pressure; C- cholesterol; D- diabetes; S- symptom relief" to help manage patients with angina or who've had a heart attack more than a year ago... Anti…
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