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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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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PPIs
Proton pump inhibitors (PPIs)
PROTON PUMP INHIBITORS... EXAMPLES: Omeprazole, lansoprazole, esomeprazole, pantoprazole. MECHANISM OF ACTION: Inhibit H + /K + ATPase on luminal surface of gastric parietal cells and thereby reduce gastric acid secretion. INDICATIONS Gastric/duodenal ulceration. As part of triple therapy for eradication of Helicoba…
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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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Hematology and Oncology
Is the combination of aspirin, clopidogrel, and warfarin appropriate and effective or inappropriate and too dangerous?
As a pharmacist, you will see warfarin ( Marevan ) used in combination with aspirin AND clopidogrel ( Plavix ) in more cardiac patients especially the elderly. Older patients are at higher risk for conditions that require two antiplatelet drugs plus anticoagulation. A common scenario is a patient who needs clopidogrel and aspir…
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