Anti-platelets:
https://cks.nice.org.uk/topics/antiplatelet-treatment/ [NICE guideline ref]
Definition: Antiplatelet treatment is drug treatment that decreases platelet aggregation and
inhibit thrombus formation in the arterial circulation.
Four main types of antiplatelet drugs are available:
Aspirin — this irreversibly inhibits cyclo-oxygenase and blocks the production of
thromboxane.
Clopidogrel, prasugrel and ticagrelor — these are are thienopyridines, P2Y12
antagonists. They inhibit the binding of adenosine diphosphate to its platelet
receptor, this is thought to inhibit platelet aggregation by blocking activation of the
glycoprotein IIb/IIIa pathway.
Dipyridamole — this has both antiplatelet and vasodilatory properties. It inhibits
uptake of adenosine into erythrocytes, platelets, and endothelial cells, resulting in an
increased extracellular concentration of adenosine, which is a potent inhibitor of
platelet activation and aggregation. It may also act by inhibiting the breakdown of
cyclic guanosine monophosphate.
Glycoprotein IIb/IIIa inhibitors (for example, abciximab, eptifibatide, and tirofiban)
block the binding of fibrinogen to glycoprotein IIb/IIIa receptors on the platelet. They
are given intravenously in secondary care.
Complications:
Antiplatelet drugs increase the risk of bleeding, which can lead to complications such
as gastrointestinal bleeding.
The risk is further increased when antiplatelet drugs are used in combination with
one another or with drugs known to increase bleeding (for example, anticoagulants)
Management:
Primary prevention of CVD
Do not routinely prescribe antiplatelet treatment for the primary prevention of CVD
Consider prescribing aspirin in people with high risk of stroke or MI (perform QRISK)
People can reduce their risk of CVD by lifestyle changes, stop smoking, statins.
Advice people taking antiplatelets to tell their dentist before surgery.
Secondary prevention of CVD
Antiplatelet treatment should be prescribed for the secondary prevention of
cardiovascular events in people with:
Acute coronary syndrome (ACS).
Angina.
Atrial fibrillation (AF) — in these people anticoagulants are more usually prescribed.
Peripheral arterial disease (PAD).
Antiplatelet treatment should also be prescribed for the secondary prevention of
cardiovascular events in people after:
o Myocardial infarction (MI).
o Stent implantation.
o Stroke or transient ischaemic attack (TIA)
https://cks.nice.org.uk/topics/antiplatelet-treatment/ [NICE guideline ref]
Definition: Antiplatelet treatment is drug treatment that decreases platelet aggregation and
inhibit thrombus formation in the arterial circulation.
Four main types of antiplatelet drugs are available:
Aspirin — this irreversibly inhibits cyclo-oxygenase and blocks the production of
thromboxane.
Clopidogrel, prasugrel and ticagrelor — these are are thienopyridines, P2Y12
antagonists. They inhibit the binding of adenosine diphosphate to its platelet
receptor, this is thought to inhibit platelet aggregation by blocking activation of the
glycoprotein IIb/IIIa pathway.
Dipyridamole — this has both antiplatelet and vasodilatory properties. It inhibits
uptake of adenosine into erythrocytes, platelets, and endothelial cells, resulting in an
increased extracellular concentration of adenosine, which is a potent inhibitor of
platelet activation and aggregation. It may also act by inhibiting the breakdown of
cyclic guanosine monophosphate.
Glycoprotein IIb/IIIa inhibitors (for example, abciximab, eptifibatide, and tirofiban)
block the binding of fibrinogen to glycoprotein IIb/IIIa receptors on the platelet. They
are given intravenously in secondary care.
Complications:
Antiplatelet drugs increase the risk of bleeding, which can lead to complications such
as gastrointestinal bleeding.
The risk is further increased when antiplatelet drugs are used in combination with
one another or with drugs known to increase bleeding (for example, anticoagulants)
Management:
Primary prevention of CVD
Do not routinely prescribe antiplatelet treatment for the primary prevention of CVD
Consider prescribing aspirin in people with high risk of stroke or MI (perform QRISK)
People can reduce their risk of CVD by lifestyle changes, stop smoking, statins.
Advice people taking antiplatelets to tell their dentist before surgery.
Secondary prevention of CVD
Antiplatelet treatment should be prescribed for the secondary prevention of
cardiovascular events in people with:
Acute coronary syndrome (ACS).
Angina.
Atrial fibrillation (AF) — in these people anticoagulants are more usually prescribed.
Peripheral arterial disease (PAD).
Antiplatelet treatment should also be prescribed for the secondary prevention of
cardiovascular events in people after:
o Myocardial infarction (MI).
o Stent implantation.
o Stroke or transient ischaemic attack (TIA)
