Introduction to Antiplatelet Drugs
- Prevent platelet aggregation
→ inhibit thrombus formation
- Primarily used in arterial
thrombosis
- Important in cardiovascular
and cerebrovascular disease
List of Common Antiplatelet Agents
1.Cox Inhibitor E.g. Aspirin
2. PDE Inhibitor E.g. Dipyridamole
3. ADP Receptor (P2Y12) Blockers E.g.
Ticlopidine, Clopidogrel
4. GPIIb/IIIa Inhibitors E.g. Abciximab
Aspirin – Mechanism of Action
- Irreversibly inhibits COX-1
enzyme
- ↓ Thromboxane A₂ (TXA₂) → ↓
platelet aggregation
- Effect lasts for lifespan of
platelet (7–10 days)
Indications
- Acute coronary syndrome
(ACS)
- Secondary prevention of MI
and stroke
- Atrial fibrillation (in
low-risk patients)
- Post-PCI (Percutaneous
Coronary Intervention)
Adverse Effects
- GI irritation, ulcers
- Bleeding
- Tinnitus (high doses)
- Hypersensitivity reactions
Contraindications
- Active GI bleeding or peptic
ulcer
- Allergy to NSAIDs
- Children with viral illness
(→ Reye's syndrome)
- Severe hepatic or renal
impairment
Dipyridamole – Mechanism of Action
- Inhibits phosphodiesterase
(PDE) → ↑ cAMP → ↓ platelet aggregation
- Also inhibits adenosine
uptake → vasodilation
Indications
- Secondary prevention of
ischemic stroke (usually with aspirin)
- Cardiac stress testing (in
pharmacologic stress tests)
Adverse Effects
- Headache
- Dizziness
- Hypotension
- GI upset
Ticlopidine – Mechanism of Action
- Irreversibly blocks P2Y12
ADP receptor on platelets → ↓ aggregation
Indications
- Stroke prevention
(alternative to aspirin)
- Prevention of stent
thrombosis (rare use now)
Adverse Effects
- Neutropenia (requires blood count
monitoring)
- Thrombocytopenia
- GI upset
- Rash
Clopidogrel – Mechanism of Action
- Prodrug; irreversibly blocks
P2Y12 ADP receptor
- Inhibits platelet
aggregation
Indications
- ACS (with or without PCI)
- Stroke prevention
- Peripheral artery disease
- Dual antiplatelet therapy
(DAPT with aspirin)
Adverse Effects
- Bleeding
- GI upset
- Rare: Thrombotic
thrombocytopenic purpura (TTP)
Abciximab – Mechanism of Action
- Monoclonal antibody against GP
IIb/IIIa receptor on platelets
- Prevents fibrinogen binding
→ blocks platelet aggregation
Indications
- Adjunct in PCI to
prevent ischemic complications
- High-risk ACS (short-term
use)
Adverse Effects
- Bleeding (especially at
vascular access site)
- Thrombocytopenia
- Hypersensitivity (as it's a
monoclonal antibody)
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