Page 488 - fbkCardioDiabetes_2017

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464 Cardio Diabetes Medicine 2017

When To Use ? When Not To Use ?

-Antiplatelets.

Prof.A.S.Mohan, M.D.,F.I.C.P.,
Professor & HOD, Medicine
Tirunelveli Medical College, Tirunelveli, Tamilnadu, India

The platelet is integral to the initiation of thrombosis. • Adenosine reuptake inhibitors
Drugs that affect platelet function are a fundamental • Dipyridamole
part of primary and secondary management of
atherosclerotic thrombotic disease. As reviewed in • Thromboxane inhibitors
various guideline documents, authoritative reviews, • Thromboxane synthase inhibitors
and meta-analyses, the indications for the use of
antiplatelet drugs in the management of thrombotic • Thromboxane receptor antagonists
diseases include stroke, acute myocardial infarction • Terutroban
(AMI),acute coronary syndrome (ACS),angina,
percutaneous coronary intervention (PCI), cardiac Uses Of Antiplatelet Agents :
surgery, primary and secondary cardiovascular
disease prevention, peripheral vascular disease, and Prevention and treatment of arterial
thrombotic disorders such as atrial fibrillation.
thrombosis
There are several anti platelet drugs available for use Prevention and treatment of arterial thrombosis is
in clinical practice and several under trial . essential in patients with certain medical conditions
whereby the risk of thrombosis or thromboembolism
Classification of antiplatelet drugs may result in disastrous consequences such as heart
• Irreversible cyclooxygenase inhibitors attack, pulmonary embolism or stroke. Patients who
require the use of antiplatelet drugs are: stroke with or
• Aspirin, Triflusal
without atrial fibrillation, any heart surgery (especially
• Adenosine diphosphate (ADP) receptor prosthetic replacement heart valve), Coronary Heart
inhibitors Disease such as stable angina, unstable angina and
heart attack, patients with coronary stent, Peripheral
• Clopidogrel , Prasugrel , Ticagrelor , Ticlopidine
Vascular Disease/Peripheral Arterial Disease and
• Phosphodiesterase inhibitors apical/ventricular/mural thrombus.
• Cilostazol Treatment of established arterial thrombosis includes
• Protease-activated receptor-1 (PAR-1) the use of antiplatelet drugs and thrombolytic therapy.
antagonists Antiplatelet drugs alter the platelet activation at the
site of vascular damage crucial to the development
• Vorapaxar of arterial thrombosis.
• Glycoprotein IIB/IIIA inhibitors (intravenous use Asprin:
only)
Irreversibly inhibits the enzyme COX, resulting in
• Abciximab , Eptifibatide, Tirofiban
reduced platelet production of TXA2 (thromboxane -
powerful vasoconstrictor that lowers cyclic AMP and
initiates the platelet release reaction).

GCDC 2017