Antiplatelet (aka antiaggregant) are drugs that decrease platelet aggregation and inhibit thrombus formation.

• Widely used in primary and secondary prevention of thrombotic cerebrovascular or cardiovascular disease

• Irreversible COX inhibitors:
  • Aspirin
  • Triflusal (Disgren)
• ADP receptor inhibitors:
  • Clopidogrel (Plavix), which is an oral drug used to inhibit blood clots in CAD, peripheral vascular disease, cerebrovascular disease, and to prevent MI. It works by irreversibly inhibiting a receptor P2Y12, an ADP chemoreceptor on platelet cell membranes. Side effects include bleeding, severe neutropenia, and thrombotic thrombocytopenic purpura
  • Prasugrel (Effient)
  • Ticagrelor (Brilinta)
  • Ticlopidine (Ticlid)
• Phosphodiesterase inhibitors:
  • Cilostazol (Pletal)
• PAR-1 antagonists:
  • Vorapaxar (Zontivity)
• Glycoprotein IIB/IIIA inhibitors (IV use only):
  • Abciximab (ReoPro)
  • Eptifibatide (Integrilin)
  • Tirofiban (Aggrastat)
• Adenosine reuptake inhibitors:
  • Dipyridamole (Persantine)
• Thromboxane inhibitors:
  • Thromboxane synthase inhibitors
  • Thromboxane receptor antagonists
    • Terutroban

• Low dose aspirin increases the risk of major bleeding 2-fold compared w/ placebo
• Drug toxicitiy may be increased when multiple antiplatelets are used
• GI bleeding is a common adverse event seen in many Pt's

• Annual incidence of major bleeding due to low-dose aspirin is modest, only 0.13% higher than what is observed with placebo. Thus, Tx of Pt's w/ low-dose aspirin annually for cardiovascular prophylaxis will result only in 0.125% additional major bleeding episode
• Before the expiry of the Clopidogrel patent, it was the 2nd best selling drug in the world, grossing $9bn in global annual sales

• Anticoagulant
• Thrombolytic