Antiplatelet therapy in acute coronary syndromes: current agents and impact on patient outcomes

Figures & data

Figure 1 Mechanism of action of current antiplatelet agents.¹³⁵

Table 1 Summary of current antiplatelet agents approved for clinical use in the acute coronary syndromes population

	Aspirin	Ticlopidine	Clopidogrel	Prasugrel	Ticagrelor	Abciximab, tirofiban, eptifibatide
Group	Acetylsalicylic acid	Thienopyridine	Thienopyridine	Thienopyridine	Cyclopentyl-triazolo-pyridine	GP IIb/IIIa inhibitors
FDA approval	1965	1991	1997	2009	Phase III complete 2009	1993–>
Route	Oral	Oral	Oral	Oral	Oral	IV
Pharmacokinetics	Block COX to prevent formation of thromboxane A2 and prostaglandins	Prodrug, modify P2Y12 receptor, inhibiting activation of GP IIb/IIA complex	Prodrug, modify P2Y12 receptor, inhibiting activation of GP IIb/IIA complex	Prodrug, modify P2Y12 receptor, inhibiting activation of GP IIb/IIA complex	Direct-acting, inhibitor of P2Y12	Blocks binding of von Willebrand factor to GP IIb/IIIa, inhibiting platelet aggregation
Inhibition	Irreversible	Irreversible	Irreversible	Irreversible	Reversible	Abciximab: irreversible Others: reversible
Frequency	Daily	Twice daily	Daily	Daily	Twice daily	Once
Time to peak effect	20 min (150–300-mg load)	1–3 h (250-mg dose)	4–6 h (300-mg load)	1 h (60-mg load)	2 h (180-mg load)	10 min
Metabolism	Hepatic	Hepatic	Hepatic	Hepatic	Direct/none	None
Clearance	Renal	Renal/biliary	Renal/biliary	Renal	Biliary	Renal

Notes: Taken from multiple sources.

Figure 2 The delicate balance of an individual’s comorbidities: risk of thrombosis versus risk of bleeding.

Abbreviations: BMI, body mass index; CVA, cerebrovascular accident; PVD, peripheral vascular disease.

Figure 3 Algorithm proposing an approach to cost effective utilization of PPI cotherapy for the prevention of gastrointestial bleeding.

Copyright © 2008, American College of Cardiology. Reproduced with permission from Bhatt DL, Scheiman J, Abraham NS, et al. ACCF/ACG/AHA 2008 expert consensus document on reducing the gastrointestinal risks of antiplatelet therapy and NSAID use: a report of the American College of Cardiology Foundation Task Force on Clinical Expert Consensus Documents. J Am Coll Cardiol. 2008;52(18):1502–1517.

Abbreviations: GERD, gastroesophageal reflux disease; GI, gastrointestinal; PPI, proton pump inhibitor.

SchaferAIAntiplatelet therapyAm J Med199610121992098757361

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