An antiplatelet drug (antiaggregant), also known as a platelet agglutination inhibitor or platelet aggregation inhibitor, is a member of a class of pharmaceuticals that decrease platelet aggregation and inhibit thrombus formation. They are effective in the arterial circulation where classical Vitamin K antagonist anticoagulants have minimal effect.

Antiplatelet drugs are widely used in primary and secondary prevention of thrombotic disease, especially myocardial infarction and ischemic stroke.

Choice

Antiplatelet medications are one of the primary recommendations for treatment of both stable and unstable ischemic heart disease. Most commonly, aspirin is used as a single medication (SAPT = single antiplatelet therapy) in cases of uncomplicated stable angina, and in some cases of unstable angina. If a patient does not tolerate aspirin, ADP/P2Y inhibitors may be used as single-drug therapy instead. More severe and complicated cases are treated with dual antiplatelet therapy, or in some cases triple therapy that includes direct oral anticoagulants. Clinicians must make a choice that balances patient risk with the increased risks of bleeding associated with combination therapy. (such as clopidogrel, prasugrel, ticagrelor, or another) is used to obtain greater effectiveness than with either agent alone. This is known as "dual antiplatelet therapy" (or DAPT). DAPT is used in patients who have, or are at high risk of developing, unstable angina, NSTEMI myocardial infarctions, and other high-risk thrombotic conditions.

Classification

Classes of antiplatelet drugs include:

  • Adenosine diphosphate (ADP) receptor inhibitors
  • Cangrelor (Kengreal)
  • Clopidogrel (Plavix)
  • Prasugrel (Effient)
  • Ticagrelor (Brilinta)
  • Ticlopidine (Ticlid)
  • Adenosine reuptake inhibitors
  • Dipyridamole (Persantine)
  • Glycoprotein IIB/IIIA inhibitors (intravenous use only)
  • Abciximab (ReoPro)
  • Eptifibatide (Integrilin)
  • Tirofiban (Aggrastat)
  • Irreversible cyclooxygenase inhibitors
  • Aspirin
  • Triflusal (Disgren)
  • Phosphodiesterase inhibitors
  • Cilostazol (Pletaal)
  • Protease-activated receptor-1 antagonists (which inhibit the protease-activated receptor 1 PAR-1)
  • Vorapaxar (Zontivity)
  • Thromboxane inhibitors
  • Thromboxane receptor antagonists
  • Terutroban
  • Thromboxane synthase inhibitors

Usage

<!-- This study is so narrow in focus that it can hardly be used to demonstrate across-the-board evidence. Although I cannot understand Romanian (the language in which the paper is written), a single study with a small population of 25 patients using different types of antiplatelet drugs were subjected to implant surgery in which primary collagen plugs and Vicryl sutures were used, presumably to obtain primary closure when possible, demonstrated no bleeding complications. However, various types of procedures were done (18 extractions, 6 sinus augmentations, etc.) to preclude a true comparison among surgeries and the ability to generalize to other cases.

In dental implantation procedures

Dental implant procedures can be safely performed in patients on long-term antiplatelet medication, with no interruption or alteration of their medication. Such patients do not have an increased risk of prolonged or excessive postoperative bleeding. -->=== Prevention and treatment of arterial thrombosis ===

Prevention and treatment of arterial thrombosis is essential in patients with certain medical conditions whereby the risk of thrombosis or thromboembolism may result in disastrous consequences such as heart attack, pulmonary embolism or stroke. When considering these medications and the risk-benefit ratio in the perioperative period, one must consider the risk of stopping the medication and a clot forming versus the risk of bleeding during or after the surgery if medication is continued. A 2018 Cochrane Review that included five randomized controlled trials found low-certainty evidence to suggest that continuing or discontinuing antiplatelet therapy for a non-cardiac surgery does not make a difference in mortality, major bleeds that require surgery, or ischaemic events.

Medications

Medications that may increase antiplatelet drug effect: