ANTIPLATELETS

Prabina . P K
2 nd MSc Nursing
Govt. College of Nursing
Kozhikode
ASPIRIN HYDROCHLORIDE
Classifications: 
• CENTRAL NERVOUS SYSTEM AGENT
• ANALGESIC, SALICYLATE
• ANTIPYRETIC
•  ANTIPLATELET
Availability

• 81 mg chewable tablets
• 325 mg, 500 mg tablets;
• 81 mg, 165 mg, 325 mg, 500 mg, 650 mg, 975 mg
enteric-coated tablets
• 650 mg, 800 mg sustained release tablets
• 120 mg, 200 mg, 300 mg, 600 mg suppositories
Actions
• Inhibiting the formation of prostaglandins
involved in the production of
inflammation, pain, and fever. 

• Antiinflammatory action: 
 It is as a result of peripheral inhibition of
COX-1 and COX-2, but aspirin may also
inhibit the action and synthesis of other
mediators of inflammation.  
Analgesic action
• Principally peripheral with limited action in
the CNS, possibly on the hypothalamus;
results in relief of mild to moderate pain. 

Antipyretic action
• Aspirin lowers body temperature in fever by
indirectly causing centrally mediated
peripheral vasodilation and sweating. 
• Antiplatelet action
• Powerfully inhibits platelet aggregation.
• High serum salicylate concentrations can impair
hepatic synthesis of blood coagulation factors
VII, IX, and X, possibly by inhibiting action of
vitamin K.
Therapeutic Effects

• Reduces inflammation, pain, and fever.

Also inhibits platelet aggregation, reducing
ability of blood to clot.
Indications & Dosage

• Acute myocardial infarction

• Arterial thromboembolism prophylaxis
• Arthralgia
• Claudication
• Colorectal cancer prophylaxis
• Dental pain
• Dysmenorrhea
• Fever
• Headache
• Ischemic stroke
• Kawasaki disease
• Migraine prophylaxis
• Mild pain
• Musculoskeletal pain
• Myocardial infarction prophylaxis
• Osteoarthritis
• Percutaneous coronary intervention (PCI)
• Pericarditis
• Preeclampsia prophylaxis
• Prosthetic heart valves
• Reduction of cardiovascular mortality
• Rheumatoid arthritis
• Stroke prophylaxis
• Thrombosis prophylaxis
• Unstable angina
Contraindications
• History of hypersensitivity to salicylates
including methyl salicylate
• sensitivity to other NSAIDs
• Patients with "aspirin triad" (aspirin sensitivity,
nasal polyps, asthma);
• chronic rhinitis
• chronic urticaria
• history of GI ulceration
• Bleeding, or other problems
• Hypoprothrombinemia
• vitamin K deficiency
• Hemophilia, or other bleeding disorders
• Do not use aspirin during pregnancy (category D),
especially in third trimester
• Lactation
• children under 2 y, except under advice and
supervision of physician.
• Do not use in children or teenagers with
chickenpox or influenza-like illnesses because of
possible association with Reye's syndrome
DOSE AND ROUTE
Mild to Moderate Pain, Fever
Adult: PO/PR 350–650 mg q4h (max: 4 g/d)
Child: PO/PR 10–15 mg/kg in 4–6 h (max: 3.6 g/d)

Arthritic Conditions
Adult: PO 3.6–5.4 g/d in 4–6 divided doses
Child: PO 80–100 mg/kg/d in 4–6 divided doses; max 130 mg/kg/d
Thromboembolic Disorders
Adult: PO 81–325 mg qd

TIA Prophylaxis
Adult: PO 650 mg bd

MI Prophylaxis
Adult: PO 80–325 mg/d
Interactions
• Drug: aminosalicylic acid increases risk
of salicylate toxicity.
• Ammonium chloride and other acidifying agents decrease
renal elimination and increase risk of salicylate toxicity
•  Anticoagulants increase risk of bleeding. 
• Oral hypoglycemic agents increase hypoglycemic activity
with aspirin doses >2 g/d.
•  Carbonic anhydrase
inhibitors enhance salicylate toxicity. 
• Corticosteroids add to ulcerogenic effects.
•  Methotrexate toxicity is increased
Pharmacokinetics
• Absorption: 80–100% absorbed primarily in stomach
and upper small intestine.
• Peak levels: 15 min to 2 h.
•  Distribution: Widely distributed in most body tissues;
crosses placenta. 
• Metabolism: Aspirin is hydrolyzed to salicylate in GI
mucosa, plasma, and erythrocytes; salicylate is
metabolized in liver.
•  Elimination: 50% of dose is eliminated in the urine
Excreted into breast milk. 
• Half-Life: Aspirin 15–20 min; salicylate 2–18 h (dose
dependent).
Nursing Implications
Assessment & Drug Effects
• Monitor for loss of tolerance to aspirin.
• The reaction is nonimmunologic symptoms usually occur
15 min to 3 h after ingestion: profuse rhinorrhea, erythema,
nausea, vomiting, intestinal cramps, diarrhea.
• Lab tests: PT and IRN with concurrent anticoagulant
therapy
• Monitor the diabetic child carefully for need to adjust
insulin dose.
• Children on high doses of aspirin are particularly prone to
hypoglycemia.
• Monitor for salicylate toxicity
Sensation of fullness in the ears
Tinnitus
Decreased or muffled
• Monitor children closely because salicylate
toxicity is enhanced by the dehydration
• Children tend to manifest salicylate toxicity by
hyperventilation, agitation, mental confusion, or
other behavioural changes, drowsiness, lethargy,
sweating, and constipation.
• Potential for toxicity is high in older adults and
patients with asthma, nasal polyps, perennial
vasomotor rhinitis, hay fever, or chronic urticaria.
Patient & Family Education

• Do not give aspirin to children or teenagers with

symptoms of varicella or influenza-like illnesses
because of association of aspirin usage with
Reye's syndrome.

• Use enteric-coated tablets, extended release

tablets, buffered aspirin, or aspirin administered
with an antacid to reduce GI disturbances.
• Take aspirin 1–2 d before menses when prescribed
for dysmenorrhea.

• When experiencing heavy menstrual blood loss,

take another analgesic, such as acetaminophen,
instead of aspirin.

• Discontinue aspirin therapy about 1 wk before

surgery to reduce risk of bleeding.

• Do not use aspirin-containing gum or gargles or

chew aspirin products for at least 1 wk following
oral surgery.
• Chronic use of high-dose aspirin during the
last 3 month of pregnancy can prolong
pregnancy and labor, increase maternal
bleeding before and after-delivery.

• Discontinue aspirin use with onset of ringing

in the ears, impaired hearing, dizziness, GI
discomfort or bleeding.

• Do not use aspirin for self-medication of pain

beyond 5 d without consulting a physician.
• Do not use aspirin longer than 3 d for fever

• Never use for fever over 38.9° C (102° F) in

older adults or 39.5° C (103° F) in children and
adults under 60 yrs or for recurrent fever without
medical direction.
• Consult physician before using aspirin for any fever
accompanied by rash, severe headache, stiff neck, marked
irritability, or confusion (all possible symptoms of
meningitis).
• Avoid alcohol when taking large doses of aspirin.

• Observe and report signs of bleeding

Petechiae,
ecchymoses,
Bleeding gums,
Bloody or black stools,
Cloudy or bloody urine.
• Maintain adequate fluid intake when taking
repeated doses of aspirin.
• Avoid other medications containing aspirin
unless directed by physician, because of danger
of overdosing .
• Do not breast feed while taking this drug.
CLOPIDOGREL
Availability
75 mg tablets
Actions

Inhibits platelet aggregation by selectively

preventing the binding of adenosine
diphosphate to its platelet receptor. It is an
analog of ticlopidine.
Therapeutic Effects

• clopidrogrel prolongs bleeding time.

Uses

• Secondary prevention of MI
• stroke, and vascular death in patients with
recent MI
• stroke, unstable angina or established
peripheral arterial disease.
• Reduction of atherosclerotic events.
• Prevention of late post stent thrombosis
after drug eluting stents.
• For aspirin resistance.
Contraindications

• Hypersensitivity to clopidogrel
• Intracranial hemorrhage
• Peptic ulcer, or any other active pathologic
bleeding
• Pregnancy (category B)
• Discontinue clopidogrel 7 d before surgery
• Lactation
DOSE AND ROUTE
For arterial thromboembolism prophylaxis
(MI /Stroke prophylaxis,thrombosis
prophylaxis)for patients with established
PAD/CAD
• Oral dosage
• Adults: 75 mg PO once daily
Adverse Effects.
•  CVS: Chest pain, edema, hypertension,
thrombocytic purpura. 
• GI: Abdominal pain, dyspepsia, diarrhea, nausea,
hypercholesterolemia.
•  Hematologic: Thrombotic thrombocytopenic
purpura, epistaxis. 
• CNS: Headache, dizziness, depression.
•  Respiratory: URI, dyspnea, rhinitis, bronchitis,
cough. 
• Skin: Rash, pruritus.
For patients with minor noncardioembolic
stroke who did not receive IV alteplase
Oral dosage
• Adults: 300 or 600 mg PO once, followed by 75
mg PO once daily for a total of 90 days in
combination with aspirin for the first 21 days.
Patients with unstable angina or acute myocardial
infarction, NSTEMI (non-ST-elevation myocardial
infarction)
• Oral dosage
• Adults:
• 300 mg PO once, followed by 75 mg PO once
daily in combination with aspirin.
Interactions

• Drug: NSAIDS may increase risk of

bleeding events.
 
• Herbal:  garlic, ginger, ginkgo may
increase risk of bleeding.
Nursing Implications

• Assessment & Drug Effects.

• Carefully monitor for and immediately report
signs and symptoms of GI bleeding, especially
when co-administered with NSAIDs, aspirin,
heparin, or warfarin.
• Lab tests: Periodic platelet count and lipid
profile.
• Evaluate patients with unexplained fever or
infection for myelotoxicity.
Patient & Family Education
• Report promptly any unusual bleeding (e.g.,
black, tarry stools).
• Avoid chronic aspirin or NSAID use unless
approved by physician.
• Do not breast feed while taking this drug.
ABCIXIMAB
Availability
2 mg/mL in 5 mL vials
Actions
Abciximab is a human–murine monoclonal
antibody Fab (fragment antigen binding) fragment
that binds to the glycoprotein IIb/IIIa (GPIIb/IIIa)
receptor sites of platelets.
Therapeutic Effects

• Abciximab inhibits platelet aggregation by

preventing fibrinogen, von Willebrand's factor,
and other molecules from adhering to GPIIb/IIIa
receptor sites of the platelets.
Uses

Adjunct to aspirin and heparin for the

prevention of acute cardiac ischemic
complications in patients undergoing
percutaneous transluminal coronary
angioplasty (PTCA).
Indications & Dosage
• Acute myocardial infarction
• Acute myocardial infarction, NSTEMI
• Acute myocardial infarction, STEMI
• Kawasaki disease
• Myocardial infarction prophylaxis
• Percutaneous coronary intervention (PCI)
• Unstable angina
Contraindications
• Hypersensitivity to Abciximab or to murine
proteins
• Active internal bleeding
• GI or GU bleeding within 6 week
• History of CVA within 2 y
• CVA with severe neurologic deficit
• Administration of oral anticoagulants unless PT
<1.2 times control.
CONT..
• Thrombocytopenia
• Recent major surgery or trauma
• Intracranial neoplasm
• Aneurysm
• Severe hypertension
• History of vasculitis
DOSE AND ROUTE
PTCA
Adult: IV Starting 10–60 min prior to start of
angioplasty, 0.25 mg/kg bolus over 5 min followed
by continuous infusion of 0.125 mcg/kg/min (up to
10 mcg/min) for next 12 h.
Monitoring Parameters
• Activated partial thromboplastin time (APTT)
• Clotting time
• Hemoglobin/hematocrit
• Platelet count
• Thrombin time
Adverse Effects
Hematologic:
 Bleeding, including intracranial, retroperitoneal,
and hematemesis; thrombocytopenia.
Pharmacokinetics

• Onset: >90% inhibition of platelet aggregation

within 2 h.
•  Duration: Approximately 48 h.
•  Half-Life: 30 min.
Nursing Implications
• Assessment & Drug Effects
• Monitor for S&S of: bleeding at all potential sites
catheter insertion
needle puncture
GI, GU, or retroperitoneal sites
Hhypersensitivity that may occur any
time during administration.
• Lab tests: Monitor Hgb, Hct, platelet count, PT,
APTT, INR, and activated clotting time, every 2–
4 h during first 24 h.
• Avoid or minimize unnecessary invasive
procedures and devices to reduce risk of
bleeding.
• Elevate head of bed 30° and keep limb straight
when femoral artery access is used( following
sheath removal, apply pressure for 30 min.)
• Stop infusion immediately & notify physician if
bleeding or S&S of hypersensitivity occurs.
• Patient & Family Education
• Report any S&S of bleeding immediately.
• Do not breast feed while taking this drug without
consulting physician
BIBLIOGRAPHY.
1. www.clinical key/drug monographs/norepinephrine.
2. www.Robholland.com
3. www.drugsupdate.com

4. Lionel H opie, Bernard J. Gersh Drugs for the heart 7 th

edition sunders Elsevier publications.
Thank you.