Bleeding complications associated with combinations of aspirin, thienopyridine
derivatives, and warfarin in elderly patients following acute myocardial infarction.
The COMPASS findings follow a 2012 published report from the ATLAS ACS 2-TIMI 51 trial showing that treatment with the same low-dose rivaroxaban regimen plus aspirin and a thienopyridine
(clopidogrel or ticlopidine) reduced the same combined triple endpoint by a statistically significant 16%, compared with aspirin and a thienopyridine
alone, in patients with a recent acute coronary syndrome event (N Engl J Med.
Effect of the novel thienopyridine
prasugrel compared with clopidogrel on spontaneous and procedural myocardial infarction in the Trial to Assess Improvement in Therapeutic Outcomes by Optimizing Platelet Inhibition with Prasugrel-Thrombolysis in Myocardial Infarction 38: an application of the classification system from the universal definition of myocardial infarction.
Inhibitors of gp IIb/IIIa receptor are potent anti-platelet agents and act by a mechanism distinct from that of aspirin or thienopyridine
For people with NVAF following PCI, guidelines recommend "triple therapy", which is a combination of dual antiplatelet therapy (clopidogrel or another thienopyridine
plus aspirin) and anticoagulation therapy with a vitamin K antagonist (warfarin), but this regimen comes with recognized increased rates of major bleeding, including intracranial bleeding.
Bedside evaluation of thienopyridine
Importance of hepatic metabolism in the antiaggregating activity of the thienopyridine
Main features of P2Y12 receptor inhibitors (1) Clopidogrel Prasugrel Chemical class Thienopyridine Thienopyridine
Administration Oral Oral Dose 300-600 mg bolus, 60 mg bolus, 75 mg/day 10 mg/day Receptor inhibition Irreversible Irreversible Activation Prodrug Prodrug Onset of action 2-6 h 30 min Duration of effect 3-10 days 7-10 days Withdrawal before surgery 5 days 7 days Ticagrelor Cangrelor Chemical class Cyclopentyl-triazolo Stabilized ATP -pyrimidine analogue Administration Oral Intravenous Dose 180 mg bolus, 30 mcg/kg bolus, 90 mg x 2 /day 4 mcg/kg/min inf.
Patients were administered ASA (162 to 325 mg orally), a thienopyridine
loading dose (clopidogrel 300 to 600mg), enoxaparin and glycoprotein IIb/IIIa inhibitors (tirofiban) during PCI.
All the patients were given aspirin once daily atleast 72 hours prior to procedure and thienopyridine
derivative (ticlopidine 250 mg BID or clopidogrel 150 mg BID) for 2 days before the procedure and were continued for 4 weeks.
Antiplatelet agents (aspirin, the glycoprotein IIb/IIIa receptor antagonists and the thienopyridine
derivatives) are increasingly being used for cerebrovascular disease management.
3]S, is a third-generation thienopyridine
compound approved by the Food and Drug Administration (FDA) in 2014.