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  • Review Article
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Managing adverse effects and drug–drug interactions of antiplatelet agents

Nature Reviews Cardiology volume 8, pages 592–600 (2011)Cite this article

Subjects

Abstract

Antiplatelet therapies have reduced the frequency of adverse events associated with plaque rupture in several clinical situations. These therapies include established antiplatelet agents (such as aspirin, clopidogrel, or glycoprotein IIb/IIIa inhibitors) as well as new agents (such as prasugrel and ticagrelor). In this Review, we address the most important adverse events of antiplatelet therapy, including hemorrhage, hematologic reactions, and dyspnea. We discuss strategies to reduce the incidence of complications and outline potential methods to manage adverse reactions. Interactions between antiplatelet agents and other drugs—such as proton-pump inhibitors, calcium-channel blockers, statins, warfarin, or NSAIDs—are also addressed, as well as specific issues relating to the use of antiplatelet therapies in elderly patients.

Key Points

  • Identification of patients at high risk of bleeding is important for the prevention of hemorrhage during antiplatelet therapy

  • The rate of major bleeding associated with the use of clopidogrel is comparable with that of aspirin, but the risk of major bleeding increases when aspirin and clopidogrel are combined

  • Prasugrel reduces the incidence of ischemic end points compared with clopidogrel, but is associated with an increased risk of bleeding

  • Prasugrel should be utilized extremely cautiously in the elderly (>75 years of age), unless the benefits clearly outweigh the risk of bleeding

  • The first of the thienopyridines, ticlopidine, is now rarely used as it is associated with a significant risk of neutropenia

  • Several medications interact in vitro with antiplatelet agents, particularly clopidogrel, although the clinical consequences of these interactions remain uncertain

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Figure 1: The antiplatelet agents clopidogrel, prasugrel, and ticlopidine need to be converted enzymatically into their active metabolites.

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Acknowledgements

C. P. Vega, University of California, Irvine, CA, is the author of and is solely responsible for the content of the learning objectives, questions and answers of the Medscape, LLC-accredited continuing medical education activity associated with this article.

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  1. Department of Cardiovascular Medicine, Cleveland Clinic, 9500 Euclid Avenue, J2–3 Cleveland, 44195, OH, USA

    Arun Kalyanasundaram & A. Michael Lincoff

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Kalyanasundaram, A., Lincoff, A. Managing adverse effects and drug–drug interactions of antiplatelet agents. Nat Rev Cardiol 8, 592–600 (2011). https://doi.org/10.1038/nrcardio.2011.128

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