Antiplatelet therapy

Action

Antiplatelet treatment is drug treatment that decreases platelet aggregation and inhibit thrombus formation in the arterial circulation.

Drugs

Low dose Aspirin 75mg once daily

Clopidogrel 75mg daily

Ticagrelor 90mg twice daily

Prasugrel 10 mg daily

Dipyridamole

Secondary prevention of atherothrombotic events in people with cardiovascular disease

 

Angina

Acute coronary syndrome (ACS)

ACS —> PCI

Stable coronary artery disease —> PCI

Atrial Fibrillation

Peripheral arterial disease (PAD)

Stroke or TIA

 

Aspirin (preferred) OR Clopidogrel

DAPT Aspirin + Ticagrelor (preferred) OR Aspirin + Clopidogrel

DAPT Aspirin + Prasugrel/ Ticagrelor/ Clopidogrel

DAPT Aspirin + Clopidogrel (preferred) OR Aspirin + Ticagrelor/Prasugrel

DAPT (aspirin + clopidogrel) if unable to give anticoagulants

Clopidogrel (preferred) OR Aspirin

Clopidogrel (preferred) OR Aspirin + MR dipyridamole

 

People at high risk of GI adverse effects

Risk Factors

  • High dose of aspirin.

  • Older age, especially aged over 70 years.

  • History of gastroduodenal ulcer, GI bleeding, or gastroduodenal perforation.

  • Helicobacter pylori infection.

  • Concomitant use of medicines that are known to increase the risk of GI bleeds.

If the person has a high risk of GI adverse effects (for example, bleeding) and is taking: Low-dose aspirin alone, or in combination with ticagrelor or prasugrel OR Clopidogrel alone, or in combination with low-dose aspirin:

Co-prescribe a proton pump inhibitor (PPI): lansoprazole or pantoprazole, for gastroprotection

Enteric-coated aspirin does not reduce the risk of GI complications, as the main effect of aspirin on the gastric mucosa depends on the systemic effects rather than the local topical effects

Dr Rajesh VarmaAntiplatelet