Drug and route of administration | Mechanism of action | Indications | Half-life | When to withhold# | When to restart h |
Aspirin p.o. | Irreversibly inhibits COX enzyme and platelet aggregation | AF, CAD and stroke | 15–20 min | No need to be withheld | |
Clopidogrel p.o. | Irreversibly inhibits ADP-induced platelet aggregation | ACS, stroke and PAD | 6 h after a single oral dose of 75 mg | 5–7 days | 24–48 |
Prasugrel p.o. | Irreversibly inhibits ADP-induced platelet aggregation | ACS | 7 h (range 2–15 h) | 7 days | 24–48 |
Ticlopidine p.o. | Irreversibly inhibits ADP-induced platelet aggregation | Stroke and CAD | 4–5 days after chronic use of 250 mg twice daily | 10–14 days¶ | 24–48 |
Cangrelor i.v. | Reversible ADP receptor antagonist | CAD undergoing PCI | 3–6 min | 2 h | 24–48 |
Ticagrelor p.o. | Reversibly inhibits ADP-induced platelet aggregation | ACS, CAD and stroke | 7–9 h | 5 days | 24–48 |
Vorapaxar p.o. | Active thrombin receptor (PAR-1) antagonist | CAD and PAD | 5–13 days | 2–3 weeks | 24–48 |
Cilostazol p.o. | Vasodilator, inhibition of PDE-3 and platelet aggregation | PAD | 11 h | 1–2 days | 24 |
Dipyridamole p.o. | Inhibition of PDE-3 and platelet aggregation | Stroke | 10–19 h | 1–2 days | 24 |
Abciximab i.v. | Inhibition of glycoprotein IIb/IIIa platelet aggregation and thrombus formation | ACS undergoing PCI | 10–30 min | 12–24 h+ | 24–48 |
Eptifibatide i.v. | Inhibition of glycoprotein IIb/IIIa platelet aggregation and thrombus formation | ACS undergoing PCI | 2.5 h | 2–4 h+ | 24 |
Tirofiban i.v. | Inhibition of glycoprotein IIb/IIIa platelet aggregation and thrombus formation | ACS undergoing PCI | 2 h | 2–4 h+ | 24 |
In addition to common measures used to control bleeding during a bronchoscopy, platelet transfusion should be considered when necessary. COX: cyclooxygenase; AF: atrial fibrillation; CAD: coronary arterial disease; ACS: acute coronary syndrome; PAD: peripheral arterial disease; PCI: percutaneous coronary intervention; PAR: protease-activated receptor; PDE: phosphodiesterase. #: consider withholding drug for longer period in patients prone to bleeding complications; ¶: consider continuing drug in low-bleeding-risk procedures and high-risk patients for thromboembolic events; +: in patients with renal disease, consider withholding these agents for a longer period prior to bronchoscopy.