Antiplatelet drugs: Antithrombotic Therapy and Prevention of Thrombosis, 9th ed: American College of Chest Physicians Evidence-Based Clinical Practice Guidelines

John W Eikelboom; Jack Hirsh; Frederick A Spencer; Trevor P Baglin; Jeffrey I Weitz

doi:10.1378/chest.11-2293

Antiplatelet drugs: Antithrombotic Therapy and Prevention of Thrombosis, 9th ed: American College of Chest Physicians Evidence-Based Clinical Practice Guidelines

Chest. 2012 Feb;141(2 Suppl):e89S-e119S. doi: 10.1378/chest.11-2293.

Authors

John W Eikelboom¹, Jack Hirsh², Frederick A Spencer³, Trevor P Baglin⁴, Jeffrey I Weitz³

Affiliations

¹ Department of Medicine, McMaster University, Hamilton, ON, Canada; Population Health Research Institute, Hamilton, ON, Canada; Thrombosis and Atherosclerosis Research Institute, Hamilton, ON, Canada. Electronic address: eikelbj@mcmaster.ca.
² Department of Medicine, McMaster University, Hamilton, ON, Canada; Population Health Research Institute, Hamilton, ON, Canada; Thrombosis and Atherosclerosis Research Institute, Hamilton, ON, Canada.
³ Department of Medicine, McMaster University, Hamilton, ON, Canada; Thrombosis and Atherosclerosis Research Institute, Hamilton, ON, Canada.
⁴ Department of Haematology, Addenbrooke's NHS Trust, Cambridge, England.

Abstract

The article describes the mechanisms of action, pharmacokinetics, and pharmacodynamics of aspirin, dipyridamole, cilostazol, the thienopyridines, and the glycoprotein IIb/IIIa antagonists. The relationships among dose, efficacy, and safety are discussed along with a mechanistic overview of results of randomized clinical trials. The article does not provide specific management recommendations but highlights important practical aspects of antiplatelet therapy, including optimal dosing, the variable balance between benefits and risks when antiplatelet therapies are used alone or in combination with other antiplatelet drugs in different clinical settings, and the implications of persistently high platelet reactivity despite such treatment.

Publication types

Comparative Study
Review

MeSH terms

Aspirin / adverse effects
Aspirin / pharmacokinetics
Aspirin / therapeutic use
Cilostazol
Dipyridamole / adverse effects
Dipyridamole / pharmacokinetics
Dipyridamole / therapeutic use
Dose-Response Relationship, Drug
Drug Therapy, Combination
Evidence-Based Medicine*
Humans
Platelet Activation / drug effects
Platelet Aggregation / drug effects
Platelet Aggregation Inhibitors / adverse effects
Platelet Aggregation Inhibitors / pharmacokinetics
Platelet Aggregation Inhibitors / therapeutic use*
Platelet Glycoprotein GPIIb-IIIa Complex / antagonists & inhibitors
Practice Guidelines as Topic*
Randomized Controlled Trials as Topic
Societies, Medical*
Tetrazoles / adverse effects
Tetrazoles / pharmacokinetics
Tetrazoles / therapeutic use
Thienopyridines / adverse effects
Thienopyridines / pharmacokinetics
Thienopyridines / therapeutic use
Thrombosis / blood
Thrombosis / drug therapy*
Thrombosis / prevention & control*
United States

Substances

Platelet Aggregation Inhibitors
Platelet Glycoprotein GPIIb-IIIa Complex
Tetrazoles
Thienopyridines
Dipyridamole
Cilostazol
Aspirin

Grants and funding

R13 HL104758/HL/NHLBI NIH HHS/United States