Anti-platelet drug 

IRREVERSIBLE Inhibition of COX → decreases TXA2 → inhibition of platelet formation/aggregation 

Inhibition of ADP receptor 

Prodrug → requires liver activaion 

Clopidogre:

• More effective than aspirin but...
• > incid. + severity of bleeding
• Prodrug activated by liver so careful in patient's with hepatic disease 

Anti-platelet Drug 

Same as clopidogrel

Prophylaxis:  

     Stroke, MI, PAD, ACS

Treatment:  

     Venous thrombosis; thrombosis due to a.fib

• No evidence for efficacy for venous + a.fib induced thrombosis  

Anti-platetel drugs 

Ticagrelor:

     Better outcomes than clopidogrel 

     But NO difference in major bleeding 

          Used more than clopidogrel b/c not a                 prodrug 

     NOT a prodrug, so less variable in liver dys. 

Anti-Platelet Formation

ADP blocker 

Prodrug

Same as clopidogrel

Prophylaxis:  MI, ACS, PAD, stroke

Treatment:  A. fib or venous thromsosis 

Anti-platelet formation 

Prasugrel:

     Alternate to clopidogrel (like ticagrelor) 

     Outcomes > than with clopidogrel (like                   ticagrelor) 

     Prodrug like clopidogrel (so concern                       w/hepatic dysfunction)

Anti-platelet formation

Blocks platelet aggregation 

Causes vasodilation 

Intermittent claudication

Peripheral arterial disease 

• Efficacy is being SIGNIFICANTLY ?ed

Dipyridamole MOA

(Extended release)

Anti-platelet formation 

Phosphodiesterase inhibitor 

Blocks platelet aggregation via inhibition of adenosine uptake + cGMP 

Anti-platelet drug

Intermittent claudication of the limbs 

Peripheral vascular disease 

• Efficacy is SIGNIFICANTLY questioned 

Antiplatelet drug 

Monoclonal antibody against glycoprotein IIb/IIIa complex 

ACS

Percutatenous coronary angioplasty h

Anti-platelet 

Blocks fibrinogen by binding to IIb/IIIa compelx of the coagulation pathway 

ACS

Percutatenous coronary angioplasty

ACS

Percutatenous coronary angioplasty  

Abciximab 

Eptifibatide 

Tirofiban 

Clopidogrel

Ticagrelor

Prasugrel 

Anticoagulant

Combines with anti-thrombin III → binds and inactivates clotting factors IIa, IXa, Xa, XIa, XIIa 

Anti-coagulatant 

Rapid parenteral anticoagulation 

It is used for in-vitro anti-coagulation such as tubes for blood collection 

IV 

SC

Unfractionated Heparin Pharmacokinetics

Onset

Duration 

Elimination 

IV Onset = Fast 

SC Onset = 20-30 minutes

IV duration = 1-3 hours

SC duration = 12-24 hours 

Elimination = urinary

aPTT 1.5-2.5X the normal thrombin time

Very high dosese increase PT 

Anti-coagulation

Binds antithrombin III → Primarily cuases inhibition of Xa

Anticoagulation 

Prophylaxis of DVT + PE 

(replacing heparin)

Anti-coagulation 

SC 

Low MW Heparin Phamacokinetics

Onset

Half-life

Elimination 

Taken SC

Onset = 20 minutes

Half-life = 4.5 hours

Urinary excretion

Inhibits Vitamin K → Caues inhibition of clotthing factors II, VII, IX, X + Protein C and S 

Effects both the extrinsic and common pathways 

Anti-coagulation 

Slow + sustained oral anticoagulation 

Warfarin Pharmokinetics

Onset 

Duration 

Excretion 

Oset = 36-72 hours

Duration = 2-5 days

Excretion = Liver + Kidney metabolism

PT test 

Use INR

Bleeding 

Drug-drug interaction 

Enoxaparin 

Dalteparin 

Tinzaparin

Low MW Heparin 

Binds to anti-thrombin III 

Primary effects coagulation factor Xa

Low MW Heparin 

Binds anti-thrombin III

Inhibition primarily to Xa

Low MW Heparin 

Binds anti-thrombin III

Primiarly affects Xa

Anti-Coagulant 

Inhibition of factor Xa 

Syn. analog of heparin (w/o HIT phenomenon)

Prophylaxis:  DVT

Treatment:  Pulmonary embolism 

Anti-coagulation

Factor Xa Inhibition 

Used long-term as an anti-coagulant

Fondaparinux 

Rivoroxaban

Low MW Heparin:

     Enoxaparin

     Dalteparin

     Tinzaparin  

Lepirudin 

Bivalirudin 

Argatroban 

Dabigatran

Anti-coagulation 

Direct inhibition of thombin 

Anti-coagulation

Direct binding/inhibition of thrombin → inhibition of platelet activation 

Anti-coagulation

Direct binding/inhibition of thrombin

Heparin-induced thrombocytopenia (HIT)

Coronary angioplasty in patients with HIT

Anticoagulation

Direct binding/inhibition of thrombin

Streptokinase

Alteplase (rt-PA)

Reteplase (t-PA)

Tenecteplase (TNKase)

Anistreplase (APSAC)

Thrombolytic 

Non-enzymatic activator of plasminogen 

Stimulates dissolution of fibrin clots

Acute MI 

Pulmonary embolism 

DVT

Arterial thrombosis 

Acute MI 

Non-hemorrhagic stroke

Thrombolytic 

Activator of plasminogen 

Thrombolytic 

Activator of plasminogen 

Thrombolytic 

Streptokinase-plasminogen complex