Antiplatelet agents vs anticoagulant drugs

This is a short video comparing antiplatelet agents and anticoagulant drugs.

All images were adapted from Wikimedia Commons

ADDITIONAL TAGS:
anti-platelet
antiplatelet

Antiplatelets block platelet activation, aggregation, and/or thrombus formation; used for management and prophylaxis of cardiovascular events, like MI and CVA

Irreversible COX inhibitor:  aspirin (ASA)
Indications: ACS, ischemic stroke, prevention of cardiovascular dz 
Side effects: Reye syndrome, aspirin induced resp dz, GI upset, salicylate toxicity, kidney damage

P2Y12 and ADP receptor antagonists: clopidogrel, prasugrel, ticagrelor, cangrelor 
Indications: DAPT (with ASA) in STEMI/NSTEMI/unstable angina 
Side effects: allergic rxn, hemorrhage, GI upset

GP IIb/IIIa inhibitors: abciximab, eptifibatide, tirofiban 
Indication: high risk patients with unstable angina/NSTEMI before PCI 
Side effects: thrombocytopenia, hemorrhage
Anticoagulants impact coagulation cascade to prevent or reduce coagulation of blood; used for treating and preventing embolic events, like VTE (DVT and PE)

Vitamin K antagonists:  warfarin, phenprocoumon: Inhibit vit K epoxide reductase → ↓ carboxylation of factors II, VII, IX, X, protein C and S
Pros: cheap, well-established, easy to reverse with prothrombin complex concentrate, FFP
Cons: difficult to manage; regular monitoring with PT/INR; requires bridging; interacts with cytochrome P450 (CYP) enzymes

Direct oral thrombin inhibitor:  dabigatran (reversal: idarucizumab)
Direct oral factor Xa inhibitors: apixaban, rivaroxaban (reversal: andexanet alfa)
Pros: easy to manage, like heparins
Cons: expensive, cannot use with artificial heart valves or valvular afib

Unfractionated heparin:  enhances activity of antithrombin
Antidote: protamine sulfate.  Monitor with aPTT; short half-life; cleared hepatically
Low molecular weight heparin (LMWH): enoxaparin, dalteparin
Antidote: protamine sulfate (50%)
Cleared renally
Synthetic heparin: fondaparinux
Antidote: activated prothrombin complex concentrate

By Dr Graham Beards - Own work (Based on Figure 7.5 on page 167 of "Blood Science: principles and pathology"by Andrew Blann and Nessar Ahmed, Publishers Wiley Blackwell (2014) ISBN:978-1-118-35146-8), CC BY-SA 3.0, https://commons.wikimedia.org/w/index...
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