Antiplatelets Dr. Ahmed Amin FCARCSI Arab Board M. Sc

AntiplateletsDr. Ahmed Amin

FCARCSIArab Board

M. Sc.

ADP

TXA2

Epinephrine

Th

rom

bin

Collagen

ADP

TXA2

GP IIb/IIIa

Epinephrine

Th

rom

bin

Collagen

ADP

TXA2

GP IIb/IIIaFibrinogen

Collagen

Th

rom

bin

Epinephrine

GP IIb/IIIa

GP IIb/IIIa

Fibrinogen

GP IIb/IIIa

Antagonists

ADP

TXA2

Epinephrine

Th

rom

bin

Collagen

ADP

TXA2

Epinephrine

Th

rom

bin

Collagen

Fibrinogen

Abciximab

Monoclonal

Ab.

50Kd

Abciximab

Eptifibatide

Monoclonal AB

Cyclic Peptide

50Kd

800d

Abciximab

EptifibatideTirofiban

Monoclonal AB

Cyclic PeptideNon-Peptide

50Kd

500d800d

Peptidase

Abciximab

ReoPro

Non-Competitive Block

12-24h

Non-Competitive

Block

T1/2 12-24h

Long Acting

Non-Competitive

Block

Platelets Transfusion

Competitive block

TirofibanAggrastat

T1/2 1.8h

Bile 80 %

Urine 20 %

TirofibanAggrastat

Competitive block

Competitive block

T1/2 2.5 h

EptifibatideIntegrilin

Urine

EptifibatideIntegrilin

Platelets Transfusion

EptifibatideIntegrilin

On cessation, coagulation normalises

Abciximab 12-24 h

Tirofiban , Eptifibatide 4-6h

Abciximab, Eptifibatide,Tirofiban

Thrombocytopenia

Bleeding

FDA 1999

Abciximab, Eptifibatide,Tirofiban

20% Less HeparinACT 30-80 sec more

Urgent CAGBFailure or Complicated PCI

< 1 % since 1995

Bleeding ? Angelini : J Am Coll Cardiol

1999

Perioperative Guidelines

Don't Delay for 12 h

with Abciximab

Perioperative Guidelines

OP CABG

Perioperative Guidelines

Heparin

Standard Dose

Perioperative Guidelines

Platelets TransfusionAbciximab,ReoPro

ReadyOff-Bypass

Perioperative Guidelines

Emergency CABG

Safe

Angelini : J Am Coll Cardiol 1999

Perioperative Guidelines

Emergency CABG

Platelets ready

Angelini : J Am Coll Cardiol 1999