Cardiovascular Critical Care I
Medication
Aspirin
Clopidogrel
Prasugrel
Ticagrelor
Onset
30 min
2–6 hr
30 min
30 min
% Platelet
inhibition
~ 10–20
30–40
60–70
60–70
Recommended
holding duration
before CABGb
Do not hold
5 days
7 days
3 days
Other notable
adverse effect(s)
or clinical pearls
Pharmacogenomic
variability
(CYP2C19) in
response is well
documented
Contraindication in
patients with any
history of stroke or
TIA, and warning
for use in patients
≥ 75 y or weight <
60 kg because of
bleeding risk
| • | Adenosine-induced |
|---|
dyspnea and
bradyarrhythmias
| • | Older adult patients and |
|---|
patients with moderate or
severe hepatic impairment
may be at increased risk of
bleeding
aPatients with lean body weight (< 60 kg) should receive a 5 mg daily maintenance dose of prasugrel
bDecisions to hold these agents before other invasive procedures must consider indications for use, risk of thrombosis (i.e., stent type, locations, and number), and risk
2013;368:2113-24; J Am Coll Cardiol 2011;58:e44-122; Reg Anesth Pain Med 2010;35:64-101; J Am Coll Cardiol 2007;49:734-9).
ADP = adenosine diphosphate; BID = twice daily; TIA = transient ischemic attack.
Parenteral antithrombotics
Use of these agents is most concentrated in the procedural setting, although use may continue for
a finite period post-procedurally.
The selection and use among the agents in Table 5 may depend on presentation, timing/dose of pre-
procedural antiplatelet medication administration, clot burden during procedure, and estimated
bleeding risk of the procedure.
Cardiol 2011;58:e123-210; J Am Coll Cardiol 2011;58:e44-122; Br J Clin Pharmacol 2011;72:647-57) (continued)