"Antiplatelet Drug Comparison Chart"

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ANTIPLATELET DRUG COMPARISON CHART
Drug
ASA
Clopidogrel (Plavix®)
Prasugrel (Effient®) Ticagrelor (Brilinta®)
- 1° and 2° prevention
- ASA intolerance or
- With ASA, for
- With ASA, for treatment
Indications
of stroke and MI
failure
treatment of ACS in
of ACS
- ACS
- 1° and 2° prevention
patients treated with
See BCHA restrictions
1
- PCI with stent
of stroke and MI (+/-
PCI
below
- PVD
ASA)
Contraindicated if:
- ACS (+ ASA)
age > 75 years; OR
- PCI (+ ASA)
wt < 60 kg; OR
- PVD
history of stroke
NON-FORMULARY
Dose and
Load: 160-325 mg
Load: 300-600 mg
Load: 60 mg
Load: 180 mg
Duration
Maintenance: 80 or 81
Maintenance: 75 mg
Maintenance: 10 mg
Maintenance: 90 mg BID
mg daily
daily
daily
Duration: up to 1 year
Duration: Indefinite
Duration:
Duration: up to 1 year
ACS: up to 1 year
BMS: minimum 30 days
DES: minimum 1 year
Non-Steroidal Anti-
Second generation
Third-generation
Cyto-pentyl-triazolo-
Class
Inflammatory Agent
thienopyridine
thienopyridine
pyrimidine
(Prodrug)
(Prodrug)
Mechanism of
Irreversible inhibitor of
Irreversible inhibitor of
Irreversible inhibitor
Reversibly modifies
Platelet
COX-1 causing
P2Y
component of
of P2Y
component
P2Y
component of ADP
12
12
12
decrease in
ADP receptor
of ADP receptor
receptor (preventing ADP
Inhibition
thromboxane A
(preventing ADP
(preventing ADP
binding and activation of
2
binding and activation
binding and activation
platelets)
of platelets)
of platelets)
Oral
50-75%
> 50% (active
> 78% (active
30-42%
Bioavailability
metabolite)
metabolite)
Peak Effect
1-3 hours
6 hours (after load)
4 hours (after load)
2 hours (after load)
Half-life
3 hrs (salicylate)
0.5 hrs
7 hrs (range 2-15 hrs) 9 hrs (range 6.7-9.1 hrs )
(active
metabolite)
Elimination
Hydrolyzed by
Esterases;
Esterases;
Metabolism by CYP-450
esterases;
Metabolism by CYP-
Metabolism by CYP-
enzymes
Hepatic conjugation
450 enzymes
450 enzymes
CYP
No
CYP2C19
CYP3A4, CYP2B6
CYP3A4/5
Metabolism
When to Hold
7 days (optional)
5-7 days
7 days
5 days
Dose Prior to
Surgery
1
Ticagrelor restricted to patients on prior to admission or those on ASA with ACS i.e. STEMI, non-STEMI, unstable angina (UA) AND one of the
following:
Failure on optimal doses of clopidogrel and ASA therapy or recurrent ACS after revascularization with PCI; OR
STEMI and undergoing revascularization via PCI; OR
Non-STEMI or UA and high risk angiographic anatomy and undergoing revascularization via PCI
Abbreviations:
ACS = Acute Coronary Syndrome; PCI = Percutaneous Coronary Intervention; PVD = Peripheral Vascular Disease;
BMS = Bare Metal stent; DES = Drug-Eluting Stent; ADP = Adenosine Diphosphate
ANTIPLATELET DRUG COMPARISON CHART
Drug
ASA
Clopidogrel (Plavix®)
Prasugrel (Effient®) Ticagrelor (Brilinta®)
- 1° and 2° prevention
- ASA intolerance or
- With ASA, for
- With ASA, for treatment
Indications
of stroke and MI
failure
treatment of ACS in
of ACS
- ACS
- 1° and 2° prevention
patients treated with
See BCHA restrictions
1
- PCI with stent
of stroke and MI (+/-
PCI
below
- PVD
ASA)
Contraindicated if:
- ACS (+ ASA)
age > 75 years; OR
- PCI (+ ASA)
wt < 60 kg; OR
- PVD
history of stroke
NON-FORMULARY
Dose and
Load: 160-325 mg
Load: 300-600 mg
Load: 60 mg
Load: 180 mg
Duration
Maintenance: 80 or 81
Maintenance: 75 mg
Maintenance: 10 mg
Maintenance: 90 mg BID
mg daily
daily
daily
Duration: up to 1 year
Duration: Indefinite
Duration:
Duration: up to 1 year
ACS: up to 1 year
BMS: minimum 30 days
DES: minimum 1 year
Non-Steroidal Anti-
Second generation
Third-generation
Cyto-pentyl-triazolo-
Class
Inflammatory Agent
thienopyridine
thienopyridine
pyrimidine
(Prodrug)
(Prodrug)
Mechanism of
Irreversible inhibitor of
Irreversible inhibitor of
Irreversible inhibitor
Reversibly modifies
Platelet
COX-1 causing
P2Y
component of
of P2Y
component
P2Y
component of ADP
12
12
12
decrease in
ADP receptor
of ADP receptor
receptor (preventing ADP
Inhibition
thromboxane A
(preventing ADP
(preventing ADP
binding and activation of
2
binding and activation
binding and activation
platelets)
of platelets)
of platelets)
Oral
50-75%
> 50% (active
> 78% (active
30-42%
Bioavailability
metabolite)
metabolite)
Peak Effect
1-3 hours
6 hours (after load)
4 hours (after load)
2 hours (after load)
Half-life
3 hrs (salicylate)
0.5 hrs
7 hrs (range 2-15 hrs) 9 hrs (range 6.7-9.1 hrs )
(active
metabolite)
Elimination
Hydrolyzed by
Esterases;
Esterases;
Metabolism by CYP-450
esterases;
Metabolism by CYP-
Metabolism by CYP-
enzymes
Hepatic conjugation
450 enzymes
450 enzymes
CYP
No
CYP2C19
CYP3A4, CYP2B6
CYP3A4/5
Metabolism
When to Hold
7 days (optional)
5-7 days
7 days
5 days
Dose Prior to
Surgery
1
Ticagrelor restricted to patients on prior to admission or those on ASA with ACS i.e. STEMI, non-STEMI, unstable angina (UA) AND one of the
following:
Failure on optimal doses of clopidogrel and ASA therapy or recurrent ACS after revascularization with PCI; OR
STEMI and undergoing revascularization via PCI; OR
Non-STEMI or UA and high risk angiographic anatomy and undergoing revascularization via PCI
Abbreviations:
ACS = Acute Coronary Syndrome; PCI = Percutaneous Coronary Intervention; PVD = Peripheral Vascular Disease;
BMS = Bare Metal stent; DES = Drug-Eluting Stent; ADP = Adenosine Diphosphate