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06.01 Anti-Platelet Aggregate

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Overview

  1. Overview
    1. Purpose
      1. Prevent the formation of thrombi, aka thrombo-prevention
    2. Mechanism of Action
      1. Most common pathway: Cyclooxygenase inhibition
        1. Basically, operates within platelets and BV walls
        2. Prevents formation of TXA2
          1.    Causes BV to constrict & platelets to aggregate
      2. There are various pathways
        1.     Clotting factors VII, IX, X
  2. Indications
    1. Stroke risk reduction
    2. Stroke prophylaxis
    3. Acute unstable MI
    4. Thromboembolic complications
    5. Thromboembolic disorders
    6. Post-MI thrombo-prevention
    7. PCI (angioplasty)
  3. Types
    1. Glycoprotein IIb/IIIa Inhibitors
      1. Abcimab
      2. Eptifibitide
      3. Tirofiban
    2. Aggregation Inhibitors / Vasodilators
      1. Treprostinil
    3. Aggregation Inhibitors
      1. Cilostazol
      2. Clopidogrel
    4. Miscellaneous
      1. Anagrelide
      2. Dipyridamole
  4. Contraindications
    1. Drug allergy
    2. Thrombocytopenia
    3. Active bleeding
    4. Leukemia
    5. Traumatic injury
    6. GI ulcer
    7. Vitamin K deficiency
    8. Recent stroke
  5. Interactions

    A.    Heparin

    B.    Oral antidiabetic drugs

    C.     Dipyridamole

    D.    Steroids

  6. Side Effects

    A.    Aspirin

    1.     CNS

    a.     Drowsiness

    b.     Dizziness

    c.     Confusion

    d.     Flushing

    2.     GI

    a.     N / V / D

    b.     GI Bleeding

    c.     Heartburn

    3.     Hematologic

    a.     Thrombocytopenia

    b.     Leukopenia

    c.     Anemia

    d.     Bleeding

    B.    Clopidogrel

    1.     Cardiovascular

    a.     Chest pain, HTN, edema

    2.     CNS

    a.     Flulike symptoms

    b.     Headache

    c.     Dizziness

    d.     Fatigue

    3.     GI

    a.     Abdominal pain

    b.     Dyspepsia

    c.     Diarrhea

    d.     Nausea

    4.     Miscellaneous

    a.     Epistaxis

    b.     Rash

    C.     GP IIb / IIIa Inhibitors

    1.     Bleedings

    2.     Bradycardia

    3.     Dizziness

    4.     Edema

    5.     Leg pain

    6.     Pelvic pain

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Video Transcript

Welcome back and today we are going to discuss anti-platelet aggregrates.  

Alright, let’s do a quick review. The purpose of anti-platelet aggregates is thrombus prevention. Now don’t get them confused with dissolve current clots. These simply prevent FUTURE thrombus formation.

The mechanism of actions is the inhibition of Cyclooxygenase. Basically it works within the platelet and BV walls to dilate and prevent platelet grouping. It also prevents the formation of TXA2, which has prothrombotic properties.

Alright, let’s do a quick review. The purpose of anti-platelet aggregates is thrombus prevention. Now don’t get them confused with dissolve current clots. These simply prevent FUTURE thrombus formation. The mechanisms of actions are the inhibition of Cyclooxygenase. Basically it works within the platelet and BV walls to dilate and prevent platelet grouping.

Types of anti-platelet aggregates include glycoprotein inhibitors, aggregation inhibitors, aggregation inhibitors with vasodilation properties and miscellaneous. An easy way to remember this is GAAM.

Anti-platlet contraindications are plentiful and include drug allergies, thrombocytopenia, active bleeding, leukemia, traumatic injury, GI ulcer, vitamin K deficiency, and a recent stroke. All of which are side effects of the very drug class. So, we wouldn’t want a patient who is at risk of bleeding receiving a drug that will exacerbate that condition. We want therapeutic responses in the right settings.

Heparin + glycoproteins = increased bleeding potential, oral antidiabetic drugs + aspirin = uncontrolled BG results, dipyridamole + anti-platelet aggregates = increase bleeding potential, and lastly steroids + aspirin = increased risk for GI ulceration. Any easy way to remember this is HODS.

Aspirin side effects include hematologic (thrombocytopenia, anemia, bleeding), GI (N/V/D), GI bleeding, heartburn, and CNS (drowsiness, dizziness, confusion).

Clopidogrel side effects include GI (abdominal pain, dyspepsia, diarrhea, nausea), CNS (headache, dizziness, fatigue), and cardiovascular (chest pain, HTN, and edema).  

Glycoprotein inhibitor side effects include bleeding, bradycardia, dizziness, edema, leg, and pelvic pain, along with edema.

Nursing priorities for a patient taking anti-platelet aggregates include clotting and pharmacology.

Indications include stroke risk reduction, stroke prophylaxis, MI, thromboembolic complications and disorders, along with PCI (angioplasty). Types of anti-platelet aggregates include glycoprotein inhibitors, aggregation inhibitors, aggregation inhibitors with vasodilation properties and miscellaneous (GAAM). Anti-platelet contraindications are plentiful and include drug allergies, thrombocytopenia, active bleeding, leukemia, traumatic injury, GI ulcer, vitamin K deficiency, and a recent stroke. Interactions include heparin, oral antidiabetic drugs, dipyridamole and steroids (HODS). Side effects are extensive but focus on CNS (headache, dizziness drowsiness), Heme (thrombocytopenia, bleeding), GI (N/V/D, bleeding), and Other (leg and pelvic pain).

You know now the important details regarding anti-platelet aggregates. Now, go out and be your best self today and as always, Happy Nursing!

Read more

  • Question 1 of 5

A client is being admitted to the intensive care unit following an acute ischemic stroke. The nurse has an order to administer clopidogrel. The nurse knows that in addition to preventing recurrent strokes, which of the following conditions indicate this type of medication?

  • Question 2 of 5

The nurse is administering an anti-platelet drug to a client. The nurse knows it is most important to monitor for which of the following adverse effects?

  • Question 3 of 5

The nurse is preparing to administer aspirin to a client. Which of the following conditions in the client’s health history would concern the nurse?

  • Question 4 of 5

The nurse is preparing to administer clopidogrel to a client. The nurse knows that the purpose of this medication is which of the following?

  • Question 5 of 5

Types of anti-platelet aggregates include which of the following? Select all that apply.

Module 0 – Pharmacology Course Introduction

Module 3 – Disease Specific Medications

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