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Antiplatelet medicines - P2Y12 inhibitors

Blood thinners - clopidogrel; Antiplatelet therapy - clopidogrel; Thienopyridines

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Description

Platelets are small particles in your blood that your body uses to form clots and stop bleeding. If you have too many platelets or your platelets stick together too much, you are more likely to form clots. This clotting can take place on the inside of your arteries and lead to heart attack or stroke.

Antiplatelet medicines work to make your platelets less sticky and thereby help prevent blood clots from forming in your arteries.

• Aspirin is an antiplatelet medicine that may be used.
• P2Y12 receptor blockers are another group of antiplatelet medicines. This group of medicines includes: clopidogrel, ticlopidine, ticagrelor, prasugrel, and cangrelor.

Who Should Take Antiplatelet Drugs

Antiplatelet medicines may be used to:

• Prevent heart attack or stroke for those with peripheral arterial disease (most often blockage of an artery in the leg).
• Prevent or treat heart attacks.
• Prevent stroke or transient ischemic attacks (TIAs are early warning signs of stroke. They are also called "mini-strokes.")
• Prevent clots from forming inside stents put inside your arteries to open them.
• Treat acute coronary syndrome.
• Prevent clots after bypass graft surgery that uses a man-made or prosthetic graft performed on arteries below the knee.

Clopidogrel (Plavix, generic) may be used in place of aspirin for people who have narrowing of the coronary arteries. Sometimes 2 antiplatelet medicines (one of which is almost always aspirin) are prescribed for people with acute coronary syndrome (unstable angina or heart attack).

Aspirin and a second antiplatelet medicine are usually recommended for people who are undergoing angioplasty with or without stenting.

Your health care provider will choose which one of these medicines are best for your problem.

Side Effects

Side effects of these medicines may include:

• Diarrhea
• Itching
• Nausea
• Skin rash
• Stomach pain

Before you start taking these medicines, tell your provider if:

• You have bleeding problems or stomach ulcers.
• You are pregnant, plan to become pregnant, or are breastfeeding.

There are a number of other possible side effects, depending on which medicines you are prescribed. For example:

• Ticlopidine may lead to a very low white blood cell count or an immune disorder that destroys platelets.
• Ticagrelor may cause episodes of shortness of breath.

Taking P2Y12 Inhibitors

This medicine is taken as a pill. Your provider may change your dose from time to time.

Take this medicine with food and plenty of water to reduce side effects. You may need to stop taking clopidogrel before you have surgery or dental work. Do not just stop taking your medicine without first talking with your provider.

Talk with your provider before taking any of these medicines:

• Heparin and other blood thinners, such as warfarin (Coumadin)
• Pain or arthritis medicine that are NSAIDs (such as diclofenac, etodolac, ibuprofen, indomethacin, Advil, Aleve, Daypro, Dolobid, Feldene, Indocin, Motrin, Orudis, Relafen, or Voltaren)
• Phenytoin (Dilantin), tamoxifen (Nolvadex, Soltamox), tolbutamide (Orinase), or torsemide (Demadex)

Do not take other medicines that may have aspirin or ibuprofen in them before talking with your provider. Read the labels on cold and flu medicines. Ask what other medicines are safe for you to take for aches and pains, colds, or the flu.

If you have any type of procedure scheduled, you may need to stop these medicines 5 to 7 days before hand. However, always check with your provider first about whether it is safe to stop.

Tell your provider if you are pregnant or planning to become pregnant, or breastfeeding or planning to breastfeed. Women in the later stages of pregnancy should not take clopidogrel. Clopidogrel can be passed to infants through breast milk.

Talk with your provider if you have liver or kidney disease.

If you miss a dose:

• Take it as soon as possible, unless it is time for your next dose.
• If it is time for your next dose, take your usual amount.
• Do not take extra pills to make up for a dose you have missed, unless your provider tells you to.

Store these medicines and all other medicines in a cool, dry place. Keep them where children cannot get to them.

When to Call the Doctor

Contact your provider if you have any of these side effects and they do not go away:

• Any signs of unusual bleeding, such as blood in the urine or stools, nosebleeds, any unusual bruising, heavy bleeding from cuts, black tarry stools, coughing up blood, heavier than usual menstrual bleeding or unexpected vaginal bleeding, vomit that looks like coffee grounds
• Dizziness
• Difficulty swallowing
• Tightness in your chest or chest pain
• Swelling in your face or hands
• Itching, hives, or tingling in your face or hands
• Wheezing or difficulty breathing
• Very bad stomach pain
• Skin rash

Related Information

Heart bypass surgery
Carotid artery surgery - open
Angioplasty and stent placement - carotid artery
Heart bypass surgery - minimally invasive
Cardiac ablation procedures
Heart pacemaker
Implantable cardioverter-defibrillator
Chronic obstructive pulmonary disease (COPD)
Heart failure
Peripheral artery disease - legs
High blood cholesterol levels
High blood pressure in adults – hypertension
Angina
Coronary heart disease
Angioplasty and stent placement - peripheral arteries
Peripheral artery bypass - leg
Aortic valve surgery - minimally invasive
Aortic valve surgery - open
Mitral valve surgery - minimally invasive
Mitral valve surgery - open
Angina - discharge
Heart attack – discharge
Angioplasty and stent - heart - discharge
Aspirin and heart disease
Being active when you have heart disease
Cardiac catheterization - discharge
Controlling your high blood pressure
Heart bypass surgery - discharge
Heart bypass surgery - minimally invasive - discharge
Heart failure - discharge
Stroke - discharge
Diabetes - preventing heart attack and stroke
Angioplasty and stent placement - peripheral arteries - discharge
Angioplasty and stent placement - carotid artery - discharge
Atrial fibrillation - discharge
Carotid artery surgery - discharge
Peripheral artery bypass - leg - discharge
Heart valve surgery - discharge

References

Abraham NS, Hlatky MA, Antman EM, et al. ACCF/ACG/AHA 2010 expert consensus document on the concomitant use of proton pump inhibitors and thienopyridines: a focused update of the ACCF/ACG/AHA 2008 expert consensus document on reducing the gastrointestinal risks of antiplatelet therapy and NSAID use: a report of the American College of Cardiology Foundation Task Force on Expert Consensus Documents. Circulation. 2010;122(24):2619-2633. PMID: 21060077 pubmed.ncbi.nlm.nih.gov/21060077/.

Alberts MJ. Prevention and management of ischemic stroke. In: Libby P, Bonow RO, Mann DL, Tomaselli GF, Bhatt DL, Solomon SD, eds. Braunwald's Heart Disease: A Textbook of Cardiovascular Medicine. 12th ed. Philadelphia, PA: Elsevier; 2022:chap 45.

Joglar JA, Chung MK, Armbruster AL, et al. 2023 ACC/AHA/ACCP/HRS Guideline for the diagnosis and management of atrial fibrillation: A report of the American College of Cardiology/American Heart Association Joint Committee on Clinical Practice Guidelines. Circulation. 2024;149(1):e1-e156. PMID: 38033089 pubmed.ncbi.nlm.nih.gov/38033089/.

Kumbhani DJ, Bhatt DL. Percutaneous coronary intervention. In: Libby P, Bonow RO, Mann DL, Tomaselli GF, Bhatt DL, Solomon SD, eds. Braunwald's Heart Disease: A Textbook of Cardiovascular Medicine. 12th ed. Philadelphia, PA: Elsevier; 2022:chap 41.

Kleindorfer DO, Towfighi A, Chaturvedi S, et al. 2021 Guideline for the prevention of stroke in patients with stroke and transient ischemic attack: A guideline from the American Heart Association/American Stroke Association. Stroke. 2021;52(7):e364-e467. PMID: 34024117 pubmed.ncbi.nlm.nih.gov/34024117/.

Morrow DA, de Lemos JA. Stable ischemic heart disease. In: Libby P, Bonow RO, Mann DL, Tomaselli GF, Bhatt DL, Solomon SD, eds. Braunwald's Heart Disease: A Textbook of Cardiovascular Medicine. 12th ed. Philadelphia, PA: Elsevier; 2022:chap 40.

Powers WJ, Rabinstein AA, Ackerson T, et al. Guidelines for the early management of patients with acute ischemic stroke: 2019 update to the 2018 Guidelines for the early management of patients with acute ischemic stroke: a guideline for healthcare professionals from the American Heart Association/American Stroke Association. Stroke. 2019;50(12):e344-e418. PMID: 31662037 pubmed.ncbi.nlm.nih.gov/31662037/.

Virani SS, Newby LK, Arnold SV, et al. 2023 AHA/ACC/ACCP/ASPC/NLA/PCNA guideline for the management of patients with chronic coronary disease: a report of the American Heart Association/American College of Cardiology Joint Committee on Clinical Practice Guidelines. Circulation. 2023;148(9):e9-e119. PMID: 37471501 pubmed.ncbi.nlm.nih.gov/37471501/.

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Review Date: 7/14/2024  

Reviewed By: Michael A. Chen, MD, PhD, Associate Professor of Medicine, Division of Cardiology, Harborview Medical Center, University of Washington Medical School, Seattle, WA. Also reviewed by David C. Dugdale, MD, Medical Director, Brenda Conaway, Editorial Director, and the A.D.A.M. Editorial team.

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