Brilinta

[turnupthevapor]

Question for some smarty pants out there......If brilinta has a t 1/2 of 9 hrs than why does the PI want u to wait 5 days before surgery rather than 5 t 1/2's

Pt for tfn and ortho wants to go ASAP

Desmopressin and plts should work if I am in trouble but rather use a tincture of time. Fresh cardiac stents too so I'd rather get it done @48 hr mark


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[deleted171991]

Because t1/2 and duration of action are two different things. Sometimes, a drug will induce an effect that lasts even after the drug is metabolized/eliminated.

Take, for example, Aspirin. Duration of (antiplatelet) action: 5-7 days. t1/2 is 2-3 hours for low doses.

For short-acting drugs, such as heparin, the 4-5 x t1/2 still applies.

What does PI come from?

 

[urge]

What kind of stents? What does PI mean?

 

[BuzzPhreed]

PI = Package Insert (what the manufacturer of the drug tells you to do with it)

 

[BLADEMDA]

Like the thienopyridinesprasugrel, clopidogrel and ticlopidine, ticagrelor blocks adenosine diphosphate (ADP) receptors of subtype P2Y12. In contrast to the other antiplatelet drugs, ticagrelor has a binding site different from ADP, making it an allosteric antagonist, and the blockage is reversible.[9] Moreover, the drug does not need hepatic activation, which might work better for patients with genetic variants regarding the enzyme CYP2C19 (although it is not certain whether clopidogrel is significantly influenced by such variants).[10][11][12
Consistently with its reversible mode of action, ticagrelor is known to act faster and shorter than clopidogrel.[16] This means it has to be taken twice instead of once a day which is a disadvantage in respect of compliance, but its effects are more quickly reversible which can be useful before surgery or if side effects occur

 

[BLADEMDA]

Run a P2Y12 assay:

P2Y12: Recommendations
Former recommendation:

< 10% inhibition: No inhibition (neuraxial)
10‐20%: May do surgery
30%: Significant inhibition (No neuraxial block)
New interpretation:

> 259 PRU (< 10% inhibition): No inhibition
> 237 PRU (< 20% inhibition): Weigh risk/benefit