Aspirin+Clopidogrel+gpIIb/IIIa!!!

[adagio]

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From what I understood is the following:

Aspirin: Always

Clopidogrel: ONLY IF either: Do not tolerate aspirin, OR going for PCI---> going for a PCI gets Aspirin+Clopidogrel

2b/3a: ONLY IF either: NSTEMI, OR going for stenting ---?? does this mean a guy who is going for PCI will get THREE drugs> Aspirin + Plavix +2b/3a?!?

Thanks

 

[OveractiveBrain]

Abciximab is really a theoretical drug. Ive never seen it used IRL, though it can be given if going to PCI. If given for that reason, thats all they get. Realistically, they will likely have gotten ASA at initial presentation, and therefore will have gotten "2 meds." Abciximab is an IV medication, and is continued while on their way.

Aspirin is given at initial presentation and continued throughout life. It is only discontinued if the patient becomes aspirin allergic. It is also switched to clopidogrel if given for a stroke, and the patient strokes on ASA.

Clopidogrel is just another clot-preventer (Thromboxane instead of COX inhibitor). If given the option between this an ASA only choose ASA. UNLESS they are allergic to aspirin.

If doing a test question and it says they are definitely going to get a stent what do you give them on the way to the OR --> Abciximab
If doing a test question and it says what do you give first --> Aspirin
If doing a test question about clopidogrel, you better see Aspirin allergy or Stroke on ASA, otherwise its WRONG

 

[Fuzuli]

Excellent points from OveractiveBrain. I'm going to add one more point: If CABG is a possibility, hold clopidogrel. They mention this in Kaplan LN as well.

 

[adagio]

If doing a test question about clopidogrel, you better see Aspirin allergy or Stroke on ASA, otherwise its WRONG

First of all, thank you so much for taking the time to answer my inquires, its very kind of you.

Regarding clopidogrel, the reason I asked, is that they explicitly say in Kaplan and MTB 2, that it should be given when there is plan to do PCI. your last three lines are really really what i wanted to read, I mean they represent scenarios for questions, which I need to grasp the concept. so thank you so much.

Excellent points from OveractiveBrain. I'm going to add one more point: If CABG is a possibility, hold clopidogrel. They mention this in Kaplan LN as well.

Very true, i didnt understand why clopi should be withheld if CABG is a possibiity, but this is ridiculous: how can they say that, and say give it if you are planning to do PCI ... how can you foresee how many arteries are clogged, so that a CABG might take place?! this is really confusing ...

 

[slowlybutshelly]

I had a question on my recent exam that included the answer choices aspirin, heparin, clopidogrel. I am trying to remember the question itself. I do not remember anything about an ASA allergy or a stroke given the patient was on aspirin. In fact, I think I put heparin as an answer choice. Can someone elaborate on when to give heparin? I always thought it was just if the patient was transitioning from coumadin.

 

[zenna]

In the kaplan LN it says that clopidogrel should be given with asprin for both NSTEMI and STEMI ( fibrinolysis or PCI), However if is thought that the pateint is likely to require CABG, clopidrogrel should be withheld.

And the dose of unfractionated heparin in STEMI will depend upon the concomitant 2b/3a inhibiors??????????????

With NStEMI unfractionated heparin or subcutaneous enoxaparin should be given until angiography or for 48-72 hrs.

2b/3a, these drugs have better advantage for NSTEMI because these drugs take an avantage of the fact platelet play important role in the development of ischemia in US/NSTEMI
while for StEMI their they are used in reduced dose if fbrinolytic used
Please correct me.

 

[Fuzuli]

Which heparin to use and their dosage depends on other factors as well (renal failure, obesity, previous bleeding, etc.). Like we've discussed in the other topic, the likelihood of asking which anti-thrombotic drug to choose is extremely slim (if not none). Suffice to say that everybody should get an anti-thrombotic.

For Gp IIb/IIIa inbitors (GPI), its simple: Use it before PCI. Don't give GPIs if using fibrinolysis or conservative treatment.