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Antithrombotic medications

Dalal, Kavitha S. PharmD; Bridgeman, Mary Barna PharmD, BCPS

doi: 10.1097/01.NURSE.0000484966.85733.86

Kavitha S. Dalal is a critical care pharmacist at Virtua in Marlton, N.J. Mary Barna Bridgeman is a clinical associate professor at Rutgers University Ernest Mario School of Pharmacy in Piscataway, N.J.

Unless otherwise specified, the information in the preceding summaries applies to adults, not children. Consult the package insert for information about each drug's safety during pregnancy and breastfeeding. Also consult a pharmacist, the package insert, or a comprehensive drug reference for more details on precautions, drug interactions, and adverse reactions.

Can you identify medications used for prevention or reduction of thrombotic events? Match each medication in Section I with its generic name and description in Section II.

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Section I

_____ 1. Zontivity (Merck)

_____ 2. Brilinta (AstraZeneca)

_____ 3. Kengreal (The Medicines Company)

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Section II

a. cangrelor. A direct P2Y12 platelet receptor inhibitor, this antiplatelet agent is indicated as an adjunct to percutaneous coronary intervention (PCI) to reduce the risk of periprocedural myocardial infarction (MI), repeat coronary revascularization, and stent thrombosis in patients who've not been treated with a P2Y12 platelet inhibitor and aren't currently being given a glycoprotein IIb/IIIa inhibitor. It's administered as an I.V. bolus before PCI and followed immediately by an infusion that continues for at least 2 hours or for the duration of the PCI procedure, whichever is longer.

b. ticagrelor. This P2Y12 platelet receptor inhibitor is indicated for use with aspirin to reduce the risk of cardiovascular death, MI, and stroke in patients with acute coronary syndrome (ACS) or in patients with a history of MI. Ticagrelor is also used to reduce the risk of stent thrombosis in patients with ACS who were treated with a stent. A boxed warning in the labeling warns of an increased risk of bleeding. Avoid concurrent aspirin administration at dosages above 100 mg/day, which can decrease ticagrelor's efficacy.

c. vorapaxar. This protease-activated receptor-1 antagonist is indicated for patients with a history of MI or established peripheral arterial disease to reduce thrombotic cardiovascular events such as MI or stroke. It's approved for use in combination with aspirin and/or clopidogrel. It's contraindicated in patients with a history of stroke, transient ischemic attack, intracranial hemorrhage, or any other type of active bleeding.

ANSWERS: 1c, 2b, 3a

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