other antiplatelet drugs in ACS: unstable angina/NSTEM

1. ticagrelor

1.1. reversible

1.2. used when reperfustion is not indicated

1.3. PREFFERED ANTIPLATELET THERAPY

1.4. CI: avoid in symptomatic bradycardia and heart blocks

2. glycoprotein IIb/IIIa inhibitors

2.1. abciximab; tirofiban; eptifibatide

2.1.1. MOA: GPIIb/IIIa antibody and small molecule receptor blockers inhibit the final common pathway of platelet aggregation

2.2. may be used with ASA and heparin for acs pts who undergo PCI

2.3. abcximab: PCI with stenting

2.4. tirofiban and eptifibatide: NSTEMI with high risk features

3. clopidogrel

3.1. MOA: prodrug, antiplatelet (irreversible effect on platelets) block binding of ADP to p2Y12 on platelets

3.2. more rapid onset of action, especially after loading dose

3.3. loading dose->maintenance dose

3.4. added to ASA as dual antiplatlet therapy

3.5. least preferred compared to other antiplatelet drug

3.6. used when fibrinolytic therapy is indicated

3.7. AE: bleeding; decreassed effects with PPIs like prilosec or genetic issues

4. prasugrel

4.1. used if pt is getting PCI; loading dose-> maintenance dose

4.2. AE: less issues with PPIs and genetics; more pleeding than clopidogrel; race dependent: lower dose in easter asian pts

4.3. not to be used in pts >75