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Over time, numerous antiplatelet agents have been developed with many indications. Antiplatelet medications divide into oral and parenteral agents, and oral agents subdivide further based on the mechanism of action. Aspirin was the first antiplatelet medication and is a cyclooxygenase inhibitor. Other oral antiplatelet include clopidogrel, ticagrelor, and prasugrel, cilostazol, and dipyridamole. Glycoprotein IIb/IIIa inhibitors such as tirofiban and eptifibatide are only available as parenteral agents and are used in acute phases of acute coronary syndrome. This activity reviews the indications, contraindications, actions, adverse events, and other key elements of antiplatelet drugs essential to clinical practice. Objectives: Determine the mechanisms of action of the different antiplatelet agents. Identify the appropriate indications for the various antiplatelet drugs. Assess the potential adverse event profiles of the different antiplatelet agents. Communicate interprofessional team strategies for improving care coordination and communication to enhance patient outcomes and minimize adverse events with antiplatelet medications. Access free multiple choice questions on this topic.

Aspirin is the most commonly used of all antiplatelet drugs, so accidental intake is common. The effect can be life-threatening if taken over 150 mg/kg of body weight. Supportive measures to decrease the absorption of the drug are achievable by using activated charcoal, but only if administered within 4 hours of ingestion. The patient needs monitoring for signs and symptoms of bleeding and the development of metabolic derangements, such as acidosis. If acidosis develops, immediate dialysis is indicated.[10] No antidote is available for most of these drugs; however, a monoclonal antibody against ticagrelor is in development, but it is not commercially available yet.

Antiplatelet drug therapy requires an interprofessional team approach, including clinicians (MDs, DOs, NPs, PAs), specialty-trained nurses, and pharmacists. To achieve optimal patient results, these professionals must collaborate and engage in open communication. The choice of an antiplatelet agent depends on the clinical situation. Because of the availability of many antiplatelet agents, the ordering/prescribing clinician should consult with a cardiology or pharmacotherapy specialized pharmacist. When prescribing these agents, the pharmacist should review the patient's medication list and past diagnoses to determine if specific agents are recommended or contraindicated. Communication between the clinical provider and the pharmacists is essential to minimize adverse patient outcomes when using these drugs. A cardiac pharmacist can offer direction regarding agent selection, drug-drug interactions, dose verification, and medication reconciliation for high-risk patients. The role of the cardiac nurse administering these medications in the acute setting involves monitoring for any acute adverse symptoms. Prompt communication by the astute nursing staff of an adverse reaction or a complication can significantly reduce patient morbidity and mortality. Nurses are often the first healthcare providers to verify these agents' therapeutic effectiveness and monitor for adverse effects. This role becomes crucial in patients receiving dual antiplatelet therapy, as is often the case for preventing stent thrombosis or after an ACS event. The specialty-trained clinicians educate the patient on possible complications, the indications for the prescribed therapy, and the need for adherence to the medication treatment regimen. The nurse should communicate with the clinical provider and the pharmacist if noting any adverse reaction or if there is a concern for patient adherence to drug therapy so that alternative therapies can be considered. An interprofessional approach, with a multifaceted and targeted approach to treatment, is necessary to improve patient outcomes with antiplatelet medications.