AntiplättchenTherapien

AntiplättchenTherapien, also known as antiplatelet therapies, are medications used to prevent blood clots by inhibiting platelet aggregation. They form a cornerstone of treatment for acute coronary syndromes, stable coronary artery disease, and certain cerebrovascular disorders. The most common agents include aspirin, which irreversibly inhibits cyclo‑oxygenase‑1 and reduces thromboxane A₂ production; clopidogrel, prasugrel, and ticagrelor, which block the P2Y₁₂ receptor on platelets; and glycoprotein IIb/IIIa inhibitors such as eptifibatide, tirofiban, and abciximab, which obstruct the final common pathway of fibrinogen binding. Newer drugs, like cangrelor, provide rapid, reversible inhibition of platelet activity.

Indications are broad. In patients with myocardial infarction or unstable angina, dual antiplatelet therapy (aspirin plus a P2Y₁₂ inhibitor) is initiated early and continued for at least a year, especially after percutaneous coronary intervention. In patients undergoing primary PCI, triple therapy—adding a low‑dose anticoagulant to dual antiplatelet therapy—may be used short‑term. Antiplatelet agents are also employed in the secondary prevention of ischemic stroke, atrial fibrillation‑related embolism, and peripheral arterial disease. In certain surgical settings, short‑term antiplatelet therapy may be required to mitigate thrombotic risk while avoiding excessive bleeding.

Typical dosing regimens include aspirin 75–100 mg daily, clopidogrel 75 mg daily (after a 300 mg loading dose), prasugrel 10 mg daily (after 60 mg loading), and ticagrelor 90 mg twice daily. Glycoprotein IIb/IIIa inhibitors are generally administered by intravenous infusion during high‑risk PCI. Regular monitoring of platelet function, bleeding signs, and kidney and liver function is advised, as drug interactions and patient comorbidities can modify efficacy or safety.

Potential adverse effects range from mild gastrointestinal irritation and bruising to severe gastrointestinal bleeding, hemorrhagic stroke, or hypersensitivity reactions. Contraindications include active bleeding, known sensitivity to the drug, concurrent use of potent anticoagulants, and severe thrombocytopenia. Careful balancing of thrombotic versus bleeding risk is essential for optimal patient outcomes.