1-abciximab (Reopro ®):
Platelet aggregation inhibition: (PCI): 0.25 mg/kg IV 10–60 minute prior to PCI, then 0.125 mcg/kg/minute (Maximum 10 mcg/min) IV Infusion x 12 hours.
The safety and efficacy of Abciximab have only been investigated with concomitant administration of heparin and aspirin as described in CLINICAL STUDIES. In patients with failed PCls, the continuous infusion of Abciximab should be stopped because there is no evidence for Abciximab efficacy in that setting. In the event of serious bleeding that cannot be controlled by compression, Abciximab and heparin should be discontinued immediately.
2- Aggrenox ® (dipyridamole/ASA):
INDICATIONS: AGGRENOX (aspirin/extended-release dipyridamole) is indicated to reduce the risk of stroke in patients who have had transient ischemia of the brain or completed ischemic stroke due to thrombosis.
DOSAGE AND ADMINISTRATION: The recommended dose of AGGRENOX (aspirin/extended-release dipyridamole) is one capsule given orally twice daily, one in the morning and one in the evening. The capsules should be swallowed whole without chewing. AGGRENOX capsules may be administered with or without food.
3-anagrelide (Agrylin ®):
INDICATIONS: AGRYLIN Capsules are indicated for the treatment of patients with thrombocythemia, secondary to myeloproliferative disorders, to reduce the elevated platelet count and the risk of thrombosis and to ameliorate associated symptoms including thrombo-hemorrhagic events.
DOSAGE AND ADMINISTRATION: Treatment with AGRYLIN Capsules should be initiated under close medical supervision. The recommended starting dosage of AGRYLIN is 0. 5 mg orally four times daily or 1 mg orally twice daily which should be maintained for at least one week. Dosage should then be adjusted to the lowest effective dosage required to reduce and maintain platelet count below 600,000/L, and ideally to the normal range. The dosage should be increased by not more than 0.5 mg/day in any one week. Dosage should not exceed 10 mg/day or 2.5 mg in a single dose.
4-cilostazol (Pletal ®)
Mechanism of Action:
The mechanism of the effects of cilostazol tablets on the symptoms of intermittent claudication is not fully understood. Cilostazol tablets and several of its metabolites are cyclic AMP (cAMP) phosphodiesterase III inhibitors (PDE III inhibitors), inhibiting phosphodiesterase activity and suppressing cAMP degradation with a resultant increase in cAMP in platelets and blood vessels, leading to inhibition of platelet aggregation and vasodilation, respectively.
Cilostazol tablets reversibly inhibits platelet aggregation induced by a variety of stimuli, including thrombin, ADP, collagen, arachidonic acid, epinephrine, and shear stress. Effects on circulating plasma lipids have been examined in patients taking cilostazol tablets
INDICATIONS AND USAGE
Cilostazol is indicated for the reduction of symptoms of intermittent claudication, as indicated by an increased walking distance.
Cilostazol and several of its metabolites are inhibitors of phosphodiesterase III. Several drugs with this pharmacologic effect have caused decreased survival compared to placebo in patients with class III-IV congestive heart failure. Cilostazol is contraindicated in patients with congestive heart failure of any severity.
Dosing (Adults): Peripheral vascular disease: 100 mg orally twice daily taken at least 30 minutes before or 2 hours after breakfast and dinner. Dosage should be reduced to 50 mg twice daily during concurrent therapy with inhibitors of CYP3A4 or CYP2C19.
5-clopidogrel (Plavix ® ):
INDICATIONS: Plavix (clopidogrel bisulfate) is indicated for the reduction of atherothrombotic events as follows:
* Recent MI, Recent Stroke or Established Peripheral Arterial Disease: For patients with a history of recent myocardial infarction (MI), recent stroke, or established peripheral arterial disease, Plavix has been shown to reduce the rate of a combined endpoint of new ischemic stroke (fatal or not), new MI (fatal or not), and other vascular death.
* Acute Coronary Syndrome: For patients with non-ST-segment elevation acute coronary syndrome (unstable angina/non-Q-wave MI) including patients who are to be managed medically and those who are to be managed with percutaneous coronary intervention (with or without stent) or CABG, Plavix has been shown to decrease the rate of a combined endpoint of cardiovascular death, MI, or stroke as well as the rate of a combined endpoint of cardiovascular death, MI, stroke, or refractory ischemia.
For patients with ST-segment elevation acute myocardial infarction, Plavix has been shown to reduce the rate of death from any cause and the rate of a combined endpoint of death, re-infarction or stroke. This benefit is not known to pertain to patients who receive primary angioplasty.
DOSAGE AND ADMINISTRATION:
Recent MI, Recent Stroke, or Established Peripheral Arterial Disease
The recommended daily dose of Plavix is 75 mg once daily.
Acute Coronary Syndrome
For patients with non-ST-segment elevation acute coronary syndrome (unstable angina/non-Q-wave MI), Plavix should be initiated with a single 300-mg loading dose and then continued at 75 mg once daily. Aspirin (75 mg-325 mg once daily) should be initiated and continued in combination with Plavix. In CURE, most patients with Acute Coronary Syndrome also received heparin acutely.
For patients with ST-segment elevation acute myocardial infarction, the recommended dose of Plavix is 75 mg once daily, administered in combination with aspirin, with or without thrombolytics. Plavix may be initiated with or without a loading dose (300 mg was used in CLARITY — Review CLINICAL STUDIES).
Plavix can be administered with or without food.
No dosage adjustment is necessary for elderly patients or patients with renal disease.
Supplied: 75 mg, 300 mg tablet.
6-dipyridamole (Persantine ®):
INDICATIONS: Dipyridamole is indicated as an adjunct to coumarin anticoagulants in the prevention of postoperative thromboembolic complications of cardiac valve replacement.
DOSAGE AND ADMINISTRATION:
Adjunctive Use in Prophylaxis of Thromboembolism after Cardiac Valve Replacement
The recommended dose is 75-100 mg four times daily as an adjunct to the usual warfarin therapy. Please note that aspirin is not to be administered concomitantly with coumarin anticoagulants.
Supplied: 25 mg, 50 mg and 75 mg tablets.
7- eptifabatide (Integrilin ®):
Administration: Bolus: withdraw dose from 10ml vial and give by IV push over 1-2 minutes. Continuous infusion: administer calculated rate directly from 100ml vial.
Properties: Onset: within 1 hr. T1/2 = 2.5 hours. Platelet fcn restored in @ 4hours after discontinuation. [Supplied: 0.75 mg/ml (100ml) vial. 20 mg/10 ml vial.]
Acute Coronary Syndrome: The recommended adult dosage of eptifibatide in patients with acute coronary syndrome and normal renal function is an intravenous bolus of 180 µg/kg (maximum: 22.6 mg) over 1-2 minutes as soon as possible following diagnosis, followed by a continuous infusion of 2.0 µg/kg/min (maximum: 15 mg/hour) until hospital discharge or initiation of CABG surgery, up to 72 hours.
8- ticlopidine (Ticlid ®):
–To reduce the risk of thrombotic stroke (fatal or nonfatal) in patients who have experienced stroke precursors, and in patients who have had a completed thrombotic stroke. Because TICLID is associated with a risk of life-threatening blood dyscrasias including thrombotic thrombocytopenic purpura (TTP), neutropenia/agranulocytosis and aplastic anemia, TICLID should be reserved for patients who are intolerant or allergic to aspirin therapy or who have failed aspirin therapy.
–As adjunctive therapy with aspirin to reduce the incidence of subacute stent thrombosis in patients undergoing successful coronary stent implantation.
DOSAGE AND ADMINISTRATION:
Stroke: The recommended dose of TICLID is 250 mg bid taken with food. Other doses have not been studied in controlled trials for these indications.
Coronary Artery Stenting: The recommended dose of TICLID is 250 mg bid taken with food together with antiplatelet doses of aspirin for up to 30 days of therapy following successful stent implantation.
Supplied: 250 mg tablet.
9-tirofiban (Aggrastat ®):
Dosing: 0.4 mcg/kg/min for 30 minutes, followed by 0.1 mcg/kg/min. Therapy should continue through angiography and for 12-24 hours after angioplasty or atherectomy.
Dosing adjustment in renal impairment:
(Note: Reduce dose by 50% if CRCL < 30 ml/min – 0.2 mcg/kg/min x 30 min, followed by 0.05 mcg/kg/min).
Supplied: 250 mcg/ml-50 ml vial (12.5 mg/50ml).