Clopidogrel Heparin

Eptifibatide (Integrelin), a cyclic heptapeptide based on a peptide sequence in snake venom, is a GPIIb/llla inhibitor used in conjunction with heparin and aspirin for the treatment of ACS or in PCI, with or without stenting and clopidogrel (Table I). 

Di Nisio M, Bijsterveld NR, Meijers JC, Levi M, Buller HR, Peters RJ. Effects of clopidogrel on the rebound hypercoagula-ble state after heparin discontinuation in patients with acute coronary syndromes. J Am Coll Cardiol 2005 46 I 582-1583,... 

For premedication aspirin 300 mg twice a day 48 hours prior to the procedure and a loading dose of clopidogrel 300 mg (or ticlopidine 250 mg) is recommended. Endocarditis prophylaxis with a first generation cephalosporin (e.g., cefuroxime, 1, 5 g, i.v.) should be administered before and after intervention. After transseptal puncture, 10,000 units of heparin are administered. An activated clotting time of 200-300 seconds is desirable. 

Intravenous antibiotics are given before and after the procedure. Five thousand to ten thousand units of heparin should be administered after transseptal puncture. Aspirin (100-300 mg/day, p.o.) and clopidogrel (75 mg/day, p.o.) is prescribed for the following six months as well as endocarditis prophylaxis. A TEE is performed at six months. If the LAA is completely occluded, no further anticoagulation is required. 

The procedures may be performed under local anesthesia and mild sedation or general anesthesia with heparin anticoagulation. Aspirin (160mg, p.o.) and a loading dose of clopidogrel (300 mg, p.o.) are administered 24 hours before intervention for the aortic valve. Antibiotics (e.g., first generation cephalosporin, i.v.) are given before the procedure and continued for 48 hours, After the procedure aspirin is continued for three to six months,... 

Before intervention heparin is administered (100 U/kg) in addition to endocarditis prophylaxis (e.g., cefuroxime, l,5g, i.v.). Endocarditis prophylaxis is repeated afterthe procedure. Aspirin (100mg, p.d.) and clopidogrel (75mg/day, p.o.) are prescribed for six months after implantation. The incidence of thrombus formation varies between devices (50). If thrombus is seen during follow-up, coumadin therapy should be commenced. 

Medications known to increase the risk of bleeding in cirrhotic patients include aspirin, clopidogrel, dipyridamole, corticosteroids, NSAIDs, heparin and warfarin. Mrs MW would need to be counselled about the risks associated with these medications and advised to always check with the pharmacist before buying any medications over the counter. 

NSAIDs Aspirin Clopidogrel Dipyridamole Warfarin Heparin SSRIs... 

Antiplatelet therapy (aspirin or clopidogrel) reduces the incidence of fatal and of nonfatal myocardial infarction in patients with unstable angina, used alone or with low-dose heparin. 

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