antiplatelets dr. ahmed amin fcarcsi arab board m. sc
TRANSCRIPT
AntiplateletsDr. Ahmed Amin
FCARCSIArab Board
M. Sc.
ADP
TXA2
Epinephrine
Th
rom
bin
Collagen
ADP
TXA2
GP IIb/IIIa
Epinephrine
Th
rom
bin
Collagen
ADP
TXA2
GP IIb/IIIaFibrinogen
Collagen
Th
rom
bin
Epinephrine
GP IIb/IIIa
GP IIb/IIIa
Fibrinogen
GP IIb/IIIa
Antagonists
ADP
TXA2
Epinephrine
Th
rom
bin
Collagen
ADP
TXA2
Epinephrine
Th
rom
bin
Collagen
Fibrinogen
Abciximab
Monoclonal
Ab.
50Kd
Abciximab
Eptifibatide
Monoclonal AB
Cyclic Peptide
50Kd
800d
Abciximab
EptifibatideTirofiban
Monoclonal AB
Cyclic PeptideNon-Peptide
50Kd
500d800d
Peptidase
Abciximab
ReoPro
Non-Competitive Block
12-24h
Non-Competitive
Block
T1/2 12-24h
Long Acting
Non-Competitive
Block
Platelets Transfusion
Competitive block
TirofibanAggrastat
T1/2 1.8h
Bile 80 %
Urine 20 %
TirofibanAggrastat
Competitive block
Competitive block
T1/2 2.5 h
EptifibatideIntegrilin
Urine
EptifibatideIntegrilin
Platelets Transfusion
EptifibatideIntegrilin
On cessation, coagulation normalises
Abciximab 12-24 h
Tirofiban , Eptifibatide 4-6h
Abciximab, Eptifibatide,Tirofiban
Thrombocytopenia
Bleeding
FDA 1999
Abciximab, Eptifibatide,Tirofiban
20% Less HeparinACT 30-80 sec more
Urgent CAGBFailure or Complicated PCI
< 1 % since 1995
Bleeding ? Angelini : J Am Coll Cardiol
1999
Perioperative Guidelines
Don't Delay for 12 h
with Abciximab
Perioperative Guidelines
OP CABG
Perioperative Guidelines
Heparin
Standard Dose
Perioperative Guidelines
Platelets TransfusionAbciximab,ReoPro
ReadyOff-Bypass
Perioperative Guidelines
Emergency CABG
Safe
Angelini : J Am Coll Cardiol 1999
Perioperative Guidelines
Emergency CABG
Platelets ready
Angelini : J Am Coll Cardiol 1999