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Stroke
Published in Jahangir Moini, Matthew Adams, Anthony LoGalbo, Complications of Diabetes Mellitus, 2022
Jahangir Moini, Matthew Adams, Anthony LoGalbo
With use of warfarin, antiplatelet drugs have additive effects that increase bleeding risks. Aspirin is sometimes used with warfarin, but for only some high-risk patients. Clopidogrel can be used if the patient is allergic to aspirin. While taking clopidogrel, if the patient has a recurrent ischemic stroke or a coronary artery stent becomes blocked, there must be suspicion of impaired clopidogrel metabolism. During acute treatment, clopidogrel with aspirin is only given for less than 3 months. This combination is given before 30 days after stenting, usually up to a maximum of 6 months. When a patient cannot tolerate clopidogrel, ticlopidine can be used.
Effects of Antithrombotic and Results of Drug Screening
Published in Josef Hladovec, Antithrombotic Drugs in Thrombosis Models, 2020
In conclusion, it is evident that the effect on the vessel wall, or more appropriately on the endothelium, is a contributing component in the overall antithrombotic effect of ticlopidine. This finding comes as no surprise supposing its general effect on cell membranes. On the other hand, the effect on platelets is probably predominant. The prolonged effect of the drug was confirmed. Ticlopidine is an effective antithrombotic even at a relatively low dose level and particularly in the arterial thrombosis model.
Anemias of Bone Marrow Failure
Published in Harold R. Schumacher, William A. Rock, Sanford A. Stass, Handbook of Hematologic Pathology, 2019
Ticlopidine is an antiplatelet agent used following cerebrovascular accidents and myocardial ischemia. Reversible agranulocytosis is observed in 2.4% of patients; aplastic anemia is much less frequent. These events are characteristically observed in the first 12 weeks of therapy.
Nanotechnological approach to delivering nutraceuticals as promising drug candidates for the treatment of atherosclerosis
Published in Drug Delivery, 2021
Sindhu C. Pillai, Ankita Borah, Eden Mariam Jacob, D. Sakthi Kumar
Anti-thrombotic therapy is a sought-after treatment option for thrombosis that underlies acute coronary syndrome. The appropriate management of reduction in platelet aggregation is warranted for anti-thrombotic drugs. Aspirin is one of the keystone anti-thrombotic drugs that has been demonstrated to reduce fatal and non-fatal risk of myocardial infarction in at least 50% of patients. Aspirin interferes with the formation of thromboxane A2 and reduces platelet aggregation via the blockade of the cyclo-oxygenase pathway. A beneficial dose of 75–50 mg seems to have a sustained effect with lower side effects related to gastrointestinal conditions (Watson et al., 2002). Clopidogrel and Ticlopidine belong to the adenosine diphosphate (ADP) inhibitors class of anti-thrombotic drugs (Sharis et al., 1998). Ticlopidine has previously been shown to reduce infarction, stroke, and angina for at least six months nonetheless associated with reversible neutropenia and thrombocytopenia. Clopidogrel represents the advanced derivative version of ticlopidine which is highly effective in reducing platelet aggregation. Clopidogrel also reports decreased risk of bleeding than aspirin and has better tolerability. Anti-thrombotic therapy additionally comprises of other strategies such as glycoprotein IIb/IIIa receptor inhibitors, anti-coagulant therapy (heparin treatment and fibrinolytic treatment) that has elucidated varied results in patients of the acute coronary syndrome in different experimental settings (Watson et al., 2002).
Successes, failures, and future prospects of prodrugs and their clinical impact
Published in Expert Opinion on Drug Discovery, 2019
Platelet aggregation inhibitors are crucial to the management of clotting disorders and to the prevention and follow-up treatment of strokes and cardiovascular incidents. Clopidogrel [22], prasugrel [23], and dabigatran etexilate are prodrugs amongst the most prescribed agents in this class. Clopidogrel and prasugrel are adenosine diphosphate (ADP) receptor blockers while dabigatran etexilate is a direct thrombin inhibitor. Clopidogrel is activated by two-step CYP450 metabolism to furnish its active form. Similarly, prasugrel is hydrolysed by human carboxylesterase 2 (hCE2) to R-95913 and then metabolized to yield R-138727, the active form [24]. Ticlopidine is another prodrug in this therapeutic group. It is an older agent that also inhibits adenosine diphosphate receptors. Though, its use in the daily treatment is limited due to serious side effects such as neutropenia and thrombotic thrombocytopenic purpura.
Ticagrelor improves systemic immune-inflammation index in acute coronary syndrome patients
Published in Acta Cardiologica, 2022
Mehmet Koray Adali, Ipek Buber, Oguz Kilic, Anil Turkoz, Samet Yilmaz
Recently, in a PLATO substudy investigating the effect of clopidogrel and ticagrelor on leukocyte counts has been found lower WBC counts in ACS patients treated with clopidogrel. This effect of clopidogrel on WBC is independent of baseline biomarkers and clinical risk factors and is consistent across the one-, three- and six-month timepoints [12]. Thienopyridines have been associated with bone marrow suppression. Ticlopidine has been limited for clinical use due to this side effect. Clinically apparent leukopenia is rare with clopidogrel, and this slight decrease may be considered as a group effect of thienopyridines. Similarly, in the present study, we found a decrease in WBC in the CG during the follow-up period compared to the TG.