• Irreversibe COX-1 inhibition preventing thromboxane production.
  • 75 to 150 mg/day.
  • Higher doses increase GI bleeding risk.

P2Y12 inhibitors

  • Inhibit ADP receptor P2Y12.
  • CAPRIE trial showed that clopidogrel is better than 325mg/day aspirin in post MI patients, post stroke patients and PVD patients. Clopidogrel benefit was driven by the PVD subgroup.
  • Clopidogrel is recommended for aspirin intolerant patients only.
  • Prasugel and ticagrelor are not recommended.
  • Dual antiplatelet therapy is not recommended.
  • CHARISMA trial- dual antiplatelet therapy was not beneficial in stable angina.
  • There is no recommendation for genetic testing for clopidogrel resistance. Nor is there any recommendation for platelet function testing.

Vorapaxar

  • Vorapaxar is a PAR-1 antagonist. PAR stands for protease activated¬†receptor. It increases bleeding when added to aspirin in stable¬†angina.

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