page172
Contra-indications
active internal bleeding;
major
surgery,
intracranial or intraspinal surgery or trauma
within last 2 months;
stroke within last 2 years;
intracranial neoplasm, arteriovenous malformation or
aneurysm,
severe hypertension,
haemorrhagic dia-
thesis,
thrombocytopenia,
vasculitis, hypertensive
retinopathy
Hepatic impairment
avoid in severe liver disease—
increased risk of bleeding
Renal impairment
caution in severe impairment—
increased risk of bleeding
Pregnancy
manufacturer advises use only if potential
benefit outweighs risk—no information available
Breast-feeding
manufacturer advises avoid—no
information available
Side-effects
bleeding manifestations; nausea,
vomi-
ting, hypotension, bradycardia, chest pain, back pain,
headache,
fever,
puncture site pain, thrombocytope-
nia;
rarely
cardiac tamponade,
adult respiratory dis-
tress,
hypersensitivity reactions
Dose
.
ADULT
initially by intravenous injection over 1 minute,
250 micrograms/kg,
then by intravenous infusion,
125 nanograms/kg/minute (max.
10 micrograms/
minute); for prevention of ischaemic complications
start 10–60 minutes before percutaneous coronary
intervention and continue infusion for 12 hours;
for
unstable angina start up to 24 hours before possible
percutaneous coronary intervention and continue
infusion for 12 hours after intervention
ReoPro
c
(Lilly) A
Injection
, abciximab 2 mg/mL, net price 5-mL vial =
£250.24
ASPIRIN (antiplatelet)
(Acetylsalicylic Acid)
Indications
secondary prevention of thrombotic
cerebrovascular or cardiovascular disease,
and fol-
lowing by-pass surgery (see also section 2.10.1 and
notes above)
Cautions
asthma; uncontrolled hypertension; previous
peptic ulceration (but manufacturers may advise
avoidance of low-dose aspirin in history of peptic
ulceration);
concomitant use of drugs that increase
risk of bleeding;
G6PD deficiency (section 9.1.5);
interactions: Appendix 1 (aspirin)
Contra-indications
use other than as an antiplatelet in
children and adolescents under 16 years (Reye’s
syndrome,
section 4.7.1);
active peptic ulceration;
haemophilia and other bleeding disorders
Hypersensitivity
Aspirin and other
NSAIDs are contra-
indicated in history of hypersensitivity to aspirin or any
other NSAID—which includes those in whom attacks of
asthma,
angioedema, urticaria,
or rhinitis have been preci-
pitated by aspirin or any other NSAID
Hepatic impairment
avoid in severe impairment—
increased risk of gastro-intestinal bleeding
Renal impairment
use with caution;
avoid in severe
impairment;
sodium and water retention;
deteriora-
tion in renal function;
increased risk of gastro-intes-
tinal bleeding
Pregnancy
use with caution during third trimester;
impaired platelet function and risk of haemorrhage;
delayed onset and increased duration of labour with
increased blood loss; avoid analgesic doses if possible
in last few weeks (low doses probably not harmful);
with high doses,
closure of fetal ductus arteriosus
in
utero
and possibly persistent pulmonary hypertension
of newborn;
kernicterus in jaundiced neonates
Breast-feeding
avoid—possible risk of Reye’s
syndrome; regular use of high doses could impair
platelet function and produce hypoprothrombinaemia
in infant if neonatal vitamin K stores low
Side-effects
bronchospasm; gastro-intestinal irrita-
tion,
gastro-intestinal haemorrhage (occasionally
major), also other haemorrhage (e.g. subconjunctival)
Dose
. See notes above
1
Aspirin
(Non-proprietary) A
Dispersible tablets
,
aspirin 75 mg,
net price 28 =
83p;
300 mg,
see section 4.7.1.
Label:
13, 21,
32
Tablets
,
e/c,
aspirin 75 mg,
net price 28-tab pack =
93p;
56-tab pack = £1.03;
300 mg,
see section 4.7.1.
Label:
5,
25,
32
Brands include
Micropirin
c
Caprin
c
(Pinewood) A
Tablets
,
e/c,
pink,
aspirin 75 mg,
net price 28-tab
pack = £1.51,
56-tab pack = £2.52,
100-tab pack =
£5.24;
300 mg,
see section 4.7.1.
Label:
5,
25,
32
Nu-Seals
c
Aspirin
(Alliance) A
Tablets
,
e/c,
aspirin 75 mg,
net price 56-tab pack =
£3.12;
300 mg,
see section 4.7.1.
Label:
5,
25,
32
Note
Tablets may be chewed at diagnosis for rapid absorption
CLOPIDOGREL
Indications
prevention of atherosclerotic events in
peripheral arterial disease,
or within 35 days of myo-
cardial infarction,
or within 6 months of ischaemic
stroke; prevention of artherosclerotic events in acute
coronary syndrome without ST-segment elevation
(given with aspirin—see notes above) and in acute
myocardial infarction with ST-segment elevation
(given with aspirin—see notes above)
Cautions
patients at risk of increased bleeding from
trauma,
surgery or other pathological conditions;
concomitant use of drugs that increase risk of bleed-
ing;
discontinue 7 days before elective surgery if
antiplatelet effect not desirable;
interactions:
Appendix 1 (clopidogrel)
Contra-indications
active bleeding
Hepatic impairment
manufacturer advises caution
(risk of bleeding);
avoid in severe impairment
Renal impairment
manufacturer advises caution
Pregnancy
manufacturer advises avoid—no informa-
tion available
Breast-feeding
manufacturer advises avoid
Side-effects
dyspepsia,
abdominal pain,
diarrhoea;
bleeding disorders (including gastro-intestinal and
intracranial);
less commonly
nausea, vomiting,
gastri-
tis,
flatulence,
constipation, gastric and duodenal
ulcers, headache,
dizziness,
paraesthesia, leucopenia,
decreased platelets (very rarely severe thrombocyto-
penia), eosinophilia, rash, and pruritus;
rarely
vertigo;
very rarely
colitis,
pancreatitis,
hepatitis,
acute liver
failure,
vasculitis,
confusion, hallucinations,
taste dis-
turbance,
stomatitis,
bronchospasm, interstitial pneu-
monitis, blood disorders (including thrombocytopenic
1.
Aspirin tablets 75 mg may be sold to the public in packs of
up to 100 tablets; for details relating to other strengths see
section 4.7.1 and
Medicines,
Ethics and Practice
,
No.
34,
London,
Pharmaceutical
Press,
2010
(and subsequent
editions as available)
152
2.9 Antiplatelet drugs
BNF 61
2
Cardiovascular system