Abstract
The current adenosine diphosphate inhibitors, ticlopidine and clopidogrel, are thienopyridine compounds that inhibit adenosine diphosphate mediated platelet aggregation. They interfere with platelet activation by selectively and irreversibly blocking P2Y12 sub-unit of the adenosine diphosphate receptor on the surface of platelets. This provides an antiplatelet effect that is additive to the inhibition of the thromboxane A2 pathway by aspirin. Dual antiplatlet therapy is extensively used in cardiovascular medicine. Randomized controlled trials have substantiated the fact that thrombotic complications after percutaneous coronary intervention procedures can be decreased by using dual antiplatelet therapy. However, there is a concern of bleeding due to enhanced and irreversible platelet inhibition in patients who will require any operation including coronary artery bypass grafting while on adenosine diphosphate inhibitors. This applies to a large population of patients requiring either coronary artery bypass grafting after angiographic definition of their coronary anatomy, or patients requiring semi-elective or urgent operation while under dual antiplatlet therapy. This concern is more present in era of drug-eluting stents, where long-term use of dual antiplatelet therapy is encouraged, and the incidence of late thrombosis after late cessation of adenosine diphosphate inhibitors is increasingly surfacing in the literature. The goal this review is to provide the medical chemistry of most commonly used adenosine diphosphate inhibitors, examine the literature on the effect of adenosine diphosphate inhibitors in hemorrhagic-related complications after surgical intervention, and provide the ramifications and alternatives in modern clinical practice.
Keywords: Adenosine diphosphate inhibitors, clopidogrel, postoperative bleeding, perioperative hemorrhage, complications, myocardial infarction, stent thrombosis, outcomes
Current Medicinal Chemistry
Title: Perioperative Management of Patients on Adenosine Diphosphate Inhibitors in the Era of Drug-Eluting Stents: Review of the Literature and Clinical Implications
Volume: 16 Issue: 5
Author(s): Ali Khoynezhad, Mohammad Reza Movahed, Mehrnoosh Hashemzadeh, Abbas Emaminia and Ziba Jalali
Affiliation:
Keywords: Adenosine diphosphate inhibitors, clopidogrel, postoperative bleeding, perioperative hemorrhage, complications, myocardial infarction, stent thrombosis, outcomes
Abstract: The current adenosine diphosphate inhibitors, ticlopidine and clopidogrel, are thienopyridine compounds that inhibit adenosine diphosphate mediated platelet aggregation. They interfere with platelet activation by selectively and irreversibly blocking P2Y12 sub-unit of the adenosine diphosphate receptor on the surface of platelets. This provides an antiplatelet effect that is additive to the inhibition of the thromboxane A2 pathway by aspirin. Dual antiplatlet therapy is extensively used in cardiovascular medicine. Randomized controlled trials have substantiated the fact that thrombotic complications after percutaneous coronary intervention procedures can be decreased by using dual antiplatelet therapy. However, there is a concern of bleeding due to enhanced and irreversible platelet inhibition in patients who will require any operation including coronary artery bypass grafting while on adenosine diphosphate inhibitors. This applies to a large population of patients requiring either coronary artery bypass grafting after angiographic definition of their coronary anatomy, or patients requiring semi-elective or urgent operation while under dual antiplatlet therapy. This concern is more present in era of drug-eluting stents, where long-term use of dual antiplatelet therapy is encouraged, and the incidence of late thrombosis after late cessation of adenosine diphosphate inhibitors is increasingly surfacing in the literature. The goal this review is to provide the medical chemistry of most commonly used adenosine diphosphate inhibitors, examine the literature on the effect of adenosine diphosphate inhibitors in hemorrhagic-related complications after surgical intervention, and provide the ramifications and alternatives in modern clinical practice.
Export Options
About this article
Cite this article as:
Khoynezhad Ali, Movahed Reza Mohammad, Hashemzadeh Mehrnoosh, Emaminia Abbas and Jalali Ziba, Perioperative Management of Patients on Adenosine Diphosphate Inhibitors in the Era of Drug-Eluting Stents: Review of the Literature and Clinical Implications, Current Medicinal Chemistry 2009; 16 (5) . https://dx.doi.org/10.2174/092986709787458443
DOI https://dx.doi.org/10.2174/092986709787458443 |
Print ISSN 0929-8673 |
Publisher Name Bentham Science Publisher |
Online ISSN 1875-533X |
Call for Papers in Thematic Issues
Advances in Medicinal Chemistry: From Cancer to Chronic Diseases.
The broad spectrum of the issue will provide a comprehensive overview of emerging trends, novel therapeutic interventions, and translational insights that impact modern medicine. The primary focus will be diseases of global concern, including cancer, chronic pain, metabolic disorders, and autoimmune conditions, providing a broad overview of the advancements in ...read more
Approaches to the treatment of chronic inflammation
Chronic inflammation is a hallmark of numerous diseases, significantly impacting global health. Although chronic inflammation is a hot topic, not much has been written about approaches to its treatment. This thematic issue aims to showcase the latest advancements in chronic inflammation treatment and foster discussion on future directions in this ...read more
Cellular and Molecular Mechanisms of Non-Infectious Inflammatory Diseases: Focus on Clinical Implications
The Special Issue covers the results of the studies on cellular and molecular mechanisms of non-infectious inflammatory diseases, in particular, autoimmune rheumatic diseases, atherosclerotic cardiovascular disease and other age-related disorders such as type II diabetes, cancer, neurodegenerative disorders, etc. Review and research articles as well as methodology papers that summarize ...read more
Chalcogen-modified nucleic acid analogues
Chalcogen-modified nucleosides, nucleotides and oligonucleotides have been of great interest to scientific research for many years. The replacement of oxygen in the nucleobase, sugar or phosphate backbone by chalcogen atoms (sulfur, selenium, tellurium) gives these biomolecules unique properties resulting from their altered physical and chemical properties. The continuing interest in ...read more
- Author Guidelines
- Graphical Abstracts
- Fabricating and Stating False Information
- Research Misconduct
- Post Publication Discussions and Corrections
- Publishing Ethics and Rectitude
- Increase Visibility of Your Article
- Archiving Policies
- Peer Review Workflow
- Order Your Article Before Print
- Promote Your Article
- Manuscript Transfer Facility
- Editorial Policies
- Allegations from Whistleblowers
- Announcements
Related Articles
-
Disseminated Intravascular Coagulation in Leukemia and Sepsis
Vascular Disease Prevention (Discontinued) Diffuse Correlation Spectroscopy (DCS): A Diagnostic Tool for Assessing Tissue Blood Flow in Vascular-Related Diseases and Therapies
Current Medical Imaging Human Islet Transplantation: Current Status and Future Direction
Micro and Nanosystems Proteinase-Activated Receptor 2 (PAR2): A Challenging New Target for Treatment of Vascular Diseases
Current Pharmaceutical Design Structure-Function Relationships of Plasminogen Activator Inhibitor-1 and Its Potential as a Therapeutic Agent
Current Drug Targets The Role of Vasopressin in Affective Disorders: Possible Targets of Intervention
Central Nervous System Agents in Medicinal Chemistry Why Do Mothers Die? The Silent Tragedy of Maternal Mortality
Current Women`s Health Reviews Tissue Factor and Atherothrombosis
Current Pharmaceutical Design Cyclooxygenase-2 Inhibitors: A Painful Lesson
Cardiovascular & Hematological Disorders-Drug Targets Role of Vitamin D in Vascular Complications and Vascular Access Outcome in Patients with Chronic Kidney Disease
Current Medicinal Chemistry Dietary Antioxidants and Oxidative Stress from a Human and Plant Perspective: A Review
Current Nutrition & Food Science High Density Lipoprotein Cholesterol and Statin Trials
Current Medicinal Chemistry Pharmacological Applications of Antioxidants: Lights and Shadows
Current Drug Targets The Dialogue Between Endothelial Cells and Monocytes/Macrophages in Vascular Syndromes
Current Pharmaceutical Design Emerging Molecular Targets for Treatment of Erectile Dysfunction: Vascular and Regenerative Therapies on the Horizon
Current Drug Targets Micronutrient Biofortification in Rice through New Breeding Techniques (NBTs): Bangladesh Perspective
Current Nutraceuticals Nutrigenomics and Personalized Diet: What are the Anticipated Impacts for Research on Chronic Diseases and Public Health?
Current Pharmacogenomics and Personalized Medicine Breast Cancer Chemoprevention: Current Perspectives
Current Enzyme Inhibition Free Radicals in Diseases and Potential Role of Phytoconstituents-A Cause with Emerging Importance
Current Chemical Biology Phenylbutyric Acid: Simple Structure - Multiple Effects
Current Pharmaceutical Design