Antiplatelet and Anticoagulation Therapy

With the increase in longevity and improvement in the treatment of cardiovascular diseases, a sizable proportion of Americans are on either an antiplatelet agent or full anticoagulation. These are commonly known as blood thinners. In the next two columns, I’ll talk about the most commonly used blood thinners.

Common indications for requiring antiplatelet agents are coronary artery disease, placement of stents in the heart or lower extremities, lower extremity bypass procedure, prevention of heart attack in high-risk individuals and peripheral arterial disease.

Most commonly used anti-platelet agents are the following. 

1. Aspirin 81 mg — also known as baby aspirin

2. Clopidogrel 75 mg daily — also known as Plavix 

3. Ticagrelor 60 to 90 mg twice a day — also known as Brilinta

4. Prasugrel — also known as Effient

Most of these antiplatelet agents or blood thinners will require a loading dose. This means that if you have never taken these medications before or in the past 30 days, the doctor may prescribe a very high dose like 300 mg or 600 mg the first time.


The antiplatelet agents help the circulation by preventing the formation of plaque in the blood vessels that may help keep them open or prevent stents from closing. Plaque is a hard material that builds up inside blood vessels much like our kitchen sink slowly clogging up over time. This may be related to age, high blood pressure, high levels of cholesterol in your diet, obesity, lack of exercise, smoking or genetic factors.
Risks of being on blood thinners are mainly increased tendency to bleed and taking longer for blood to clot with minor or major injuries. This has a significant impact if you are undergoing any surgical procedure or even a dental extraction, and you may need to stop the antiplatelet agent five to 10 days before any procedures. Be sure to check with the doctor who prescribed the antiplatelet agent (primary care doctor, cardiologist or vascular surgeon) before stopping the antiplatelet agent for any reason that it is safe to do so. Your doctor may sometimes prescribe you to be on a combination of antiplatelet agents, which significantly increases your bleeding risk. Be sure to check with your doctor that you definitely need to be on two kinds of antiplatelet agent at the same time.

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