The article describes the mechanisms of action, pharmacokinetics, and pharmacodynamics of aspirin, dipyridamole, cilostazol, the thienopyridines, and the glycoprotein IIb/IIIa antagonists. The relationships among dose, efficacy, and safety are discussed along with a mechanistic overview of results of randomized clinical trials. The article does not provide specific management recommendations but highlights important practical aspects of antiplatelet therapy, including optimal dosing, the variable balance between benefits and risks when antiplatelet therapies are used alone or in combination with other antiplatelet drugs in different clinical settings, and the implications of persistently high platelet reactivity despite such treatment.From the Department of Medicine (Drs Eikelboom, Hirsh, Spencer, and Weitz), McMaster University; Population Health Research Institute (Drs Eikelboom and Hirsh); and Thrombosis and Atherosclerosis Research Institute (Drs Eikelboom, Hirsh, Spencer, and Weitz), Hamilton, ON, Canada; and Department of Haematology (Dr Baglin), Addenbrooke’s NHS Trust, Cambridge, England.
Correspondence to: John W. Eikelboom, MBBS, McMaster University, Hamilton General Site, 237 Barton St E, Hamilton, ON, L9K 1H8, Canada; e-mail: firstname.lastname@example.org
Author contributions: As Topic Editor, Dr Eikelboom oversaw the development of this article, including any analysis and subsequent development of the information contained herein.
Dr Eikelboom: contributed as Topic Editor.
Dr Hirsh: contributed as a panelist.
Dr Spencer: contributed as a panelist.
Dr Baglin: contributed as a panelist.
Dr Weitz: contributed as a panelist.
Financial/nonfinancial disclosures: In summary, the authors have reported to CHEST the following conflicts of interest: Dr Eikelboom has received consulting fees and/or honoraria from Astra-Zeneca, Bayer, Boehringer-Ingelheim, Bristol-Myers-Squibb, Corgenix, Daiichi-Sankyo, Eisai, Eli-Lilly, GlaxoSmithKline, Haemoscope, Johnson and Johnson, McNeil, Pfizer, Portola and Sanofi. He has received grants and/or in-kind support from Accumetrics, Astra-Zeneca, AspirinWorks, Bayer, Boehringer Ingelheim, Bristol-Myers-Squibb, Corgenix, Dade-Behring, GlaxoSmithKline, Johnson and Johnson, Portola and Sanofi. Dr Weitz has served as a consultant to Boehringer Ingelheim GmbH, Bristol-Myers Squibb; Pfizer Inc; Daiichi-Sankyo, Inc; Bayer Healthcare Pharmaceuticals, and Johnson & Johnson. Drs Hirsh, Spencer, and Baglin have reported that no potential conflicts of interest exist with any companies/organizations whose products or services may be discussed in this article.
Role of sponsors: The sponsors played no role in the development of these guidelines. Sponsoring organizations cannot recommend panelists or topics, nor are they allowed prepublication access to the manuscripts and recommendations. Guideline panel members, including the chair, and members of the Health & Science Policy Committee are blinded to the funding sources. Further details on the Conflict of Interest Policy are available online at http://chestnet.org.
Endorsements: This guideline is endorsed by the American Association for Clinical Chemistry, the American College of Clinical Pharmacy, the American Society of Health-System Pharmacists, the American Society of Hematology, and the International Society of Thrombosis and Hematosis.Funding/Support: The Antithrombotic Therapy and Prevention of Thrombosis, 9th ed: American College of Chest Physicians Evidence-Based Clinical Practice Guidelines received support from the National Heart, Lung, and Blood Institute [R13 HL104758] and Bayer Schering Pharma AG. Support in the form of educational grants was also provided by Bristol-Myers Squibb; Pfizer, Inc; Canyon Pharmaceuticals; and sanofi-aventis US.Disclaimer: American College of Chest Physician guidelines are intended for general information only, are not medical advice, and do not replace professional medical care and physician advice, which always should be sought for any medical condition. The complete disclaimer for this guideline can be accessed at http://chestjournal.chestpubs.org/content/141/2_suppl/1S.Reproduction of this article is prohibited without written permission from the American College of Chest Physicians (http://www.chestpubs.org/site/misc/reprints.xhtml).