Complications of oral antiplatelet medications

One by-product of the flurry of large-scale clinical trials accompanying the emergence of drugs that inhibit platelet function is volumes of information chronicling the adverse effects of this class of medications. One aspect all antiplatelet drugs share is a propensity toward bleeding. Beyond that similarity, however, the different pharmacologic agents in this broad collection have few attributes in common. Aspirin, by virtue of its long history, has been studied most extensively, and has proven to be an exceptionally valuable therapy. However, the complicated adverse profile of this seemingly simple drug is commonly overlooked by practitioners and deserves clinical review. The thienopyridine class (including ticlopidine and clopidogrel) share certain peculiarities that continue to be clarified, including life-threatening thrombotic thrombocytopenia purpura. Dipyridamole is a veteran drug that is enjoying renewed attention as a prophylactic aid in preventing cerebrovascular events. One class, the oral platelet glycoprotein IIb/IIIa receptor inhibitors, has failed to find its way into clinical implementation due to an unfavorable balance between efficacy and adverse effect. This review summarizes the adverse profiles of each of these drug classes and draws on data gathered in large clinical studies.