Table 2 Antiplatelet agents: relevant... | American Society of Hematology

Table 2

Antiplatelet agents: relevant information for perioperative management of antiplatelet agents^6-9

Name	Mechanism of action	Time to maximum level	Elimination half-life	Notes
Aspirin	Irreversible inhibition of COX-1 and COX-2	30-40 min*	15-30 min	Antiplatelet effect appears within 1 h and persists for at least 4 d after stopping therapy
Clopidogrel	Irreversible inhibition of P2Y₁₂ ADP receptor	1 h for circulating drug; 3-7 d for maximal antiplatelet effect	8 h for circulating drug	More rapid inhibition of platelet function can be achieved with a loading dose; antiplatelet effect lasts up to 10 d
Ticlopidine	Irreversible inhibition of P2Y₁₂ ADP receptor	1-3 h	24-36 h (after one dose)	Antiplatelet effect lasts for the life span of the platelet (5-7 d)
Prasugrel	Irreversible inhibition of P2Y₁₂ ADP receptor	30 min	7 h	Antiplatelet effect lasts 5-7 d
Ticagrelor	Reversible inhibition of P2Y₁₂ ADP receptor	1.5 h	7 h	Residual antiplatelet effect decreased to 30% after ∼ 2.5 d
Cangrelor†	Reversible inhibition of P2Y₁₂ ADP receptor	Seconds with intravenous administration	2-5 min	Normal platelet function returns by 60 min after infusion is stopped

Name	Mechanism of action	Time to maximum level	Elimination half-life	Notes
Aspirin	Irreversible inhibition of COX-1 and COX-2	30-40 min*	15-30 min	Antiplatelet effect appears within 1 h and persists for at least 4 d after stopping therapy
Clopidogrel	Irreversible inhibition of P2Y₁₂ ADP receptor	1 h for circulating drug; 3-7 d for maximal antiplatelet effect	8 h for circulating drug	More rapid inhibition of platelet function can be achieved with a loading dose; antiplatelet effect lasts up to 10 d
Ticlopidine	Irreversible inhibition of P2Y₁₂ ADP receptor	1-3 h	24-36 h (after one dose)	Antiplatelet effect lasts for the life span of the platelet (5-7 d)
Prasugrel	Irreversible inhibition of P2Y₁₂ ADP receptor	30 min	7 h	Antiplatelet effect lasts 5-7 d
Ticagrelor	Reversible inhibition of P2Y₁₂ ADP receptor	1.5 h	7 h	Residual antiplatelet effect decreased to 30% after ∼ 2.5 d
Cangrelor†	Reversible inhibition of P2Y₁₂ ADP receptor	Seconds with intravenous administration	2-5 min	Normal platelet function returns by 60 min after infusion is stopped

COX indicates cyclooxygenase.

Peak plasma levels shown for nonenteric-coated aspirin; peak levers are delayed up to 3-4 h with enteric-coated aspirin.

Cangrelor currently is being studied in clinical trials and is not available for clinical use.