Monitor for bleeding.Īcetaminophen Aspirin Diphenhydramine: (Moderate) Avoid aspirin maintenance doses of more than 100 mg with concomitant ticagrelor. Additionally, both drugs are associated with bleeding. After the typical aspirin loading dose of 325 mg, use ticagrelor with an aspirin maintenance dose of 75 to 100 mg.
Maintenance doses of aspirin above 100 mg decreased ticagrelor effectiveness in a clinical trial. Monitor for bleeding.Īcetaminophen Aspirin: (Moderate) Avoid aspirin maintenance doses of more than 100 mg with concomitant ticagrelor. Ticagrelor is a P-gp substrate and abrocitinib is a P-gp inhibitor.Īcetaminophen Aspirin, ASA Caffeine: (Moderate) Avoid aspirin maintenance doses of more than 100 mg with concomitant ticagrelor. After 3 months of abrocitinib therapy, monitor for increased bleeding if coadministered with ticagrelor as concurrent use may also increase the exposure of ticagrelor. Platelet transfusion did not reverse the antiplatelet effect of ticagrelor in healthy volunteers and is not likely to be of benefit in patients with bleeding.Ībciximab: (Moderate) Concomitant use of platelet glycoprotein IIb/IIIa inhibitors (i.e., abciximab, eptifibatide, or tirofiban) with an ADP receptor antagonist (i.e., clopidogrel, prasugrel, ticagrelor, or ticlopidine) may be associated with an increased risk of bleeding.Ībrocitinib: (Contraindicated) Concurrent use with ticagrelor is contraindicated during the first 3 months of abrocitinib therapy due to an increased risk of bleeding with thrombocytopenia. Since there is an increased risk of subsequent cardiovascular events associated with discontinuation of ticagrelor, if possible, manage bleeding without stopping ticagrelor. Bleeding should be suspected in any patient who is hypotensive and has recently undergone coronary angiography, percutaneous coronary intervention (PCI), CABG, or other surgical procedures in the setting of ticagrelor. Do not start ticagrelor in patients planned to undergo urgent coronary artery bypass graft surgery (CABG).
In order to decrease the risk of bleeding, discontinue ticagrelor at least 5 days prior to any surgery, particularly in those with a high risk of bleeding, when possible ticagrelor may be resumed once hemostasis achieved. The risk of bleeding may be increased in older patients, patients with a history of bleeding disorders, performance of percutaneous invasive procedures, and concomitant use of medications that increase the risk of bleeding (e.g., anticoagulant and fibrinolytic therapy, higher doses of aspirin, and chronic nonsteroidal anti-inflammatory drugs ). Like other antiplatelet agents, ticagrelor can cause significant, sometimes fatal, bleeding. Patients with acute ischemic stroke or transient ischemic attacks (TIAs) and an NIH stroke scale score greater than 5, as well as, patients receiving thrombolysis were excluded from the THALES study thus, ticagrelor is not recommended in these patients. Ticagrelor is contraindicated in any patient with active pathological bleeding including peptic ulcer (GI bleeding) or intracranial bleeding. Bleeding, coronary artery bypass graft surgery (CABG), GI bleeding, intracranial bleeding, stroke, surgery
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