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Discontinuing Anti-Platelet Medications – 6 Must Know Considerations

The decision to discontinue anti-platelet medications is a challenging one.  Antiplatelet therapy is something I see everyday in practice.  Aspirin and clopidogrel are the two most common medications I see utilized.  What’s often the greatest challenge with these agents?  For me, it’s assessing the risk versus benefit in patients who have had a significant bleeding event.  Here’s 5 really important considerations that I think about.

  1. The first question I like to think about is the indication for use.  Has this patient had 5 heart attacks?  If they have had multiple cardiac events and only one or two bleeding events, you might lean toward leaving it alone and monitoring.
  2. What does the patient want?  Are they concerned more so about bleed risk or a thrombosis type event?  This is certainly a strong consideration as the patient may want to make that determination for themselves.
  3. Type and severity of bleed. If the bleeding event was a GI bleed and we can use GI prophylaxis, we might be less likely to discontinue an antiplatelet medication. Compare that to a life changing intracranial bleed and we may come to a different conclusion.
  4. Life expectancy. In geriatrics and long term care especially, it is imperiative to think about the probable life expectancy as well as the goals of therapy. In patients who’ve had a bleeding event, a limited life expectancy might lead you down the path of discontinuing for good.
  5. What do the hemoglobin and platelet levels look like? Have they been dropping or do they remain constant despite use of an antiplatelet medication.
  6. Other medications. Is the patient on an anticoagulant as well?  Maybe they are on another NSAID for pain management that can impair platelet function?

What else would you think about?

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Written By Eric Christianson

March 8, 2017

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