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use recreational drugs (同)do drugs
administer a drug to; "They drugged the kidnapped tourist" (同)dose
a substance that is used as a medicine or narcotic

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『薬』,薬品,薬剤 / 『麻薬』,麻酔剤 / 〈人〉‘に'薬(特に麻酔剤)を与える / 〈飲食物〉‘に'(麻酔薬・毒薬などの)薬を混ぜる

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出典(authority):フリー百科事典『ウィキペディア（Wikipedia）』「2013/02/27 23:39:39」(JST)

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An antiplatelet drug (antiaggregant) is a member of a class of pharmaceuticals that decrease platelet aggregation ^[1] and inhibit thrombus formation. They are effective in the arterial circulation, where anticoagulants have little effect.^{[citation needed]}

They are widely used in primary and secondary prevention of thrombotic cerebrovascular or cardiovascular disease.

Choice of antiplatelet drug

A 2006 review ^[2] states: "...low-dose aspirin increases the risk of major bleeding 2-fold compared with placebo. However, the annual incidence of major bleeding due to low-dose aspirin is modest—only 1.3 patients per thousand higher than what is observed with placebo treatment. Treatment of approximately 800 patients with low-dose aspirin annually for cardiovascular prophylaxis will result in only 1 additional major bleeding episode."

Antiplatelet drugs

The class of antiplatelet drugs include:

Irreversible cyclooxygenase inhibitors
- Aspirin
Adenosine diphosphate (ADP) receptor inhibitors
- Clopidogrel (Plavix)
- Prasugrel (Effient)
- Ticagrelor (Brilinta)
- Ticlopidine (Ticlid)
Phosphodiesterase inhibitors
- Cilostazol (Pletal)
Glycoprotein IIB/IIIA inhibitors (intravenous use only)
- Abciximab (ReoPro)
- Eptifibatide (Integrilin)
- Tirofiban (Aggrastat)
Adenosine reuptake inhibitors
- Dipyridamole (Persantine)
Thromboxane inhibitors
- Thromboxane synthase inhibitors
- Thromboxane receptor antagonists
  - Terutroban

Usage

In dental implants procedures

Dental implant procedures can be safely performed in patients on long-term antiplatelet medication, with no interruption or alteration of their medication. Such patients do not have an increased risk of prolonged or excessive postoperative bleeding.^[3]

Prevention and treatment of arterial thrombosis

Treatment of established arterial thrombosis includes the use of antiplatelet drugs and thrombolytic therapy. Antiplatelet drugs alter the platelet activation at the site of vascular damage crucial to the development of arterial thrombosis.

Aspirin irreversibly inhibits the enzyme COX, resulting in reduced platelet production of TXA₂ (thromboxane - powerful vasoconstrictor that lowers cyclic AMP and initiates the platelet release reaction).
Dipyridamole inhibits platelet phosphodiesterase, causing an increase in cyclic AMP with potentiation of the action of PGI₂ – opposes actions of TXA₂
Clopidogrel affects the ADP-dependent activation of IIb/IIIa complex
Glycoprotein IIb/IIIa receptor antagonists block a receptor on the platelet for fibrinogen and von Willebrand factor. 3 classes:
- Murine-human chimeric antibodies (e.g., abciximab)
- Synthetic peptides (e.g., eptifibatide)
- Synthetic non-peptides (e.g., tirofiban)
Epoprostenol is a prostacyclin that is used to inhibit platelet aggregation during renal dialysis (with or without heparin) and is also used in primary pulmonary hypertension.

Thrombolytic therapy is used in myocardial infarction, cerebral infarction, and, on occasion, in massive pulmonary embolism. The main risk is bleeding. Treatment should not be given to patients having had recent bleeding, uncontrolled hypertension or a hemorrhagic stroke, or surgery or other invasive procedures within the previous 10 days.

Streptokinase forms a complex with plasminogen, resulting in a conformational change that activates other plasminogen molecules to form plasmin.
Plasminogen activators (PA), tissue-type plasminogen activators (alteplase, tenecteplase) are produced by recombinant technology.

Drug toxicity

Drug toxicity may be increased when multiple antiplatelet drugs are used. Gastrointestinal bleeding is a common adverse events seen in many patients.^[4]

References

^ "Antiplatelet agents" at Dorland's Medical Dictionary^{[dead link]}
^ The American Journal of Medicine, Volume 119, Issue 8 , Pages 624-638, August 2006: Systematic Review and Meta-analysis of Adverse Events of Low-dose Aspirin and Clopidogrel in Randomized Controlled Trials Retrieved 2013-02-08
^ Mihai Bogdan Bucur (Nov 2011). "Antiplatelet treatment implications in oral implantology" (in (Romanian)) (HTML). Rev. chir. oro-maxilo-fac. implantol. 2 (3): 6–9. ISSN 2069-3850. 39. http://www.revistaomf.ro/(39). Retrieved 2012-04-15.(webpage has a translation button)
^ Shehab, Nadine; Laurence S. Sperling, Scott R. Kegler, Daniel S. Budnitz (2010-11-22). "National Estimates of Emergency Department Visits for Hemorrhage-Related Adverse Events From Clopidogrel Plus Aspirin and From Warfarin". Arch Intern Med 170 (21): 1926–1933. doi:10.1001/archinternmed.2010.407. PMID 21098354. http://archinte.ama-assn.org/cgi/content/abstract/170/21/1926. Retrieved 2010-11-23.

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1. 非ST上昇型急性冠症候群における抗血小板薬 antiplatelet agents in acute non st elevation acute coronary syndromes
2. 脳卒中の二次予防のための抗血小板療法 antiplatelet therapy for secondary prevention of stroke
3. 冠動脈ステント留置術後の抗血小板療法 antiplatelet therapy after coronary artery stenting
4. ST上昇型心筋梗塞における抗血小板剤 antiplatelet agents in acute st elevation myocardial infarction
5. 心血管疾患の二次および一次予防におけるアスピリンの利益とリスク benefits and risks of aspirin in secondary and primary prevention of cardiovascular disease

English Journal

The impact of genetic polymorphisms of P2Y12, CYP3A5 and CYP2C19 on clopidogrel response variability in Iranian patients.

Namazi S, Kojuri J, Khalili A, Azarpira N.SourceDepartment of Pharmacotherapy, Faculty of Pharmacy, Shiraz University of Medical Sciences, Shiraz, Iran.
Biochemical pharmacology.Biochem Pharmacol.2012 Apr 1;83(7):903-8. Epub 2012 Jan 12.
Clopidogrel is an inhibitor of platelet ADP P2Y12 receptors and currently used for prevention of stent thrombosis. Despite certain clinical benefit using this drug in patients undergoing percutaneous coronary intervention (PCI), some patients do not attain adequate antiplatelet effects. In this stud
PMID 22265638

A phosphodiesterase 3 inhibitor, K-134, improves hindlimb skeletal muscle circulation in rat models of peripheral arterial disease.

Yoshida H, Itoh S, Hara T, Sasaki Y, Kondo S, Nakagawa T, Asanuma A, Tanabe S.SourceTokyo New Drug Research Laboratories, Kowa Company, Ltd., Tokyo, Japan.
Atherosclerosis.Atherosclerosis.2012 Mar;221(1):84-90. Epub 2012 Jan 5.
OBJECTIVE: Cilostazol is a phosphodiesterase (PDE)3 inhibitor used to treat peripheral arterial disease with intermittent claudication, as there is clinical evidence that it improves treadmill exercise capacity. However, details of the mechanism underlying this enhanced walking capacity remain to be
PMID 22269153

Japanese Journal

薬剤溶出ステントが留置された予定非心臓手術患者の周術期管理について

吉川範子,平川公美子,堀田有沙,中本あい,大平直子,立川茂樹
日本臨床麻酔学会誌 = The Journal of Japan Society for Clinical Anesthesia 31(4), 669-677, 2011-07-15
NAID 10029431403

Characteristics and Predictors of Drug-Eluting Stent Thrombosis : Results From the Multicenter 'Korea Stent Thrombosis (KoST)' Registry

PARK Kyung Woo,HWANG Seok-Jae,KWON Dong-A,OH Byung-Hee,PARK Young-Bae,CHAE In-Ho,GWON Hyeon-Cheol,PARK Seung-Jung,SEUNG Ki Bae,AHN Taehoon,YOON Jung-Han,JANG Yang-Soo,JEONG Myung-Ho,TAHK Seung-Jea,KIM Hyo-Soo
Circulation journal : official journal of the Japanese Circulation Society 75(7), 1626-1632, 2011-06-25
… Background: Previous studies have reported possible predictors of drug-eluting stent thrombosis (ST), but data for Asians are relatively limited. …
NAID 10029126486

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リンク元	「抗血小板薬」「血小板凝集阻害薬」「platelet aggregation inhibitor」「血小板凝集阻害剤」「platelet inhibitor」
関連記事	「drug」