Podcast 555:  Anticoagulation vs. Antiplatelet

<p><strong>Contributor: Don Stader, MD</strong></p> <p><strong>Educational Pearls:</strong></p> <ul> <li style="font-weight: 400;"><span style="font-weight: 400;">When do we give antiplatelet drugs or anti-coagulation drugs?</span></li> <li style="list-style: none; display: inline"> <ul> <li style="font-weight: 400;"><span style= "font-weight: 400;">Arterial issues get antiplatelet therapy</span></li> <li style="font-weight: 400;"><span style= "font-weight: 400;">Venous issues, or slow flow states, get anticoagulation therapy.</span></li> </ul> </li> <li style="font-weight: 400;"><span style="font-weight: 400;">High flow areas (arteries) are more prone to platelet clotting while the venous system is more prone to allowing blockages caused by coagulation factors.</span></li> <li style="font-weight: 400;"><span style="font-weight: 400;">The main side effect with antiplatelet and anticoagulants is bleeding. Typically antiplatelet drugs cause more bleeding issues because platelets are made in the bone marrow, while coagulation factors are made in the liver, so it takes longer for the bone marrow to replete platelets versus the liver which is a fast synthesizer of clotting factors.   </span></li> <li style="font-weight: 400;"><span style= "font-weight: 400;">Reversal of antiplatelet drugs can take a while, so patients on these drugs (ex. Plavix) may need a week of withholding the drug to get surgery, while anti-coagulation drugs (ex. Xarelto) can be stopped a day or two prior to surgery.</span></li> </ul> <p><span style= "font-size: 12pt;"><strong>References</strong></span></p> <p><span style="font-size: 10pt;"><a href= "https://www-ncbi-nlm-nih-gov.libproxy.tulane.edu/pmc/articles/PMC6329367/"> <span style="font-weight: 400;">1.</span></a> <span style= "font-weight: 400;">Altiok, E. Marx, N. Oral Anticoagulation: Update on Anticoagulation With Vitamin K Antagonists and Non–Vitamin K–Dependent Oral Anticoagulants. Dtsch Arztebl Int. 2018 Nov; 115(46): 776–783. Published online 2018 Nov 16. doi: 10.3238/arztebl.2018.07