Aspirin, Clopidogrel, and Abciximab

by Carlo Raj, MD

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    00:01 Aspirin, so we know that it irreversibly inhibits COX pathway both one and two, and so therefore without this, you don't have the thromboxane, guess what you'd lose? Platelet aggregation.

    00:16 Bleeding time is the only thing to be affected, and increase in, but no change in PT, PTT, why please? Why? Because we're only dealing with platelets.

    00:28 Is that clear? May I ask another important question? Will there be a decrease in platelet count if all that you do is inhibit thromboxane formation, of course not.

    00:39 The platelet count will be perfectly normal.

    00:42 Clinical use, antipyretics, so for example, patient has fever, analgesia, anti-inflammatory, and antiplatelet.

    00:50 Toxicity here, you're thinking about bleeding.

    00:53 Now, this is interesting.

    00:54 I need you to memorize this.

    00:56 In physiology and in a patient that unfortunately may be popping in too many aspirin pills, over the counter, popping these like crazy maybe because they're wishing to take care of a headache and unfortunately, the first thing that may happen for reasons that we're quite unsure of but please memorize that aspirin up in the respiratory center will stimulate it.

    01:22 Yes, stimulate it acutely.

    01:26 So one of the first things that you're going to find with aspirin toxicity if a patient is taking too many, it actually stimulates the respiratory center which means that the patient has hyperventilation.

    01:37 Now, what does that mean to you? On your labs, what are you looking for? An ABG has been done.

    01:42 An ABG, what are you going to find in terms of your carbon dioxide? Decrease in carbon dioxide. Welcome to respiratory alkalosis.

    01:53 Keep that in mind, very important.

    01:55 In addition, they're taking aspirin.

    01:58 Who is? A child.

    02:00 Maybe the child has, who's this patient? The child, eight years of age, fever, big time.

    02:07 Take a look at the tongue, it looks like a peel of a strawberry in a child.

    02:12 Fever, strawberry tongue.

    02:15 Take a look at the skin of this child.

    02:17 It looks like the skin is falling off.

    02:20 It's called a desquamating rash.

    02:22 Maybe you have lymphadenopathy.

    02:24 You put all this together, you should be thinking Kawasaki.

    02:26 But with Kawasaki, maybe this child has been taking aspirin.

    02:30 Right? It could be.

    02:31 Now, I know in clinical practice, we use IVIG granted.

    02:35 However, you might be given a situation where such a child is given aspirin.

    02:39 You think that child may ever, ever experience a viral infection? Influenza, maybe chicken pox, what have you, and the patient's taking aspirin.

    02:51 Now, for reasons that once again are unclear but yet we know is that in that child, a virus plus aspirin may result in death of the liver, highlight, it makes you pay attention to Reye's syndrome and it also has a side effect, Tinnitus.

    03:07 It may affect your vestibulocochlear nerve.

    03:10 Told you earlier whenever you see the letters GREL, G-R-E-L, what exactly are you doing? Good, you are then inhibiting your P2Y12 receptors.

    03:23 You see where it says irreversibly blocking ADP receptors? The name of those receptors are P2Y12 receptors.

    03:29 Once you inhibit those receptors and then, what are you doing? You're inhibiting the activation of the platelet.

    03:37 If you inhibit the activation of platelet, obviously, I am going to then inhibit aggregation.

    03:42 Welcome to Clopidogrel, Prasugrel, Ticagrelor, or Ticlopidine.

    03:48 Clinical use once again as an alternative for aspirin.

    03:52 So therefore, you're thinking about acute coronary syndrome once again.

    03:55 Let it be unstable angina, maybe coronary stenting, and increased incidence of recurrence of thrombotic stroke, a thrombotic stroke.

    04:04 Not embolic but thrombotic.

    04:05 In other words, maybe a thrombi formation in the middle cerebral artery.

    04:10 Those are clinical uses.

    04:11 The toxicity especially Ticlopidine, would be neutropenia.

    04:16 Look for a patient that has susceptibility to infection.

    04:19 Let's take a look at Abciximab here.

    04:22 Abciximab is going after what? A glycoprotein IIb/IIIa, picture that for me one more time.

    04:29 You have one IIb here and we have another IIb/IIIa here.

    04:34 And you have Dr. Roger's ugly face.

    04:36 My ugly face is fibrinogen.

    04:39 You'll never forget that.

    04:41 Welcome to Abciximab.

    04:43 Clinical use, as an alternative for aspirin would be acute coronary syndrome.

    04:47 It could be part of the regimen of percutaneous coronary angioplasty when you need to go in there and open up and balloon your coronary to make it easier.

    04:57 And then, toxicity here may be bleeding and thrombocytopenia.

    About the Lecture

    The lecture Aspirin, Clopidogrel, and Abciximab by Carlo Raj, MD is from the course Hemostasis: Basic Principles with Carlo Raj.

    Included Quiz Questions

    1. Cyclooxygenase 1 and cyclooxygenase 2
    2. Lipoprotein lipase
    3. NADPH oxidase
    4. Nitric oxide synthase
    5. Hydrolase
    1. Reye syndrome
    2. Excessive bleeding
    3. Stomach ulcers
    4. Hyperventilation
    5. Tinnitus
    1. Rare aspirin-associated syndrome of rapidly progressive encephalopathy with hepatic dysfunction in children
    2. Rare aspirin-associated syndrome of rapidly progressive encephalopathy with hepatic dysfunction in adults
    3. Common aspirin-associated syndrome of rapidly progressive encephalopathy with hepatic dysfunction in children
    4. Common aspirin-associated syndrome of rapidly progressive encephalopathy with hepatic dysfunction in adults
    5. Common aspirin-associated syndrome of rapidly progressive encephalopathy with hepatic dysfunction in both children and adults

    Author of lecture Aspirin, Clopidogrel, and Abciximab

     Carlo Raj, MD

    Carlo Raj, MD

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