Antiplatelets (Arterial / “White Clots”)
- Patho: High-shear stress arteries. Endothelial injury → platelet aggregation.
- Key Drugs: ASA, P2Y12 inhibitors (Clopidogrel, Ticagrelor).
- Indications:
- CAD & ACS: Stable angina, STEMI, NSTEMI, UA.
- Post-PCI: DAPT (ASA + P2Y12i) to prevent stent thrombosis.
- Cerebrovascular: Atherothrombotic CVA/TIA.
- Peripheral: Chronic PAD (symptomatic claudication).
Anticoagulants (Venous & Stasis / “Red Clots”)
- Patho: Low-shear stress veins/stagnant chambers. Stasis → coagulation cascade activation.
- Key Drugs: UFH, LMWH (Enoxaparin), Warfarin, DOACs (Apixaban).
- Indications:
- VTE: DVT/PE treatment and prophylaxis.
- AFib/AFlutter: Prevent cardioembolic CVA.
- Mechanical Valves: Warfarin ONLY (DOACs contraindicated).
- Intracardiac Thrombus: e.g., LV mural thrombus post-MI.
High-Yield Step 2 Distinctions
- CVA: Non-cardioembolic (atherosclerosis) → Antiplatelets. Cardioembolic (AFib) → Anticoagulants.
- Lower Extremity: Chronic PAD → Antiplatelets. Acute Limb Ischemia (ALI) → IV Heparin (prevent clot propagation).
- ACS Initial: Acute presentation gets BOTH (ASA + P2Y12i + Heparin/Enoxaparin). Discharge regimen focuses on antiplatelets.