Anticoagulant Use (Aspirin, Clopidogrel, Warfarin)
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- Aspirin: secondary prevention: treatment of transient transchemic attack (TIA) and ischemic stroke; prevent recurrent myocardial infarction (MI); reduce risk of MI or sudden death in unstable angina and chronic stable angina; after angioplasty, coronary artery bypass graft (CABG), carotid endarterectomy.
- Clopidogrel (Plavix): secondary prevention: acute coronary syndromes (unstable angina, non-ST elevation MI including those who are to be managed with coronary revascularization, ST elevation MI, after MI, stroke, established peripheral vascular disease.
- Warfarin: secondary indication: prophylaxis or treatment of thromboembolism in atrial fibrillation, mechanical heart valves; reduce risk of stroke or recurrent MI after MI; prophylaxis or treatment of venous thrombosis or thromboembolism in high-risk patients.
- Dabigatran (Pradaxa): primary and secondary prevention of stroke in non-valvular atrial fibrillation. FDA warning: do not use in patients with mechanical heart valves.
- Rivaroxaban (Xarelto): primary and secondary prevention of sroke in non-valvular atrial fibrillation; prevention of deep vein thrombosis (DVT) after hip and knee surgery; secondary prevention after DVT and pulmonary embolism.
- Apixaban (Eliquis): primary and secondary prevention of stroke in non-valvular atrial fibrillation.
NON-FDA APPROVED USES
- Aspirin: primary prevention of cardiovascular events in diabetes (see Routine Preventive Care).
- Clopidogrel (Plavix): primary prevention not established.
- Warfarin: primary prevention not established.
- Pradaxa, Rivaroxaban, Apixaban: primary prevention not established. Note FDA warnings re: mechanical heart valves.