Other Antithrombotics: Antiplatelets and Fibrinolytics

Antithrombotic agents such as antiplatelets and fibrinolytics play a significant role in the care of patients with neurovascular diseases. As with all antithrombotic agents, bleeding complications are a potential risk with both drug classes and are dependent on several factors (e.g., the specific drug, pharmacokinetic/ pharmacodynamic parameters, organ dysfunction, synergism, and patient-specific risk factors). Several oral and intravenous antiplatelet drug classes exist for both acute and chronic management of patients with neurovascular diseases. These agents may be used alone or in combination with other agents. In the setting of acute ischemic stroke, they are usually initiated after the use of fibrinolytic agents. While there are various monitoring tools for assessing the safety and efficacy of antiplatelets and fibrinolytics, widespread, quantitative standards are not as prevalent as with anticoagulants. In this chapter, we will discuss the nuances between specific agents within these drug classes and current monitoring techniques.