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Semin Thromb Hemost 2012; 38(08): 865-883
DOI: 10.1055/s-0032-1328881
Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

Drugs that Affect Platelet Function[*]

Rüdiger E. Scharf
1   Department of Clinical and Experimental Hemostasis, Hemotherapy and Transfusion Medicine, Hemophilia Comprehensive Care Center, Heinrich Heine University Medical Center, and Biological Medical Research Center, Heinrich Heine University, Düsseldorf, Germany
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Publikationsdatum:
30. Oktober 2012 (online)

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Abstract

Drugs represent the most common cause of platelet dysfunction in our overmedicated society. While acetylsalicylic acid (aspirin), adenosine diphosphate receptor antagonists (clopidogrel and prasugrel), and integrin αIIbβ3 (GPIIb-IIIa) receptor blockers (abciximab, eptifibatide, and tirofiban) are well-known prototypes of antiplatelet drugs, other widely used agents such as nonsteroidal anti-inflammatory drugs, antibiotics, cardiovascular and lipid-lowering drugs, selective serotonin reuptake inhibitors, and volume expanders can also impair platelet function and thus cause or aggravate hemorrhages in certain clinical settings. Therefore, induction of a bleeding diathesis remains a significant concern. This is especially relevant in patients with preexisting hemostatic defects of any kind, which may remain compensated as long as platelet function (and/or coagulation) is not inhibited pharmacologically. Identification of individual patients with preexisting hemostatic defects remains crucial (1) to prevent otherwise unexpected bleeding complications, (2) to manage hemorrhagic symptoms adequately, (3) to minimize the risk from invasive procedures, and (4) to avoid unnecessary patient exposure to blood products. This article provides a review of the large variety of agents that have not been designed for antiplatelet therapy but nevertheless interfere with platelet reactivity or induce platelet inhibition. In particular, drug interactions and mechanisms by which these agents can trigger or cause platelet dysfunction are detailed.

Keywords

nonsteroidal anti-inflammatory drugs (NSAIDs) - antibiotics - cardiovascular and lipid-lowering drugs - psychotropic agents - drug interactions

* Dedicated to the memory of Professor E.F. Lüscher and Professor W. Schneider