BIOMEDICINE – CARDIOVASCULAR: Antiplatelet
ACTION: Inhibits platelet aggregation.
INDICATION: Unstable angina/non–ST-segment elevation MI. ST-segment elevation, MI, stroke, or established peripheral arterial disease.
OFF-LABEL: Graft patency (saphenous vein), stable coronary artery disease (in combination with aspirin). Initial treatment of acute coronary syndrome in patients allergic to aspirin.
SIDE EFFECTS:
Frequent: (15%) Skin disorders – rash, pruritus, bruising.
Occasional: (8%–6%) Upper respiratory tract infection, chest pain, flu-like symptoms, headache, dizziness, arthralgia.
Rare: (5%–3%) Fatigue, edema, hypertension, abdominal pain, dyspepsia, diarrhea, nausea, epistaxis, dyspnea, rhinitis.
PRECAUTIONS:
Contraindications: Active bleeding (e.g., peptic ulcer, intracranial hemorrhage).
Cautions: Severe hepatic/renal impairment, patients at risk of increased bleeding (e.g., trauma), concurrent use of anticoagulants. Avoid concurrent use of CYP2C19 inhibitors, omeprazole.
INTERACTIONS:
DRUG: Aspirin, NSAIDs, warfarin may increase risk of bleeding. Proton pump inhibitors (e.g., omeprazole) may de- crease efficacy, increase risk of cardiovascular events.
HERBAL: Cat’s claw, dong quai, evening primrose, feverfew, garlic, ginger, ginkgo, ginseng, green tea, red clover may have additive antiplatelet effects.
FOOD: Grapefruit products may decrease effects.
LAB VALUES: May increase serum bilirubin, ALT, AST, cholesterol, uric acid. May decrease neutrophil count, platelet count.
(Plavix)
TCM – Chapter 10a: Substances that Move the Blood
Enters: Ht, Lu, LV,
Temperature: warm
Taste: pungent
ACTION: move Blood, warm Blood, disperse Qi, vent rashes
INDICATIONS: Blood stasis d/t Blood cold, chest impediment disorders
Tongue: purple, dusky
Pulse: deep, constrained, knotted, wiry, tight
RATIONALE: Its warm temperature reduces blood viscosity that makes blood more fluid. Its pungent taste moves Blood. It outward motion opens Ht and vents out rushes. In patients with preexisting Liver Blood and Yin deficiency may cause Liver Yang Hyperactivity due to its Blood warming properties resulting in headache, hypertension and dizziness. Strong Qi dispersing properties may cause Qi deficiency resulting in dyspnea, fatigue , Flu-like symptoms and arthralgia.
CAUTION: in patients with preexisting Qi, Blood and Yin deficiency.
NOTE: excessive use may deplete Qi via it dispersing action and with prolonged use warm properties may damage Yin and Blood
MODIFICATIONS: To counteract Plavix Qi depleting properties add Huang Jing, Shan Yao, Tai Zi Shen. To protect Blood from damage without counteracting add E Jiao (nourish) and Bai Shao (subdue Liver Yang)