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Medical Author:

Daniel Lee Kulick, MD, FACC, FSCAI

Daniel Lee Kulick, MD, FACC, FSCAI

Dr. Kulick received his undergraduate and medical degrees from the University of Southern California, School of Medicine. He performed his residency in internal medicine at the Harbor-University of California Los Angeles Medical Center and a fellowship in the section of cardiology at the Los Angeles County-University of Southern California Medical Center. He is board certified in Internal Medicine and Cardiology.

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Medical Editor:

Jay W. Marks, MD

Jay W. Marks, MD

Jay W. Marks, MD, is a board-certified internist and gastroenterologist. He graduated from Yale University School of Medicine and trained in internal medicine and gastroenterology at UCLA/Cedars-Sinai Medical Center in Los Angeles.

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In this Article

• What is a heart attack?
• How is a heart attack treated?
• Antiplatelet agents
• Aspirin
• Thienopyridines
• Glycoprotein IIb/IIIa inhibitors
• Anticoagulants
• Clot-dissolving drugs
• Coronary angiography and percutaneous transluminal coronary angioplasty (PTCA)
• Coronary artery stents
• Nitrates
• Angiotensin converting enzyme (ACE) inhibitors
• Beta blockers
• Oxygen
• Coronary artery bypass
• What can a patient expect during recovery from a heart attack?
• How can a second heart attack be prevented?
• Find a local Cardiologist in your town
• Heart Attack Treatment Index

Thienopyridines such as ticlopidine (Ticlid), clopidogrel (Plavix), and prasugrel (Effient), inhibit the ADP receptor on the surface of platelets. Inhibiting the ADP receptors on the platelets prevent the platelets from aggregating and causing blood clots to form. The theinopyridines are more potent antiplatelet agents than aspirin. Clopidogrel (Plavix) and prasugrel (Effient) are used far more commonly than ticlopidine (Ticlid) because ticlopidine can, in rare instances, cause low platelet and/or white blood cell counts. These agents play an important role in the treatment of heart attacks and are used in the following situations:

• Clopidogrel or prasugrel is used instead of aspirin in patients who have an allergy to aspirin.
• Clopidogrel or prasugrel are often given together with aspirin in treating heart attacks. Studies have shown that the combination of aspirin and clopidogrel is more effective than aspirin alone in improving survival and limiting damage to heart muscle among patients with heart attacks.
• Clopidogrel or prasugrel is given together with aspirin to patients undergoing PTCA with or without coronary stenting (see later discussion). Studies have shown that the combination of aspirin and clopidogrel is more effective than aspirin alone in preventing formation of blood clots that can re-occlude the coronary artery unblocked by PTCA and in preventing blood clots within recently placed stents.
• After a heart attack or after PTCA, aspirin is given indefinitely. The optimal duration of clopidogrel has not been established, and duration of use by physicians varies from weeks to months.

Patients who receive the combination of clopidogrel and aspirin are more likely than patients who receive aspirin alone to develop complications of major bleeding following coronary artery bypass surgery. Therefore, ideally, clopidogrel should be stopped 3 to 7 days before surgery.