Antiplatelet Therapy

The two most commonly used antiplatelet agents for children are aspirin and dipyridamole. Aspirin acetylates the enzyme cyclooxygenase and thereby interferes with the production of thromboxane A2 and platelet aggregation. Dipyridamole interferes with platelet function by increasing the cellular concentration of adenosine 3,5-monophosphate (cyclic AMP). This latter effect is mediated by inhibition of cyclic nucleotide phosphodiesterase and/or by blockade of uptake of adenosine, which acts at A2, receptors for adenosine to stimulate platelet adenylcyclase. Antiplatelet agents are used in the following conditions:

Cardiac disorders (mechanical prosthetic heart valves, Blalock-Taussig shunts, endovascular shunts) Cardiovascular events Kawasaki disease.

Dosage

Aspirin: 5-10 mg/kg/day Dipyridamole (3-5 mg/kg/day).

Table 11-35. Effect of Drugs on Warfarin Response

Medications that potentiate the effect of warfarin

Acetaminophen Acetohexamide Allopurinol

Androgenic and anabolic steroids a-Methyldopa

Antibiotics that disrupt intestinal flora (tetracyclines, streptomycin erythromycin, kanamycin, nalidixic acid, neomycin) Cephaloridine Chloramphenicol Chlorpromazine Chlorpropamide Chloral hydrate Cimetidine Clofibrate Diazoxide Disulfiram Ethacrynic acid Glucagon

Guanethidine indomethacin

Isoniazid

Mefenamic acid

Methimazole

Methotrexate

Methylphenidate

Nalidixic acid

Nortriptyline

Oxyphenbutazone p-Aminosalicyclic acid

Paromomycin

Phenylbutazone

Phenytoin

Phenyramidol

Propylthiouracil

Quinidine

Salicylate

Sulfinpyrazone

Sulfonamides

Thyroid hormone

Tolbutamide

Medications that reduce the effect of warfarin

Antipyrine

Barbiturates

Carbamazepine

Chlorthalidone

Cholestyramine

Digitalis

Ethanol

Ethchlorvynol

Glutethimide

Griseofulvin

Haloperidol

Oral contraceptives

Phenobarbital

Prednisone

All vitamin preparations containing vitamin K

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