Pharmacologic Profile

General Use

To treat and prevent thromboembolic events such as stroke and MI.

General Action and Information

Contraindications

Hypersensitivity, ulcer disease, active bleeding, and recent surgery.

Precautions

Use cautiously in patients at risk for bleeding (trauma, surgery) or a history of GI bleeding or ulcer disease.

Interactions

Concurrent use with NSAIDs, heparin, thrombolytics, warfarin, dabigatran, rivaroxaban, apixaban, or edoxaban may ↑ the risk of bleeding. All proton pump inhibitors, except pantoprazole, may ↓ the antiplatelet effects of clopidogrel. Opioids may ↓ effectiveness of clopidogrel and ticagrelor.

Nursing Implications

Assessment

• Assess patient taking antiplatelet agents for signs/symptoms of stroke, peripheral arterial disease, or MI periodically throughout therapy.
• Monitor for signs/symptoms of bleeding (pallor of skin and conjunctiva, fatigue, weakness, easy bruising, nosebleeds, bleeding gums, hematuria), including GI bleeding (hematochezia, melena, coffee ground emesis).

Implementation

• Use an infusion pump with continuous infusions to ensure accurate dosage.

Patient/Family Teaching

• Instruct patient to notify health care provider immediately if any bleeding is noted.
• Inform patient that ticagrelor may cause shortness of breath, which usually resolves during therapy.

Evaluation/Desired Outcomes

• Prevention of stroke, MI, and vascular death in patients at risk.