Table 2.
Medications and over-the-counter medicines that entail a risk of increased bleeding33
| Class; agent | Mechanism |
|---|---|
| Antiplatelet drugs | |
| Acetylsalicylic acid | Inhibition of COX-1 and COX-2/thrombin generation |
| Clopidogrel/ticlopidine | Inhibition of P2Y12 receptor on platelet surface |
| Dipyridamole | Blocks cellular uptake of adenosine with antiplatelet due to extracellular adenosine |
| NSAIDs | Block COX-1 and COX-2 |
| Unfractionated heparin | Thrombin inactivation via antithrombin III binding sites |
| Low-molecular-weight heparin (multiple products) | Thrombin inactivation via antithrombin III binding sites |
| Fondaparinux | Inhibition of thrombin generation |
| Direct thrombin inhibitors | |
| Argatroban | Reversible and direct inhibition of circulating and fibrin-bound thrombin |
| Bivalirudin | |
| Hirudin | |
| Lepirudin | |
| Ancrod (purified snake venom protein) | Defibrinogenation |
| Fibrinolytics | |
| Anistreplase | Convert plasminogen to plasmin (fibrinolytic)Alteplase |
| Reteplase | |
| Tenecteplase | |
| Steptokinase | |
| Urokinase | |
| Drotrecogin alfa | Vitamin K–dependent antithrombotic serine protease that directly inhibits factors Va and VIIIa |
| Glycoprotein IIb–IIIa inhibitors | |
| Abciximab | Inhibition of platelet aggregation by binding of soluble fibrinogen to platelet receptor glycoprotein IIb–IIIa |
| Eptifibatide | |
| Tirofiban | |
| Herbal medicines | |
| Anise | Potential for thrombocytopenia |
| Garlic | |
| Ginger | |
| Ginseng | |
| Ginkgo biloba | |
| Feverfew | |
| Herbal Plus | |
NSAID = nonsteroidal anti-inflammatory drug.