Table 1.

Antiplatelet agents, mechanism of action and response to agonists used in platelet function testing (19,64–67)

Drug (Type)	Action	Mean Platelet Inhibition (Time Required)	Response to Collagen/AA	Response to ADP	Dosing in CKD and ESRD (68)
Aspirin (NSAIDs)	Inhibits COX-1	<30 min	Inhibits	None	Use with caution eGFR <10 ml/min per 1.73 m2
Clopidogrel (Thienopyridine)	Inhibits P2Y12 receptor	<1 h with loading dose of 300 mg; 2–3 d for daily dose of 75 mg	No	Inhibits	No dose adjustment required
Prasugrel (Thienopyridine)	Inhibits P2Y12 receptor	2–4 h	No	Inhibits	No dose adjustment required; no data in ESRD available
Ticagrelor (ATP analog)	Inhibits P2Y12 receptor	2–4 h	No	Inhibits	No dose adjustment required; no data in ESRD available
Dipyridamole (PDE inhibitor)	Increases platelet cAMP	Variable	Variable	Inhibits in whole blood not in platelet-rich plasma	No dose adjustment required
Cilostazol (PDE inhibitor)	Increases platelet cAMP	Variable	Inhibits	Inhibits	No dose adjustment required; caution advised for creatinine clearance <25 ml/min

NSAIDs, nonsteroidal anti-inflammatory agents; COX-1, cycloxygenase-1; eGFR, estimated GFR; PDE, phosphodiesterase; cAMP, cyclic AMP.