Dry Needling and Antithrombotic Drugs

Table 1

Summary of antithrombotic drugs characteristics.

Type of drug		Generic names	Brand names	Observations	Mechanism of action
Antiplatelets	Nonselective inhibitor of COX [23]	Aspirin	Ascriptin,; Ecotrin, Ecpirin	Causes gastrointestinal irritation and bleeding that can be reduced by the intake of a proton pump inhibitor (e.g., omeprazol) [17]	Nonselective inhibitor of COX [23]
	P2Y12 receptor blockers	Clopidogrel	Plavix	High interindividual variability, delayed onset of action, and bleeding episodes in certain cases [17]	Irreversible inhibitors of P2Y12 receptors in platelets [24, 25]
		Prasugrel	Effient	Faster onset of action, less interindividual variability but higher risk of bleeding vs. clopidogrel [25, 26]
		Ticagrelor	Brilinta	More benefits vs. clopidogrel and prasugrel [27]	Reversible inhibitor of P2Y12 receptors [27]
Anticoagulants	VKAs	Warfarin	Coumadin, Jantoven	Used for decades for patients that need long-term oral anticoagulation [28]; Slow onset of action, narrow therapeutic window, genetically determined inter- and intrapatient variability, and multiple possible interactions with various foods and drugs [19]	Indirect mechanism of action by inhibiting the synthesis of coagulation factors [29]
		Acenocoumarol	Sinthrome, Sintrom
		Phenprocoumon	Falithrom,; Marcoumar
	DOACs	Rivaroxaban	Xarelto	Faster onset and offset of action vs. VKAs [28], lower bleeding risk vs. warfarin in younger patients but not in those >75 years [30]; Much more expensive vs. VKAs, but lower resource consumption vs. cost of VKAs and the required therapeutic monitoring [19]; Betrixaban is not indicated for treatment. It is used as a prophylactic agent for prevention of deep vein thrombosis and pulmonary embolism in adults hospitalized for an acute medical illness [21]	Direct inhibition of factor Xa [28]
		Apixaban	Eliquis
		Dabigatran	Pradaxa, Pradax
		Edoxaban	Savaysa, Lixiana
		Betrixaban	Bevyxxa

Abbreviations: COX: cyclooxygenase enzyme; VKAs: vitamin K antagonists; DOACs: direct oral anticoagulants. There are many other brand names for some of the medications.