1. What It Is

Triflusal is an antiplatelet medication primarily used for the prevention of thromboembolic events, such as stroke or heart attacks. It belongs to the class of drugs known as nonsteroidal anti-inflammatory drugs (NSAIDs) but specifically works by inhibiting platelet aggregation, making it a potent alternative to other antiplatelet agents like aspirin. Developed in Spain, triflusal is commonly used in European and Latin American countries, but it has yet to gain widespread use in the United States.

2. Dosage Forms and Strengths

Triflusal is generally available in the following dosage forms and strengths:

• Capsules: 300 mg
• Tablets: 600 mg

The medication is designed for oral administration and should be taken as directed by a healthcare professional.

3. Brand and Generic Names

• Generic Name: Triflusal
• Brand Names: Disgren, Grendis, Aflen, among others.

These brand names vary based on the country and manufacturer. Regardless of the brand name, triflusal works similarly across different formulations.

4. Indications for Use

Triflusal is primarily indicated for:

• Secondary prevention of ischemic stroke: For patients who have already had a stroke or transient ischemic attack (TIA) to prevent recurrence.
• Prevention of myocardial infarction: In patients who have experienced unstable angina or a heart attack.
• Other cardiovascular events: It is also used in preventing clot formation in high-risk patients.

Triflusal serves as an alternative for patients who may not tolerate aspirin well due to gastrointestinal side effects or those with increased risk of bleeding.

5. Mechanism of Action

Triflusal works by inhibiting cyclooxygenase (COX) enzymes, particularly COX-1, which is responsible for converting arachidonic acid to thromboxane A2 in platelets. Thromboxane A2 is a potent inducer of platelet aggregation, leading to clot formation. By inhibiting this pathway, triflusal reduces the ability of platelets to clump together, thereby preventing the formation of harmful blood clots in arteries. Unlike aspirin, which irreversibly inhibits COX-1, triflusal has a reversible and selective effect, which may offer an improved safety profile concerning gastrointestinal bleeding risks.

Additionally, triflusal has been shown to increase nitric oxide (NO) production, further enhancing its antithrombotic properties.

6. Administration and Dosage

• Administration: Triflusal is taken orally, usually once daily, with or without food. It is important to adhere to the prescribed dosage and not discontinue use abruptly unless advised by a healthcare provider.

• Dosage: The typical dosage for triflusal is:

  • 300 mg to 600 mg daily, depending on the indication and the patient's response. A common starting dose is 600 mg once daily for stroke prevention.

• Missed Dose: If a dose is missed, it should be taken as soon as remembered, unless it is almost time for the next dose. In that case, the missed dose should be skipped.

7. Effects and Precautions

Side Effects

Common side effects of triflusal include:

• Gastrointestinal distress: Nausea, vomiting, dyspepsia, and diarrhea are the most frequently reported issues.
• Headache and dizziness: These may occur in some individuals.
• Hematologic: Mild bruising or bleeding may occur due to the drug's antiplatelet effects.

Serious side effects include:

• Bleeding: Though less likely than with aspirin, triflusal can still increase the risk of bleeding, including gastrointestinal bleeding or intracranial hemorrhage in rare cases.
• Hypersensitivity reactions: Allergic reactions, though rare, may include rash, hives, or difficulty breathing.
• Liver function abnormalities: Elevated liver enzymes have been noted in some patients.

Precautions

• Pregnancy and Breastfeeding: Triflusal is generally not recommended for pregnant women, particularly in the third trimester, due to the risk of bleeding complications. Breastfeeding mothers should consult a healthcare provider before use.
• Kidney and Liver Impairment: Patients with renal or hepatic impairment should use triflusal with caution, as it is metabolized in the liver and excreted via the kidneys.
• Concurrent Use with Other Antithrombotics: Combining triflusal with other blood thinners, like warfarin or direct oral anticoagulants, should be done cautiously due to the elevated risk of bleeding.

Patients should avoid alcohol or other NSAIDs while taking triflusal to reduce the risk of gastrointestinal side effects.

8. Conclusion

Triflusal is a valuable antiplatelet agent offering an alternative to aspirin for the prevention of thromboembolic events such as stroke and heart attacks. With a mechanism of action that inhibits platelet aggregation and increases nitric oxide production, triflusal is effective in reducing clot formation while offering a potentially lower risk of gastrointestinal bleeding. Available in capsule and tablet forms, it is typically administered at 300–600 mg daily, depending on the patient's needs.

Despite its benefits, triflusal is associated with some side effects, primarily gastrointestinal distress and bleeding risks. As such, it is important to use triflusal under proper medical guidance, particularly in patients with pre-existing conditions or those on other anticoagulant medications.

Overall, triflusal represents a useful tool in cardiovascular disease management, especially for individuals who cannot tolerate aspirin or need a more targeted antiplatelet therapy.