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NBME 24 Answers

nbme24/Block 2/Question#5

A 55-year-old man is diagnosed with coronary artery ...

Decreased adherence

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submitted by lamhtu(38),

Platelet adherence and platelet aggregation are different things and this diferrence MATTERS A LOT. Fuck you, NBME. These differences supposedly matter on some questions and not on others. Where is the consistency? Hello?

Can someone please clarify the answer. Is decreased adherence same as decreased aggregation? Wouldn;t inhibition of the IIb/IIIa receptor prevent aggregation?

xxabi  I'm not completely sure...but I think its because its aspirin, and aspirin doesn't work on IIb/IIIa receptors. That's why i picked decreased adherence of platelets, figured that was the closest thing to decreased aggregation that still made sense with aspirin's mechanism of action. Hope that helps! +  
ihavenolife  Aspirin irreversibly inhibits COX which leads to decreased TXA2. TXA2 normally is a vasoconstrictor and induces platelet aggregation, so aspirin inhibits platelet aggregation by downplaying TXA2 not by interacting with IIb/IIIa receptor. (Source FA and UWorld) +6  
fallenistand  In this case, inhibition of COX-1 by aspirin will also reduce the amount of precursors for vascular prostacyclin synthesis, provided, for example, from adhering platelets https://www.ncbi.nlm.nih.gov/pubmed/9263351 +  
niboonsh  inhibition of IIb/IIIa receptor is the moa of a completely separate class of drugs - Glycoprotein IIb/IIIa (abciximab, eptifabide, tirofiban) +