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antiplatelete therapy

L Yang, S S Diao, Y P Ding, S J Huang, T Sun, Y Lu, Q Fang, X Y Cai, Y Kong, Z Xu
Objective: To assess outcome, safety and possible mechanism of loading dose clopidogrel in patients with transient ischemic attack (TIA) and minor stroke. Methods: We reviewed patients with confirmed TIA and minor stroke admitted between July 2016 and December 2017 into the First Affiliated Hospital of Soochow University. Loss-of-function allele carriers of CYP2C19 were included and randomly divided into loading dose group (first dose of 300 mg clopidogrel) and standard dose group (first dose of 75 mg clopidogrel), 100 mg aspirin was gave at the same time, followed by aspirin 100 mg/d plus clopidogrel 75 mg/d maintaining for 20 days...
January 29, 2019: Zhonghua Yi Xue za Zhi [Chinese medical journal]
Cheng-Yang Hsieh, Cheng-Han Lee, Sheng-Feng Sung
BACKGROUND AND AIMS: Stroke occurrence while on antiplatelet therapy, i.e., a breakthrough stroke, is often conveniently attributed to antiplatelet resistance. However, undetected paroxysmal atrial fibrillation (AF) may underlie breakthrough strokes. We hypothesized that a breakthrough stroke may be a clinical marker for patients at risk of having AF detected after stroke (AFDAS). METHODS: Consecutive patients without known AF hospitalized for ischemic stroke between 2000 and 2013 were identified from nationwide claims data...
January 24, 2019: Atherosclerosis
Ben Li, Konrad Salata, Charles de Mestral, Mohamad A Hussain, Badr A Aljabri, Thomas F Lindsay, Subodh Verma, Mohammed Al-Omran
BACKGROUND: Vascular surgeons have a central role in managing peripheral artery disease (PAD). This study assessed their knowledge, attitudes, and behaviours regarding pharmacologic risk reduction in PAD and results were compared to a similar 2004 survey conducted by our group. METHODS: An online questionnaire was administered to 161 active members of the Canadian Society for Vascular Surgery. RESULTS: Forty-eight participants (30%) completed the survey...
February 13, 2019: Annals of Vascular Surgery
Stefan H Hohnloser, Edin Basic, Michael Nabauer
BACKGROUND: Underuse of oral anticoagulation (OAC) for stroke prevention in atrial fibrillation (AF) results in thousands of preventable strokes in Germany each year. This study aimed to assess changes in antithrombotic therapy in AF patients after increased use of direct oral anticoagulants (DOACs) in Germany and to evaluate whether the adoption of DOAC therapy was associated with changes in AF-related stroke and bleeding over time. METHODS: Analyses were carried out on a large claims-based dataset of 4 million health-insured Germans...
February 15, 2019: Clinical Research in Cardiology: Official Journal of the German Cardiac Society
Xiaoning He, Yumei Wang, Hongliang Cong, Chengzhi Lu, Jing Wu
PURPOSE: This study was conducted to examine the use of optimal medical therapy (OMT), consisting of an antiplatelet, a β-blocker, an angiotensin-converting enzyme inhibitor/angiotensin receptor blocker (ACEI/ARB), and a statin combined, after hospital discharge and its relationship with direct medical costs in patients with acute coronary syndromes (ACS) in Tianjin, China. METHODS: Data were obtained from the Tianjin Urban Employee Basic Medical Insurance database (2011-2015)...
February 12, 2019: Clinical Therapeutics
Sung-Jin Hong, Min-Ji Kim, Jung-Sun Kim, Eun Hwa Kim, Jinae Lee, Chul-Min Ahn, Byeong-Keuk Kim, Young-Guk Ko, Donghoon Choi, Myeong-Ki Hong, Yangsoo Jang
We investigated the association of perioperative antiplatelet therapy (APT) and outcomes in patients with drug-eluting stent (DES) placement for noncardiac surgery (NCS). In consecutive 23,358 patients who underwent percutaneous coronary interventions between 2005 and 2016, total of 2,179 patients that required 2,179 elective NCS after DES placement were retrospectively analyzed. A net adverse clinical event (NACE), composite of death, myocardial infarction, stent thrombosis, and major bleeding, was assessed at 30 days...
February 7, 2019: American Journal of Cardiology
Choongki Kim, Dong-Ho Shin, Sung-Jin Hong, Chul-Min Ahn, Jung-Sun Kim, Byeong-Keuk Kim, Young-Guk Ko, Donghoon Choi, Myeong-Ki Hong, Juhee Park, Hyeyeong Lee, Dong-Sook Kim, Sang-Kwon Oh, Yangsoo Jang
BACKGROUND: Ticagrelor has been widely accepted in clinical practice for treatment of acute myocardial infarction (AMI), however its clinical safety and efficacy have not been revealed sufficiently in Asian populations. METHODS AND RESULTS: Among a total 20,270 patients (age <75 years) with AMI undergoing percutaneous coronary intervention who received dual antiplatelet therapy for at least 30 days, clinical outcomes at 1 year were assessed from the database of Health Insurance Review and Assessment Service in Korea between 2013 and 2014...
March 2019: Journal of Cardiology
F Cagnazzo, N Limbucci, S Nappini, L Renieri, A Rosi, A Laiso, D Tiziano di Carlo, P Perrini, S Mangiafico
BACKGROUND: Flow diversion for anterior communicating artery aneurysms required further investigation. PURPOSE: Our aim was to analyze outcomes after treatment of anterior communicating artery aneurysms with flow-diverter stents. DATA SOURCES: A systematic search of 3 data bases was performed for studies published from 2008 to 2018. STUDY SELECTION: According to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines, we included studies reporting anterior communicating artery aneurysms treated with flow diversion...
February 14, 2019: AJNR. American Journal of Neuroradiology
Mukesh Dube, Raunak Dani, Ayush Dubey, Dinesh Chouksey
BACKGROUND: In the list of named numerical neuro-ophthalmological syndromes, such as one-and-a-half syndrome and others, we report for the first time twenty-and-a-half syndrome, which is characterized by one-and-a-half syndrome with bilateral seventh and right fifth nerve palsy (1.5 + 7 + 7 + 5 = 20.5) in a patient with ischemic stroke. CASE PRESENTATION: A 45-year-old Asian Hindu woman presented with vomiting and imbalance of 1 day's duration. She had left-sided ataxic hemiparesis with one-and-a-half syndrome with bilateral seventh and right fifth nerve palsy...
February 15, 2019: Journal of Medical Case Reports
Adnan K Chhatriwalla, Carole Decker, Elizabeth Gialde, Delwyn Catley, Kathy Goggin, Katie Jaschke, Philip Jones, Dave deBronkart, Tony Sun, John A Spertus
Background Drug-eluting stents reduce the risk of restenosis in patients undergoing percutaneous coronary intervention, but their use necessitates prolonged dual antiplatelet therapy, which increases costs and bleeding risk, and which may delay elective surgeries. While >80% of patients in the United States receive drug-eluting stents, less than a third report that their physicians discussed options with them. Methods and Results An individualized shared decision-making (SDM) tool for stent selection was designed and implemented at 2 US hospitals...
February 2019: Circulation. Cardiovascular Quality and Outcomes
Sung-Min Cho, Nader Moazami, Stuart Katz, Randall Starling, Jennifer A Frontera
BACKGROUND: Little data exists regarding reversal and resumption of antithrombotics following left ventricular assist device (LVAD)-associated intracranial hemorrhage (ICH). METHODS: Prospectively collected data of LVAD patients with ICH was reviewed. Coagulopathy reversal agents, antithrombotic regimens and thrombotic (venous thromboembolism, ischemic stroke, myocardial infarction) and hemorrhagic (recurrent ICH, gastrointestinal bleed, anemia requiring transfusion) complications were recorded...
February 11, 2019: Annals of Thoracic Surgery
Guy Witberg, Ygal Plakht, Tamir Bental, Becca S Feldman, Maya Leventer-Roberts, Amos Levi, Hagit Gabay, Ran Balicer, Yariv Gerber, Ran Kornowski
BACKGROUND: Decisions on dual antiplatelet therapy (DAPT) duration should balance the opposing risks of ischaemia and bleeding. Our aim was to develop a risk score to identify stable coronary artery disease (SCAD) patients undergoing PCI who would benefit or suffer from extending DAPT beyond 6 months. METHODS: Retrospective analysis of a cohort of patients who completed 6 months of DAPT following PCI. Predictors of ischaemic and bleeding events for the 6-12 month period post-PCI were identified and a risk score was developed to estimate the likelihood of benefiting from extending DAPT beyond 6 months...
2019: PloS One
Lorene Zerah, René-Sosata Bun, Sylvie Guillo, Jean-Philippe Collet, Dominique Bonnet-Zamponi, Florence Tubach
BACKGROUND: Oral antithrombotic (AT) drugs, which include antiplatelet and anticoagulant therapies, are widely implicated in serious preventable bleeding events. Avoiding inappropriate oral AT combinations is a major concern. Numerous practical guidelines have been released; a document to enhance prescriptions of oral AT combinations for adults would be of great help. OBJECTIVE: To synthesize guidelines on the prescription of oral AT combinations in adults and to create a prescription support-tool for clinicians about chronic management (≥ one month) of oral AT combinations...
2019: PloS One
Sukhi Singh, Tor Damén, Mikael Dellborg, Anders Jeppsson, Andreas Nygren
BACKGROUND: New approaches to prevent bleeding complications during cardiac surgery are needed. OBJECTIVE: To investigate if noradrenaline (NA) enhances platelet aggregation in CABG patients. PATIENTS/METHODS: Twenty-four CABG patients were included in a prospective parallel-group randomized study. All patients but one, were treated with acetylsalicylic acid (ASA). In the treatment group (n=12), mean arterial blood pressure (MAP) was maintained at pre-induction levels by NA infusion...
February 14, 2019: Journal of Thrombosis and Haemostasis: JTH
Graham C Wong, Michelle Welsford, Craig Ainsworth, Wael Abuzeid, Christopher B Fordyce, Jennifer Greene, Thao Huynh, Laurie Lambert, Michel Le May, Sohrab Lutchmedial, Shamir R Mehta, Madhu Natarajan, Colleen M Norris, Christopher B Overgaard, Michele Perry Arnesen, Ata Quraishi, Jean François Tanguay, Mouheiddin Traboulsi, Sean van Diepen, Robert Welsh, David A Wood, Warren J Cantor
Rapid reperfusion of the infarct-related artery is the cornerstone of therapy for the management of acute ST-elevation myocardial infarction (STEMI). Canada's geography presents unique challenges for timely delivery of reperfusion therapy for STEMI patients. The Canadian Cardiovascular Society/Canadian Association of Interventional Cardiology STEMI guideline was developed to provide advice regarding the optimal acute management of STEMI patients irrespective of where they are initially identified: in the field, at a non-percutaneous coronary intervention-capable centre or at a percutaneous coronary intervention-capable centre...
February 2019: Canadian Journal of Cardiology
Arjun Majithia, Deepak L Bhatt
Antiplatelet therapies are an essential tool to reduce the risk of developing clinically apparent atherothrombotic disease and are a mainstay in the therapy of patients who have established cardiovascular, cerebrovascular, and peripheral artery disease. Strategies to intensify antiplatelet regimens are limited by concomitant increases in clinically significant bleeding. The development of novel antiplatelet therapies targeting additional receptor and signaling pathways, with a focus on maintaining antiplatelet efficacy while preserving hemostasis, hold tremendous potential to improve outcomes among patients with atherothrombotic diseases...
February 14, 2019: Arteriosclerosis, Thrombosis, and Vascular Biology
Melissa D Klein, Alexis K Williams, Craig R Lee, George A Stouffer
Current guidelines recommend dual antiplatelet therapy-a P2Y12 inhibitor (clopidogrel, prasugrel, or ticagrelor) and aspirin-for patients undergoing percutaneous coronary intervention. Although clopidogrel is the most commonly prescribed P2Y12 inhibitor, it is associated with an increased risk of major adverse cardiovascular events in patients carrying loss-of-function CYP2C19 alleles. In contrast, CYP2C19 genotype does not impact clinical response to prasugrel or ticagrelor. Nevertheless, routine implementation of CYP2C19 genotyping to guide antiplatelet therapy selection has remained controversial because of the lack of large randomized controlled trials evaluating this strategy...
February 14, 2019: Arteriosclerosis, Thrombosis, and Vascular Biology
William A E Parker, Rachel C Orme, Jessica Hanson, Hannah M Stokes, Claire M Bridge, Patricia A Shaw, Wael Sumaya, Kirstie Thorneycroft, Giovanna Petrucci, Benedetta Porro, Heather M Judge, Ramzi A Ajjan, Bianca Rocca, Robert F Storey
Higher aspirin doses may be inferior in ticagrelor-treated acute coronary syndrome (ACS) patients and reducing bleeding risk whilst maintaining antithrombotic benefits could improve outcomes. We characterized the pharmacodynamics of a novel dual-antiplatelet-therapy regimen consisting of very-low-dose twice-daily (BD) aspirin with standard-dose ticagrelor. A total of 20 ticagrelor-treated ACS patients entered a randomized crossover to take aspirin 20 mg BD (12-hourly) during one 14-day period and 75 mg once-daily (OD) in the other...
February 13, 2019: Platelets
Chen Guo, Min Li, Yong-Hui Lv, Ming-Bo Zhang, Zhi-Lu Wang
Switching from a potent P2Y12 blocker to clopidogrel is not uncommon for antiplatelet therapy in patients undergoing percutaneous coronary intervention. This meta-analysis aimed to investigate the efficacy and safety of this de-escalation strategy. Medical literature databases were searched for analysis comparing continued potent antiplatelet therapy and switching to clopidogrel with no language restrictions from inception to 07/May/2018. The primary endpoints of major adverse cardiovascular events (MACE) and major bleeding together with additional efficacy outcomes were assessed by random-effects and fixed-effects meta-analysis...
February 13, 2019: Platelets
Mariusz Tomaniak, Łukasz Kołtowski, Szymon Jonik, Janusz Kochman, Adam Rdzanek, Arkadiusz Pietrasik, Ewa Pędzich-Placha, Dorota Ochijewicz, Piotr Barus, Zenon Huczek, Grzegorz Opolski, Krzysztof Jerzy Filipiak
INTRODUCTION Dual antiplatelet therapy (DAPT) with aspirin and clopidogrel remains a cornerstone of pharmacotherapy after percutaneous coronary intervention (PCI). It has been demonstrated that even up to 30% of patients receiving DAPT is characterized by inadequate response to clopidogrel, namely high on-treatment platelet reactivity (HPR). The platelet to red cell distribution width (P-RDW) ratio represents an indicator of cardiovascular risk and may be related to HPR. OBJECTIVES The aim of the present study was to establish whether the P-RDW ratio predicts HPR in clopidogrel-treated patients undergoing elective PCI...
February 13, 2019: Polish Archives of Internal Medicine
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