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clopidogrel in stroke

Joo-Yong Hahn, Young Bin Song, Ju-Hyeon Oh, Deok-Kyu Cho, Jin Bae Lee, Joon-Hyung Doh, Sang-Hyun Kim, Jin-Ok Jeong, Jang-Ho Bae, Byung-Ok Kim, Jang Hyun Cho, Il-Woo Suh, Doo-Il Kim, Hoon-Ki Park, Jong-Seon Park, Woong Gil Choi, Wang Soo Lee, Jihoon Kim, Ki Hong Choi, Taek Kyu Park, Joo Myung Lee, Jeong Hoon Yang, Jin-Ho Choi, Seung-Hyuk Choi, Hyeon-Cheol Gwon
BACKGROUND: Current guidelines recommend dual antiplatelet therapy (DAPT) of aspirin plus a P2Y12 inhibitor for at least 12 months after implantation of drug-eluting stents (DES) in patients with acute coronary syndrome. However, available data about the optimal duration of DAPT in patients with acute coronary syndrome undergoing percutaneous coronary intervention are scant. We aimed to investigate whether a 6-month duration of DAPT would be non-inferior to the conventional 12-month or longer duration of DAPT in this population...
March 9, 2018: Lancet
Francesca Maria Notarangelo, Giuseppe Maglietta, Paola Bevilacqua, Marco Cereda, Piera Angelica Merlini, Giovanni Quinto Villani, Paolo Moruzzi, Giampiero Patrizi, Guidantonio Malagoli Tagliazucchi, Antonio Crocamo, Angela Guidorossi, Filippo Pigazzani, Elisa Nicosia, Giorgia Paoli, Marco Bianchessi, Mario Angelo Comelli, Caterina Caminiti, Diego Ardissino
BACKGROUND: Clopidogrel is still frequently used in patients with acute coronary syndromes (ACS), but its efficacy is hampered by interpatient response variability, due to genetic polymorphisms associated with clopidogrel metabolism. OBJECTIVE: To evaluate whether selecting antiplatelet therapy (clopidogrel, prasugrel or ticagrelor) on the basis of a patient's genetic and clinical characteristics leads to better clinical outcomes in comparison with the standard of care, which bases the selection on clinical characteristics alone METHODS: Patients hospitalised for ACS were randomly assigned to standard of care or pharmacogenomic arm, which included the genotyping of ABCB1, CYP2C19*2, CYP2C19*17 using an ST Q3 system that provide the data within 70 minutes at each patient's bedside...
February 24, 2018: Journal of the American College of Cardiology
Young Hee Nam, Colleen M Brensinger, Warren B Bilker, Charles E Leonard, Scott E Kasner, Tilo Grosser, Xuanwen Li, Sean Hennessy
OBJECTIVE: To examine the comparative safety of individual NSAIDs when given concomitantly with clopidogrel. METHODS: We conducted a retrospective cohort study using Medicaid claims from five US states during 1999-2010, supplemented with Medicare claims for dual-enrollees. The exposure of interest was the first concomitant use of clopidogrel and one of the 10 selected NSAIDs after a 1-year baseline period. The outcomes were: all-cause mortality; acute myocardial infarction (AMI)/ischemic stroke; and gastrointestinal bleeding (GIB)/intracranial hemorrhage (ICH)...
2018: PloS One
Dennis T Ko, Harlan M Krumholz, Jack V Tu, Peter C Austin, Therese A Stukel, Maria Koh, Alice Chong, Jose Francisco de Melo, Cynthia A Jackevicius
BACKGROUND: Clopidogrel is one of the most commonly prescribed medications because of its ability to improve clinical outcomes for a broad range of cardiovascular conditions. After patent protection expired for Plavix in 2012, many healthcare systems adopted generic clopidogrel as a strategy to reduce healthcare costs. METHODS AND RESULTS: We conducted a population-based observational study to determine whether generic clopidogrel was noninferior to Plavix. Patients who were hospitalized with an acute coronary syndrome (ACS) from 2009 to 2014 in Ontario, Canada, >65 years, survived ≥7 days after discharge, were eligible for inclusion...
March 2018: Circulation. Cardiovascular Quality and Outcomes
Morten Würtz, Morten Schmidt, Erik Lerkevang Grove, Erzsébet Horváth-Puhó, Victor W Henderson, Christian Fynbo Christiansen, Henrik Toft Sørensen
Aims: The impact of preadmission antiplatelet treatment on prognosis after stroke is poorly understood. We therefore investigated whether preadmission use of aspirin and clopidogrel was associated with mortality in patients hospitalized with ischemic stroke, intracerebral hemorrhage (ICH), or subarachnoid hemorrhage (SAH). Methods and Results: We used nationwide population-based registries to identify all first-time hospitalizations for stroke and subsequent mortality in patients treated with aspirin and clopidogrel in Denmark during 2004-2012...
March 8, 2018: European Heart Journal. Cardiovascular Pharmacotherapy
Otavio Berwanger, Jose C Nicolau, Antonio C Carvalho, Lixin Jiang, Shaun G Goodman, Stephen J Nicholls, Alexander Parkhomenko, Oleg Averkov, Carlos Tajer, Germán Malaga, Jose F K Saraiva, Francisco A Fonseca, Fábio A De Luca, Helio P Guimaraes, Pedro G M de Barros E Silva, Lucas P Damiani, Denise M Paisani, Camila M R Lasagno, Carolina T Candido, Nanci Valeis, Diogo D F Moia, Leopoldo S Piegas, Christopher B Granger, Harvey D White, Renato D Lopes
Importance: The bleeding safety of ticagrelor in patients with ST-elevation myocardial infarction treated with fibrinolytic therapy remains uncertain. Objective: To evaluate the short-term safety of ticagrelor when compared with clopidogrel in patients with ST-elevation myocardial infarction treated with fibrinolytic therapy. Design, Setting and Participants: We conducted a multicenter, randomized, open-label with blinded end point adjudication trial that enrolled 3799 patients (younger than 75 years) with ST-segment elevation myocardial infarction receiving fibrinolytic therapy in 152 sites from 10 countries from November 2015 through November 2017...
March 11, 2018: JAMA Cardiology
Yu Wu, Yilun Zhou, Yuesong Pan, Xingquan Zhao, Liping Liu, David Wang, Chunxue Wang, Hao Li, S Claiborne Johnston, Xia Meng, Yilong Wang, Yongjun Wang
Clopidogrel resistance is prevalent in chronic kidney disease (CKD) patients. Genetic polymorphism is considered to be the most important factor that influences clopidogrel resistance. Limited data exist as to the role of pharmacogenetics in prognosis of stroke patients with impaired renal function on clopidogrel. We sought to explore whether decreased kidney function alters the association between CYP2C19 genetic variants and clinical outcome in patients with minor stroke or transient ischemic attack (TIA) receiving clopidogrel therapy...
March 8, 2018: Pharmacogenomics Journal
Hitesh Raheja, Aakash Garg, Sunny Goel, Kinjal Banerjee, Gerald Hollander, Jacob Shani, Stephanie Mick, Jonathan White, Amar Krishnaswamy, Samir Kapadia
OBJECTIVE: We aim to evaluate the efficacy of dual versus single anti-platelet therapy (SAPT) after TAVR through a systematic review and meta-analysis of published research. BACKGROUND: Dual antiplatelet therapy (DAPT) with aspirin and clopidogrel is a commonly practiced strategy after transcatheter aortic valve replacement (TAVR). However, there is lack of sufficient evidence supporting this approach. METHOD: We searched PubMed, EMBASE, the Cochrane Central Register of Controlled trials, and the clinical trial registry maintained at clinicaltrials...
March 8, 2018: Catheterization and Cardiovascular Interventions
Aleš Tomek, Václav Matʼoška, Alena Frýdmanová, Hana Magerová, Martin Šrámek, Jaroslava Paulasova-Schwabová, Tereza Růžičková, Petr Janský, Ivana Šarbochová, Ivana Hadačová, Vojtěch Kaplan, Zuzana Lacinová, Luděk Táborský, Victor Serebruany
BACKGROUND: Variable response after clopidogrel is well documented and may affect major adverse clinical events after stroke. Impact of CYP2C19 genetic polymorphisms is an established marker linked to variable response after clopidogrel. However, the association of certain genetic polymorphisms with prediction of major adverse clinical events following stroke still remains controversial, especially in Caucasians. STUDY QUESTION: The primary aim was to evaluate the impact of CYP2C19 allele *2 in heterozygote form on major adverse clinical events in Caucasian poststroke survivors treated with clopidogrel...
March 2018: American Journal of Therapeutics
Runqi Wangqin, Xianwei Wang, Yilong Wang, Ying Xian, Xingquan Zhao, Liping Liu, Hao Li, Xia Meng, Yongjun Wang
Objective: Many patients receiving dual antiplatelet therapy still had recurrent strokes. We aimed to identify factors associated with recurrent stroke at 90 days in patients receiving dual antiplatelet therapy in Clopidogrel in High-risk patients with Acute Non-disabling Cerebrovascular Events trial. Methods: Patients with transient ischaemic attack or minor stroke receiving clopidogrel and aspirin in the trial were analysed in the study. The primary outcome was recurrent stroke within 90 days after the index event...
December 2017: Stroke and Vascular Neurology
Monika Marcinkowska, Magdalena Kotańska, Agnieszka Zagórska, Joanna Śniecikowska, Monika Kubacka, Agata Siwek, Adam Bucki, Maciej Pawłowski, Marek Bednarski, Jacek Sapa, Małgorzata Starek, Monika Dąbrowska, Marcin Kołaczkowski
Despite the substantial clinical success of aspirin and clopidogrel in secondary prevention of ischemic stroke, up to 40% of patients remain resistant to the available antiplatelet treatment. Therefore, there is an urgent clinical need to develop novel antiplatelet agents with a novel mechanism of action. Recent studies revealed that potent alpha 2B-adrenergic receptor (alpha 2B-ARs) antagonists could constitute alternative antiplatelet therapy. We have synthesized a series of N-arylpiperazine derivatives of 4,4-dimethylisoquinoline-1,3(2H,4H)-dione as potential alpha 2B receptor antagonists...
December 2018: Journal of Enzyme Inhibition and Medicinal Chemistry
Jaya Chandrasekhar, Usman Baber, Samantha Sartori, Melissa Aquino, Annapoorna S Kini, Sunil Rao, William Weintraub, Timothy D Henry, Serdar Farhan, Birgit Vogel, Sabato Sorrentino, Zhen Ge, Samir Kapadia, Joseph B Muhlestein, Sandra Weiss, Craig Strauss, Catalin Toma, Anthony DeFranco, Mark B Effron, Stuart Keller, Brian A Baker, Stuart Pocock, George Dangas, Roxana Mehran
BACKGROUND: Potent P2Y12 inhibitors might offer enhanced benefit against thrombotic events in complex percutaneous coronary intervention (PCI). We examined prasugrel use and outcomes according to PCI complexity, as well as analyzing treatment effects according to thienopyridine type. METHODS: PROMETHEUS was a multicentre observational study that compared clopidogrel vs prasugrel in acute coronary syndrome patients who underwent PCI (n = 19,914). Complex PCI was defined as PCI of the left main, bifurcation lesion, moderate-severely calcified lesion, or total stent length ≥ 30 mm...
March 2018: Canadian Journal of Cardiology
Takehiko Nagao, Kazunori Toyoda, Kazuo Kitagawa, Takanari Kitazono, Hiroshi Yamagami, Shinichiro Uchiyama, Norio Tanahashi, Masayasu Matsumoto, Kazuo Minematsu, Izumi Nagata, Masakatsu Nishikawa, Shinsuke Nanto, Kenji Abe, Yasuo Ikeda, Akira Ogawa
BACKGROUND: This comparison of PRAsugrel and clopidogrel in Japanese patients with ischemic STROke (PRASTRO)-I trial investigates the noninferiority of prasugrel to clopidogrel sulfate in the prevention of recurrence of primary events (ischemic stroke, myocardial infarction, and death from other vascular causes), and the long-term safety of prasugrel in Japanese patients with non-cardioembolic stroke. RESEARCH DESIGN AND METHODS: This was an active-controlled, randomized, double-blind, double-dummy, parallel-group study conducted between July 2011 and March 2016 at multiple centers around Japan...
February 21, 2018: Expert Opinion on Pharmacotherapy
Yuriy I Grinshtein, Aleksandra A Kosinova, Igor Y Grinshtein, Tatyana N Subbotina, Andrey A Savchenko
AIM: To determine if there is an association between the single nucleotide polymorphisms (SNPs): rs2046934, rs1126643, rs5918, rs6065, rs4244285; rs4986893 and the occurrence of cardiovascular events (CVE) in patients following coronary artery bypass grafting (CABG) surgery. MATERIALS AND METHODS: The study included 130 CABG patients with stable angina grades II-IV. After CABG 69 of the patients were treated with acetylsalicylic acid (ASA) alone, and 61 received dual antiplatelet therapy (ASA+clopidogrel)...
February 20, 2018: Genetic Testing and Molecular Biomarkers
Stefano Savonitto, Luca A Ferri, Luigi Piatti, Daniele Grosseto, Giancarlo Piovaccari, Nuccia Morici, Irene Bossi, Paolo Sganzerla, Giovanni Tortorella, Michele Cacucci, Maurizio Ferrario, Ernesto Murena, Girolamo Sibilio, Stefano Tondi, Anna Toso, Sergio Bongioanni, Amelia Ravera, Elena Corrada, Matteo Mariani, Leonardo Di Ascenzo, A Sonia Petronio, Claudio Cavallini, Giancarlo Vitrella, Renata Rogacka, Roberto Antonicelli, Bruno M Cesana, Leonardo De Luca, Filippo Ottani, Giuseppe De Luca, Federico Piscione, Nadia Moffa, Stefano De Servi
Background -Elderly patients are at elevated risk of both ischemic and bleeding complications after an acute coronary syndrome (ACS), and display higher on-clopidogrel platelet reactivity as compared to younger patients. Prasugrel 5 mg provides more predictable platelet inhibition, as compared to clopidogrel, in the elderly, suggesting the possibility of reducing ischemic events without increasing bleeding. Methods -In a multicenter, randomized, open-label, blinded-endpoint trial, we compared a once daily maintenance dose of prasugrel 5 mg with the standard clopidogrel 75 mg in patients >74 years with ACS undergoing percutaneous coronary intervention (PCI)...
February 19, 2018: Circulation
Antonis S Manolis, Spyridon Koulouris, Efthymia Rouska, John Pyrros
OBJECTIVE: Percutaneous closure of patent foramen ovale (PFO) and atrial septal defect (ASD) is routinely performed under general anesthesia or deep sedation and use of transesophageal (TEE) or intracardiac echocardiography, incurring longer duration and higher cost. We have used a simplified, economical, fluoroscopy-only guided approach with local anesthesia, and herein report our data. METHODS: The study includes 112 procedures in 110 patients with PFO (n=75) or ASD (n=35), with use of an Amplatzer occluder, heparin and prophylactic antibiotics...
January 2018: Indian Heart Journal
Naoki Misumida, Shunsuke Aoi, Sun Moon Kim, Khaled M Ziada, Ahmed Abdel-Latif
BACKGROUND: Bleeding complications are associated with unfavorable outcomes in patients with acute coronary syndrome (ACS). Compared to Whites, several studies demonstrated a higher risk of bleeding in Asians who present with acute myocardial infarction. To date, the efficacy and safety of ticagrelor in East Asian population have not been well established. METHODS: We conducted a systematic review and meta-analysis of randomized controlled trials that compared ticagrelor and clopidogrel in East Asian patients with acute coronary syndrome (ACS)...
January 31, 2018: Cardiovascular Revascularization Medicine: Including Molecular Interventions
Jing-Xiu Li, Yang Li, Shu-Jun Yan, Bai-He Han, Zhao-Yan Song, Wei Song, Shi-Hao Liu, Ji-Wei Guo, Shuo Yin, Ye-Ping Chen, De-Jun Xia, Xin Li, Xue-Qi Li, En-Ze Jin
A challenge for antithrombotic treatment is patients who present with atrial fibrillation (AF) and acute coronary syndrome, particularly in patients who have undergone coronary percutaneous intervention with stenting (PCIS). In the present study, a total of nine observational trials published prior to July 2017 that investigated the effects of dual antiplatelet therapy (DAPT; aspirin + clopidogrel) and triple oral antithrombotic therapy (TOAT; DAPT + warfarin) among patients with AF concurrent to PCIS were collected from the Medline, Cochrane and Embase databases and conference proceedings of cardiology, gastroenterology and neurology meetings...
February 2018: Biomedical Reports
Pascal Vranckx, Thorsten Lewalter, Marco Valgimigli, Jan G Tijssen, Paul-Egbert Reimitz, Lars Eckardt, Hans-Joachim Lanz, Wolfgang Zierhut, Rüdiger Smolnik, Andreas Goette
BACKGROUND: The optimal antithrombotic treatment after percutaneous coronary intervention (PCI) with stenting in patients with atrial fibrillation (AF) is unknown. In the ENGAGE AF-TIMI 48 trial, edoxaban was noninferior to a vitamin K antagonist (VKA) with respect to the prevention of stroke or systemic embolism and was associated with significantly lower rates of bleeding and cardiovascular death in patients with nonvalvular AF. The effects of edoxaban in combination with single- or dual-antiplatelet therapy in the setting of PCI are unexplored...
February 2018: American Heart Journal
Yi-Da Tang, Wenyao Wang, Min Yang, Kuo Zhang, Jing Chen, Shubin Qiao, Hongbing Yan, Yongjian Wu, Xiaohong Huang, Bo Xu, Runlin Gao, Yuejin Yang
Background -Patients undergoing percutaneous coronary intervention (PCI) react differently to antiplatelet drugs. Those with low responsiveness to clopidogrel have a higher risk of cardiac ischemic events. The goal of this study is to conduct a head-to-head comparison of the safety and effectiveness of intensified antiplatelet therapies (either double-dose clopidogrel [DOUBLE] or adjunctive cilostazol [TRIPLE]) and conventional strategy (STANDARD) in post-PCI patients. Methods -In this single-center, randomized, controlled trial, we used thromboelastography (TEG), a platelet function test, to select 1078 PCI patients at high thrombotic risk and compared the intensified antiplatelet therapies with standard antiplatelet therapy...
February 2, 2018: Circulation
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