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clopidogrel in stroke

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https://www.readbyqxmd.com/read/28701574/antiplatelet-regimen-for-patients-with-breakthrough-strokes-while-on-aspirin-a-systematic-review-and-meta-analysis
#1
Meng Lee, Jeffrey L Saver, Keun-Sik Hong, Neal M Rao, Yi-Ling Wu, Bruce Ovbiagele
BACKGROUND AND PURPOSE: Optimal antiplatelet therapy after an ischemic stroke or transient ischemic attack while on aspirin is uncertain. We, therefore, conducted a systematic review and meta-analysis. METHODS: We searched PubMed (1966 to August 2016) and bibliographies of relevant published original studies to identify randomized trials and cohort studies reporting patients who were on aspirin at the time of an index ischemic stroke or transient ischemic attack and reported hazard ratio for major adverse cardiovascular events or recurrent stroke associated with a switch to or addition of another antiplatelet agent versus maintaining aspirin monotherapy...
July 12, 2017: Stroke; a Journal of Cerebral Circulation
https://www.readbyqxmd.com/read/28683175/cost-effectiveness-analysis-of-30-month-vs-12-month-dual-antiplatelet-therapy-with-clopidogrel-and-aspirin-after-drug-eluting-stents-in-patients-with-acute-coronary-syndrome
#2
Minghuan Jiang, Joyce H S You
Continuation of dual antiplatelet therapy (DAPT) beyond 1 year reduces late stent thrombosis and ischemic events after drug-eluting stents (DES) but increases risk of bleeding. We hypothesized that extending DAPT from 12 months to 30 months in patients with acute coronary syndrome (ACS) after DES is cost-effective. A lifelong decision-analytic model was designed to simulate 2 antiplatelet strategies in event-free ACS patients who had completed 12-month DAPT after DES: aspirin monotherapy (75-162 mg daily) and continuation of DAPT (clopidogrel 75 mg daily plus aspirin 75-162 mg daily) for 18 months...
July 6, 2017: Clinical Cardiology
https://www.readbyqxmd.com/read/28682034/-fabry-s-disease-an-example-of-cardiorenal-syndrome-type-5
#3
Gianluca Villa, Stefano Romagnoli, Aashish Sharma, Claudio Ronco
Fabry's disease (FD) is a severe congenital metabolic disorder characterized by the deficient activity of lysosomal exoglycohydrolase alpha-galactosidase, characterized by glycosphingolipid deposition in several cells, such as capillary endothelial cells, renal, cardiac, and nerve cells. As a systemic disease leading to a contemporaneous myocardial and renal dysfunction, FD might be an example of cardiorenal syndrome type 5 (CRS-5). Kidney damage is commonly characterized by proteinuria, isosthenuria and altered tubular function when occurs at the second-third decade, azotemia and end-stage renal disease in third-fifth decade...
March 2017: Giornale Italiano di Nefrologia: Organo Ufficiale Della Società Italiana di Nefrologia
https://www.readbyqxmd.com/read/28681535/microbleeds-in-the-sps3-trial-stroke-mortality-and-treatment-interactions
#4
Ashkan Shoamanesh, Lesly A Pearce, Carlos Bazan, Luciana Catanese, Leslie A McClure, Mukul Sharma, Joan Marti-Fabregas, David C Anderson, Carlos S Kase, Robert G Hart, Oscar R Benavente
OBJECTIVES: To characterize cerebral microbleeds (CMBs) in lacunar stroke patients in the SPS3 trial and to assess their relationship with recurrent stroke and death, and response to assigned treatment. METHODS: SPS3 is a randomized, clinical trial conducted between 2003 and 2011. Patients with recent MRI-documented lacunar infarcts were randomly assigned in a factorial design to target levels of systolic blood pressure (SBP; 130-149 mmHg vs <130 mmHg; open-label) and to antiplatelet treatment (aspirin/clopidogrel vs aspirin/placebo; double-blinded)...
July 6, 2017: Annals of Neurology
https://www.readbyqxmd.com/read/28677035/symptomatic-carotid-artery-stenosis-surgery-stenting-or-medical-therapy
#5
REVIEW
Ashley M Wabnitz, Tanya N Turan
Symptomatic carotid artery disease is a significant cause of ischemic stroke, and these patients are at high risk for recurrent vascular events. Patients with symptoms of stroke or transient ischemic attack attributable to a significantly stenotic vessel (70-99% luminal narrowing) should be treated with intensive medical therapy. Intensive medical therapy is a combination of pharmacologic and lifestyle interventions consistent with best-known practices as follows: initiation of antiplatelet agent or anticoagulation if medically indicated, high potency statin medication, blood pressure control with goal blood pressure of greater than 140/90, Mediterranean-style diet, exercise, and smoking cessation...
August 2017: Current Treatment Options in Cardiovascular Medicine
https://www.readbyqxmd.com/read/28675986/clinical-determinants-of-clopidogrel-responsiveness-in-a-heterogeneous-cohort-of-puerto-rican-hispanics
#6
Dagmar F Hernandez-Suarez, Stuart A Scott, Matthew I Tomey, Kyle Melin, Angel Lopez-Candales, Charlotte E Buckley, Jorge Duconge
BACKGROUND: Clopidogrel is by far the most prescribed platelet adenosine diphosphate (ADP) antagonist in Puerto Rico despite the advent of newer agents (prasugrel and ticagrelor). Given the paucity of data on clopidogrel responsiveness in Hispanics, we sought to determine the association between clinical characteristics and platelet reactivity in Puerto Rican patients on clopidogrel therapy. STUDY POPULATION: A total of 100 Puerto Rican patients on clopidogrel therapy were enrolled and allocated into two groups: Group I, without high on-treatment platelet reactivity (HTPR); and Group II, with HTPR...
July 1, 2017: Therapeutic Advances in Cardiovascular Disease
https://www.readbyqxmd.com/read/28674626/implications-of-the-pegasus-timi-54-trial-for-us-clinical-practice
#7
Steven M Bradley, Gregory P Hess, Patrick Stewart, Ehrin J Armstrong, Steven A Farmer, Jason H Wasfy, Javier Alfonso Valle, Amneet Sandhu, Thomas M Maddox
OBJECTIVES: This study aims to determine the proportion of real-world patients with myocardial infarction (MI) who would have been eligible for the PEGASUS-TIMI 54 (Prevention of Cardiovascular Events in Patients with Prior Heart Attack Using Ticagrelor Compared to Placebo on a Background of Aspirin-Thrombolysis in Myocardial Infarction 54) trial, to characterise their current use of P2Y12 inhibitors and to explore the estimated costs and ischaemic event consequences of increasing P2Y12 inhibitor use among these patients...
2017: Open Heart
https://www.readbyqxmd.com/read/28673508/comparison-of-prasugrel-versus-clopidogrel-in-korean-patients-with-acute-myocardial-infarction-undergoing-successful-revascularization
#8
Keun-Ho Park, Myung Ho Jeong, Hyun Kuk Kim, Tae Hoon Ahn, Ki Bae Seung, Dong Joo Oh, Dong-Joo Choi, Hyo-Soo Kim, Hyeon Cheol Gwon, In Whan Seong, Kyung Kuk Hwang, Shung Chull Chae, Kwon-Bae Kim, Young Jo Kim, Kwang Soo Cha, Seok Kyu Oh, Jei Keon Chae
BACKGROUND: Although there have been several reports that prasugrel can improve clinical outcomes, the efficacy and safety of prasugrel is unknown in Korean patients with acute myocardial infarction (AMI) undergoing successful revascularization. METHODS: A total of 4421 patients [637 patients were prescribed prasugrel (60/10 or 5mg, loading/maintenance dose) and 3784 patients clopidogrel (600 or 300/75mg)] with AMI undergoing successful revascularization were enrolled from the core clinical cohort of Korea Acute Myocardial Infarction Registry-National Institute of Health...
June 30, 2017: Journal of Cardiology
https://www.readbyqxmd.com/read/28672933/a-systematic-review-and-meta-analysis-of-published-randomized-controlled-trials-of-combination-of-clopidogrel-and-aspirin-in-transient-ischemic-attack-or-minor-stroke
#9
Xingjian Zhou, Jing Tian, Ming Zhen Zhu, Colin K He
The use of antiplatelet agents in patients with ischemic stroke is recommended. In this study, we compared the efficacy and safety of the treatment of clopidogrel plus aspirin (ASA) and that of ASA alone in patients with mild stroke/transient ischemic attack (TIA). Randomized controlled trial (RCT) studies of Clop + ASA vs. ASA therapy in the patients with minor stroke/TIA were identified by electronic bibliographic searches. The primary result was recurrent stroke, while myocardial infarction (MI) as well as vascular mortalities were the secondary result, and major hemorrhagic events were the safety result...
July 2017: Experimental and Therapeutic Medicine
https://www.readbyqxmd.com/read/28653333/investigating-real-world-clopidogrel-pharmacogenetics-in-stroke-using-a-bioresource-linked-to-electronic-medical-records
#10
Aleksi Tornio, Rob Flynn, Steve Morant, Elena Velten, Colin N A Palmer, Thomas M MacDonald, Alex S F Doney
Clopidogrel efficacy is influenced by genetic variation of CYP2C19, however few studies have considered stroke patients. We used electronic medical records (EMR) linked to a bioresource to examine real-world implications of clopidogrel pharmacogenetics in stroke. Patients hospitalized for any arterial thrombo-occlusive event (ATO) who subsequently redeemed clopidogrel prescriptions in the community were entered into the study (n=651). During 24 months follow-up the primary endpoint of recurrent ATO or death occurred in 299 (46%) patients...
June 27, 2017: Clinical Pharmacology and Therapeutics
https://www.readbyqxmd.com/read/28648031/-impact-of-different-antithrombotic-therapy-strategy-on-prognosis-in-coronary-heart-disease-patients-combining-with-atrial-fibrillation-a-meta-analysis
#11
C Yuan, L Zhong, R C Huang
Objective: To evaluate the impact of various anticoagulation antiplatelet therapy strategies on the prognosis of patients with coronary heart disease combining with atrial fibrillation. Methods: Present meta analysis was performed according to search results on English EMBASE database by computer retrieval, Pubmed, the Cochrane Central Register of Controlled Trials, Medline, Chinese CBM database, CNKI database, Wan Fang database, China science and technology papers online electronic databases, manual retrieval for important international conference proceedings up to April 30 2016...
June 24, 2017: Zhonghua Xin Xue Guan Bing za Zhi
https://www.readbyqxmd.com/read/28642210/rationale-and-design-for-a-randomized-comparison-of-efficacy-and-safety-between-aspirin-and-clopidogrel-in-atrial-fibrillation-patients-with-low-stroke-risk-cesac-af-trial
#12
Sang Min Park, Haemin Jeong, Mi-Hyang Jung, Kyung Soon Hong, Myeong-Ki Hong, Chang Seok Bang, Christopher Y Kim
BACKGROUND: Atrial fibrillation (AF) increases the risk of thromboembolic stroke. An oral anticoagulant should be administrated to prevent stroke in patients with moderate stroke risk (ie, CHA2DS2-VASc score>2). If the stroke risk is low (i.e. the score=1), however, antiplatelet agent such as aspirin is widely used. Aspirin can cause peptic ulcer disease (PUD) while its alternative, clopidogrel, theoretically does not. OBJECTIVE: To elucidate the efficacy and safety between aspirin and clopidogrel, a multicenter randomized controlled trial was designed in AF patients with low stroke risk...
June 19, 2017: Contemporary Clinical Trials
https://www.readbyqxmd.com/read/28641840/6-versus-24-month-dual-antiplatelet-therapy-after-implantation-of-drug-eluting%C3%A2-stents-in-patients-nonresistant-to-aspirin-final-results-of-the-italic-trial-is-there-a-life-for-des-after-discontinuation-of-clopidogrel
#13
Romain Didier, Marie Claude Morice, Paul Barragan, Arif A L Noryani, Hussam A Noor, Talib Majwal, Thomas Hovasse, Philippe Castellant, Michel Schneeberger, Luc Maillard, Erwan Bressolette, Jaroslaw Wojcik, Nicolas Delarche, Didier Blanchard, Bernard Jouve, Olivier Ormezzano, Franck Paganelli, Gilles Levy, Joël Sainsous, Didier Carrie, Alain Furber, Jacques Berlan, Olivier Darremont, Hervé Le Breton, Anne Lyuycx-Bore, Antoine Gommeaux, Claude Cassat, Alain Kermarrec, Pierre Cazaux, Philippe Druelles, Raphael Dauphin, Jean Armengaud, Patrick Dupouy, Didier Champagnac, Patrick Ohlmann, Hakim Ben Amer, Robert G Kiss, Irme Ungi, Martine Gilard
OBJECTIVES: The aim of this study was to test the hypothesis that 6-month dual antiplatelet therapy (DAPT) is noninferior to 24-month DAPT in aspirin-sensitive patients. BACKGROUND: The ITALIC (Is There a Life for DES After Discontinuation of Clopidogrel) trial showed that rates of bleeding and thrombotic events at 1 year were much the same with 6 versus 12 months of DAPT after percutaneous coronary intervention with second-generation drug-eluting stents. In this report, 2-year follow-up is presented...
June 26, 2017: JACC. Cardiovascular Interventions
https://www.readbyqxmd.com/read/28635374/sepsis-favors-high-on-clopidogrel-platelet-reactivity
#14
Karolina Akinosoglou, Angelos Perperis, Spyridoula Theodoraki, Dimitrios Alexopoulos, Charalambos Gogos
High-on-treatment platelet reactivity (HPR) is associated with ischemic events in patients on antiplatelet therapy with a history of cardiovascular disease. On the other hand, recent data have associated sepsis with adverse cardiovascular events in patients admitted with bacteremia or respiratory infection. We aimed to assess P2Y12-mediated platelet reactivity (PR) during sepsis and recovery in patients under clopidogrel. This was a prospective observational study. Incoming patients presenting with signs/symptoms of sepsis already on a maintenance dose of clopidogrel of 75 mg qd for cardiovascular events were included in this study...
June 21, 2017: Platelets
https://www.readbyqxmd.com/read/28634365/different-levels-of-blood-pressure-different-benefit-from-dual-antiplatelet-therapy-in-minor-stroke-or-tia-patients
#15
Jie Xu, Yongli Tao, Hao Li, Hongqiu Gu, Xuewei Xie, Xia Meng, Yuming Xu, Yilong Wang, Yongjun Wang
The study aimed to evaluate whether the benefits of dual antiplatelet therapy would be influenced by blood pressure (BP) levels, among acute minor stroke or transient ischemic attack (TIA). In CHANCE (Clopidogrel in High-Risk Patients with Acute Nondisabling cerebrovascular Events) trail, Patients were stratified by systolic BP (SBP) and diastolic BP (DBP) level measured on admission, respectively, using the supine position BP within 24 hours after symptoms onset. The primary efficacy outcome was stroke recurrence, bleeding was the safety outcome...
June 20, 2017: Scientific Reports
https://www.readbyqxmd.com/read/28630782/remote-assessment-of-platelet-function-in-patients-with-acute-stroke-or-transient-ischaemic-attack
#16
Philip M Bath, Jane May, Katie Flaherty, Lisa J Woodhouse, Natalia Dovlatova, Sue C Fox, Timothy J England, Kailash Krishnan, Thompson G Robinson, Nikola Sprigg, Stan Heptinstall, Tardis Investigators
BACKGROUND: The TARDIS trial assessed the safety and efficacy of intensive versus guideline antiplatelet agents given for one month in patients with acute stroke or TIA. The aim of this substudy was to assess the effect of antiplatelet agents taken at baseline on platelet function reactivity and activation. METHODS: Platelet function, assessed by remotely measured surface expression of P-selectin, was assessed in patients at their time of randomisation. Data are median fluorescence values...
2017: Stroke Research and Treatment
https://www.readbyqxmd.com/read/28623527/updating-the-evidence-of-the-interaction-between-clopidogrel-and-cyp2c19-inhibiting-selective-serotonin-reuptake-inhibitors-a-cohort-study-and-meta-analysis
#17
Katsiaryna Bykov, Sebastian Schneeweiss, Robert J Glynn, Murray A Mittleman, David W Bates, Joshua J Gagne
INTRODUCTION: We previously found that patients who initiate clopidogrel while treated with a cytochrome P450 (CYP) 2C19-inhibiting selective serotonin reuptake inhibitor (SSRI) have a higher risk of subsequent ischemic events than patients treated with other SSRIs. It is not known whether initiating an inhibiting SSRI while treated with clopidogrel will also increase risk of ischemic events. OBJECTIVE: The aim of this study was to assess clinical outcomes following initiation of a CYP2C19-inhibiting SSRI versus initiation of other SSRIs among patients treated with clopidogrel and to update existing evidence on the clinical impact of clopidogrel-SSRI interaction...
June 16, 2017: Drug Safety: An International Journal of Medical Toxicology and Drug Experience
https://www.readbyqxmd.com/read/28618904/antiplatelet-and-antithrombotic-treatment-for-secondary-prevention-in-ischaemic-heart-disease
#18
Maddalena Lettino, Sergio Leonardi, Elia De Maria, Sigrun Halvorsen
Platelets play a key role in the pathogenesis of acute coronary syndromes and this is why antiplatelet drugs are essential, both in the acute phase and in the long-term follow-up in preventing recurrent myocardial infarction, stroke and cardiovascular death. Aspirin is the most used agent and still remains the first choice drug for lifelong administration in secondary prevention after myocardial infarction. Dual antiplatelet therapy, targeting more than one pathway of platelet activation, has significantly improved the outcome of patients with acute coronary syndromes despite an increased risk of bleeding complications...
June 2017: European Journal of Preventive Cardiology
https://www.readbyqxmd.com/read/28616861/medical-therapy-and-recurrent-ischemic-events-in-high-risk-patients-surviving-their-myocardial-infarction-for-at-least-12%C3%A2-months-comparison-of-patients-with-st-elevation-versus-non-st-elevation-myocardial-infarction
#19
Uwe Zeymer, Katrin Riedel, Michael Hahn
INTRODUCTION: Data about treatments and recurrent ischemic events in patients surviving their most recent myocardial infarction event-free for at least 12 months are scarce. METHODS: In a retrospective data analysis, charts of patients who had a myocardial infarction 1-3 years ago with an event-free period of at least 12 months after the index event and at least one high risk factor were centrally collected and analyzed. Here we compare patients with ST elevation myocardial infarction (STEMI) versus non-ST elevation myocardial infarction (NSTEMI)...
June 14, 2017: Cardiology and Therapy
https://www.readbyqxmd.com/read/28608165/platelet-related-biomarkers-and-their-response-to-inhibition-with-aspirin-and-p2y12-receptor-antagonists-in-patients-with-acute-coronary-syndrome
#20
Angela Lowenstern, Robert F Storey, Megan Neely, Jie-Lena Sun, Dominick J Angiolillo, Christopher P Cannon, Anders Himmelmann, Kurt Huber, Stefan K James, Hugo A Katus, Joao Morais, Agneta Siegbahn, Phillippe Gabriel Steg, Lars Wallentin, Richard C Becker
The PLATelet inhibition and patient Outcomes (PLATO) trial showed that treatment with ticagrelor reduced the rate of death due to vascular causes, myocardial infarction and stroke when compared to clopidogrel in patients with ST-elevation or non-ST-elevation acute coronary syndrome (ACS). While the comparative benefit of ticagrelor over clopidogrel increased over time, event rates accrued in both groups during the study period. The purpose of our biomarker-based exploratory analysis was to determine whether long-term platelet inhibition may be associated with platelet adaptation...
June 12, 2017: Journal of Thrombosis and Thrombolysis
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