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clopidogrel in stroke

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https://www.readbyqxmd.com/read/28810251/a-prospective-randomized-open-label-blinded-endpoint-study-exploring-platelet-response-to-half-dose-prasugrel-and-ticagrelor-in-patients-with-the-acute-coronary-syndrome-hope-tailor-study
#1
Cai De Jin, Moo Hyun Kim, Junghee Bang, Victor Serebruany
BACKGROUND: The optimal dosing of novel oral P2Y12 receptor platelet inhibitors such as prasugrel or ticagrelor is unclear and especially challenging in East Asians. We hypothesize that half-dose prasugrel and ticagrelor may be sufficient for long-term maintenance management in Korean patients with the acute coronary syndrome (ACS) compared with conventional dosages. DESIGN: HOPE-TAILOR (Half Dose of Prasugrel and Ticagrelor in Platelet Response after Acute Coronary Syndromes) is a prospective, randomized, open-label, blinded, endpoint (PROBE) single-center, clinical trial...
August 16, 2017: Cardiology
https://www.readbyqxmd.com/read/28809046/platelet-transfusion-to-reverse-antiplatelet-therapy-before-decompressive-surgery-in-patients-with-intracranial-haemorrhage
#2
M Baschin, S Selleng, J-P Zeden, A Westphal, T Kohlmann, H W Schroeder, A Greinacher, T Thiele
BACKGROUND: Platelet concentrates (PC) are transfused to improve primary haemostasis before urgent neurosurgery in patients with intracranial haemorrhage (ICH) receiving antiplatelet therapy (APT). It is unresolved, whether PCs increase the risk for major cardio- and cerebrovascular adverse events. We evaluated a standardized transfusion regimen to reverse APT in patients with ICH who required decompressive neurosurgery. METHODS: Analysed were consecutive patients between 2012 and 2014...
August 14, 2017: Vox Sanguinis
https://www.readbyqxmd.com/read/28783201/validation-of-the-dapt-score-in-patients-randomized-to-6-or-12-months-clopidogrel-after-predominantly-second-generation-drug-eluting-stents
#3
Yukinori Harada, Jonathan Michel, Raphaela Lohaus, Katharina Mayer, Roberto Emmer, Anna Lena Lahmann, Roisin Colleran, Daniele Giacoppo, Annabelle Wolk, Jurrien M Ten Berg, Franz-Josef Neumann, Yaling Han, Tom Adriaenssens, Ralph Tölg, Melchior Seyfarth, Michael Maeng, Bernhard Zrenner, Claudius Jacobshagen, Jochen Wöhrle, Sebastian Kufner, Tanja Morath, Tareq Ibrahim, Isabell Bernlochner, Marcus Fischer, Heribert Schunkert, Karl-Ludwig Laugwitz, Julinda Mehilli, Robert A Byrne, Adnan Kastrati, Stefanie Schulz-Schüpke
The DAPT score is a recently-proposed decision tool for guiding optimal duration of dual antiplatelet therapy (DAPT). It showed modest accuracy in prior derivation and validation cohorts of patients with ≥12 months DAPT. This study was aimed to evaluate the validity of the DAPT score in a cohort of patients with 6 or 12 months DAPT after implantation of predominantly second-generation drug-eluting stents. We analyzed data of patients enrolled in the ISAR-SAFE trial. Patients were classified into low (<2) or high (≥2) DAPT score groups...
July 27, 2017: Thrombosis and Haemostasis
https://www.readbyqxmd.com/read/28780028/associations-between-chronic-kidney-disease-and-outcomes-with-use-of-prasugrel-versus-clopidogrel-in-patients-with-acute-coronary-syndrome-undergoing-percutaneous-coronary-intervention-a-report-from-the-prometheus-study
#4
Usman Baber, Jaya Chandrasekhar, Samantha Sartori, Melissa Aquino, Annapoorna S Kini, Samir Kapadia, William Weintraub, Joseph B Muhlestein, Birgit Vogel, Michela Faggioni, Serdar Farhan, Sandra Weiss, Craig Strauss, Catalin Toma, Anthony DeFranco, Brian A Baker, Stuart Keller, Mark B Effron, Timothy D Henry, Sunil Rao, Stuart Pocock, George Dangas, Roxana Mehran
OBJECTIVES: The study sought to compare clinical outcomes in a contemporary acute coronary syndrome (ACS) percutaneous coronary intervention (PCI) cohort stratified by chronic kidney disease (CKD) status. BACKGROUND: Patients with CKD exhibit high risks for both thrombotic and bleeding events, thus complicating decision making regarding antiplatelet therapy in the setting of ACS. METHODS: The PROMETHEUS study was a multicenter observational study comparing outcomes with prasugrel versus clopidogrel in ACS PCI patients...
July 27, 2017: JACC. Cardiovascular Interventions
https://www.readbyqxmd.com/read/28768848/predicting-major-bleeding-in-patients-with-noncardioembolic-stroke-on-antiplatelets-s2top-bleed
#5
Nina A Hilkens, Ale Algra, Hans-Christoph Diener, Johannes B Reitsma, Philip M Bath, Laszlo Csiba, Werner Hacke, L Jaap Kappelle, Peter J Koudstaal, Didier Leys, Jean-Louis Mas, Ralph L Sacco, Pierre Amarenco, Leila Sissani, Jacoba P Greving
OBJECTIVE: To develop and externally validate a prediction model for major bleeding in patients with a TIA or ischemic stroke on antiplatelet agents. METHODS: We combined individual patient data from 6 randomized clinical trials (CAPRIE, ESPS-2, MATCH, CHARISMA, ESPRIT, and PRoFESS) investigating antiplatelet therapy after TIA or ischemic stroke. Cox regression analyses stratified by trial were performed to study the association between predictors and major bleeding...
August 2, 2017: Neurology
https://www.readbyqxmd.com/read/28766499/association-between-platelet-function-and-recurrent-ischemic-vascular-events-after-tia%C3%A2-and-minor-stroke%C3%A2
#6
Jinbiao Zhang, Jiangshan Zhang, Hairong Sun, Tan Ming, Xinwu Liu, Yannan Cong, Fang Li, Zhenguang Li
Platelet activation and aggregation play an important role in the pathological and physiological processes of recurrent ischemic vascular events in stroke patients. The purpose of this study is to determine the association between platelet function measured in the acute period and recurrent ischemic vascular events in patients with transient ischemic attack (TIA) or minor stroke. A total of 417 patients who were within the 24-hour period of clopidogrel-aspirin therapy after onset of a minor stroke or high-risk transient ischemic attack according to the Clopidogrel in High-risk patients with Acute Nondisabling Cerebrovascular Events (CHANCE) trial were included in this study...
August 2, 2017: International Journal of Clinical Pharmacology and Therapeutics
https://www.readbyqxmd.com/read/28756905/aspirin-versus-clopidogrel-for-type-2-diabetic-patients-with-first-ever-noncardioembolic-acute-ischemic-stroke-ten-year-survival-data-from-the-athens-stroke-outcome-project
#7
Haralampos Milionis, George Ntaios, Vasileios Papavasileiou, Konstantinos Spengos, Efstathios Manios, Moses Elisaf, Konstantinos Vemmos
BACKGROUND AND OBJECTIVE: Diabetes mellitus is associated with an increased risk of stroke and poor outcome following a stroke event. We assessed the impact of discharge treatment with aspirin versus clopidogrel on the 10-year survival of patients with type 2 diabetes after a first-ever noncardioembolic acute ischemic stroke (AIS). METHODS: This was a post hoc analysis of the Athens Stroke Outcome Project. Study outcomes included death, stroke recurrence, and a composite cardiovascular disease (CVD) end point (recurrent stroke, myocardial infarction, unstable angina, coronary revascularization, aortic aneurysm rupture, or sudden death)...
July 27, 2017: Journal of Stroke and Cerebrovascular Diseases: the Official Journal of National Stroke Association
https://www.readbyqxmd.com/read/28753533/role-of-traf3-in-neurological-and-cardiovascular-diseases-an-overview-of-recent-studies
#8
Natalia Cullell, Elena Muiño, Caty Carrera, Nuria Torres, Jerzy Krupinski, Israel Fernandez-Cadenas
Tumour necrosis factor receptor-associated factor 3 (TRAF3) is a member of the TRAF adaptor protein family, which exerts different effects on the cell depending on the receptor to which it binds and the cell type in which it is expressed. TRAF3 is a major regulator of the innate immune response. To perform its functions properly, TRAF3 is transcriptionally and epigenetically regulated. At the transcriptional level, TRAF3 expression has been associated with neurological and cardiovascular diseases including stroke, among other pathologies...
July 28, 2017: Biomolecular Concepts
https://www.readbyqxmd.com/read/28750372/contemporary-antiplatelet-treatment-in-acute-coronary-syndrome-patients-with-impaired-renal-function-undergoing-percutaneous-coronary-intervention
#9
Periklis Davlouros, Ioanna Xanthopoulou, John Goudevenos, Michalis Hamilos, Emmanouil Vavuranakis, George Sitafidis, Ioannis Kanakakis, Spyridon Deftereos, Dimitrios Alexopoulos
OBJECTIVES: To assess the clinical impact of impaired renal function (IRF), in "real-world" acute coronary syndrome (ACS) patients, receiving clopidogrel, prasugrel, or ticagrelor. METHODS: This was a prospective, observational, multicenter, cohort study of ACS patients undergoing percutaneous coronary interventions (PCI) with IRF (creatinine clearance <60 mL/min by Cockroft-Gault equation), who were recruited into the Greek Antiplatelet Registry (GRAPE). Patients were followed-up until 1 year for major adverse cardiovascular events (MACE; a composite of death, nonfatal myocardial infarction, urgent revascularization, and stroke) and BARC (Bleeding Academic Research Consortium) bleeding...
July 28, 2017: Cardiology
https://www.readbyqxmd.com/read/28727358/-antiplatelet-therapy-in-secondary-stroke-prevention
#10
Lorenz Hirt, Emmanuel Carrera
New studies have refined the role of antiplatelet therapy in secondary prevention after noncardioembolic strokes. The first line antiplatelet therapy remains Aspirin. Clopidogrel and the combination aspirine plus dipyridamole are suitable alternatives with a slightly better protection. Ticagrelor, a reversible P2Y12 receptor inhibitor used in cardiology, has not demonstrated its superiority to Aspirin. Early after stroke, a double antiplatelet therapy combining Aspirin and clopidogrel is increasingly administered as a recent study demonstrated a decrease in the incidence of cerebrovascular events after a minor stroke or high-risk TIA...
April 26, 2017: Revue Médicale Suisse
https://www.readbyqxmd.com/read/28721209/recent-advances-in-preventing-stroke-recurrence
#11
REVIEW
J David Spence
Recent advances in secondary stroke prevention include new evidence in hypertension, nutrition, anticoagulation, antiplatelet therapy, intracranial stenosis, percutaneous closure of patent foramen ovale, and lipid-lowering therapy. Individualized therapy for hypertension based on phenotyping with plasma renin and aldosterone markedly improves blood pressure control in patients with resistant hypertension. A Mediterranean diet can reduce the risk of stroke by nearly half. The diagnosis and treatment of metabolic vitamin B12 deficiency, and B vitamins to lower homocysteine, can reduce the risk of stroke by approximately 30%...
2017: F1000Research
https://www.readbyqxmd.com/read/28701574/antiplatelet-regimen-for-patients-with-breakthrough-strokes-while-on-aspirin-a-systematic-review-and-meta-analysis
#12
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
#13
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
#14
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-secondary-prevention-of-small-subcortical-strokes-trial-stroke-mortality-and-treatment-interactions
#15
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
OBJECTIVE: To characterize cerebral microbleeds (CMBs) in lacunar stroke patients in the Secondary Prevention of Small Subcortical Strokes (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 magnetic resonance imaging (MRI)-documented lacunar infarcts were randomly assigned in a factorial design to target levels of systolic blood pressure (130-149mmHg vs <130mmHg; 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
#16
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
#17
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...
September 2017: Therapeutic Advances in Cardiovascular Disease
https://www.readbyqxmd.com/read/28674626/implications-of-the-pegasus-timi-54-trial-for-us-clinical-practice
#18
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
#19
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
#20
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
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