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https://www.readbyqxmd.com/read/28635374/sepsis-favors-high-on-clopidogrel-platelet-reactivity
#1
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
#2
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
#3
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
#4
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
#5
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
#6
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
#7
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
https://www.readbyqxmd.com/read/28606584/impact-of-a-modified-anti-thrombotic-guideline-on-stroke-in-children-supported-with-a-pediatric-ventricular-assist-device
#8
David N Rosenthal, Chacy A Lancaster, Doff B McElhinney, Sharon Chen, MaryLyn Stein, Aileen Lin, Lan Doan, Jenna M Murray, Mary Alice Gowan, Katsuhide Maeda, Olaf Reinhartz, Christopher S Almond
BACKGROUND: Stroke is the most feared complication associated with the Berlin Heart EXCOR pediatric ventricular assist device (VAD), the most commonly used VAD in children, and affects 1 in 3 children. We sought to determine whether a modified anti-thrombotic guideline, involving more intense platelet inhibition and less reliance on platelet function testing, is associated with a lower incidence of stroke. METHODS: All children supported with the EXCOR at Stanford from 2009 to 2014 were divided into 2 cohorts based on the primary anti-thrombotic guideline used to prevent pump thrombosis: (1) the Edmonton Anti-thrombotic Guideline (EG) cohort, which included children implanted before September 2012 when dual anti-platelet therapy was used with doses titrated to Thromboelastrography/PlateletMapping (TEG/PM); and (2) the Stanford Modified Anti-thrombotic Guideline (SG) cohort, which included children implanted on or after September 2012 when triple anti-platelet therapy was used routinely and where doses were uptitrated to high, weight-based dosing targets, with low-dose steroids administered as needed for inflammation...
May 20, 2017: Journal of Heart and Lung Transplantation
https://www.readbyqxmd.com/read/28606562/the-efficacy-and-safety-of-3-types-of-interventions-for-stroke-prevention-in-patients-with-cardiovascular-and-cerebrovascular-diseases-a-network-meta-analysis
#9
Qian Sun, Shumei Chang, Songtao Lu, Yajing Zhang, Yajun Chang
PURPOSE: The goal of this study was to compare the relative efficacy and safety of different types of interventions for stroke prevention in patients with cardiovascular and cerebrovascular diseases. METHODS: This network meta-analysis (NMA) was conducted with a random effects model of Bayesian framework using Stata version 12.0. Odds ratios (ORs) and their credible intervals (CrIs) were applied for the efficacy and safety evaluation of various medical interventions, including aspirin, dipyridamole, ticlopidine, warfarin, and apixaban...
June 10, 2017: Clinical Therapeutics
https://www.readbyqxmd.com/read/28598510/relative-efficacy-and-safety-of-ticagelor-vs-clopidogrel-as-a-function-of-time-to-invasive-management-in-non-st-segment-elevation-acute-coronary-syndrome-in-the-plato-trial
#10
Charles V Pollack, Farideh Davoudi, Deborah B Diercks, Richard C Becker, Stefan K James, Soo Teik Lim, Phillip J Schulte, Jindrich Spinar, Philippe Gabriel Steg, Robert F Storey, Anders Himmelmann, Lars Wallentin, Christopher P Cannon
BACKGROUND: Guidelines suggest that "upstream" P2Y12 receptor antagonists should be considered in patients with non-ST-segment elevation acute coronary syndromes (NSTE-ACS). HYPOTHESIS: Early use of ticagrelor in patients managed with an invasive strategy would be more effective than clopidogrel because of its more rapid onset of action and greater potency. METHODS: In the PLATO trial, 6792 NSTE-ACS patients were randomized to ticagrelor or clopidogrel (started prior to angiography) and underwent angiography within 72 hours of randomization...
June 9, 2017: Clinical Cardiology
https://www.readbyqxmd.com/read/28584203/current-use-of-oral-anticoagulants-and-prognostic-analysis-in-patients-with-atrial-fibrillation-undergoing-coronary-stenting
#11
Heng-Bo Zhai, Jun Liu, Zhi-Chao Dong, Dong-Xia Wang, Bo Zhang
BACKGROUND: It is currently believed that triple oral antithrombotic therapy in patients with atrial fibrillation (AF) after percutaneous coronary intervention (PCI) should be recommended if there are no contraindications. However, selecting triple therapy for AF patients undergoing PCI is still challenging when bleeding risk is considered. This study aimed to investigate the current use of oral anticoagulants (Vitamin K antagonists [VKA]) and perform prognostic analysis in real-world patients with AF undergoing coronary stenting...
June 20, 2017: Chinese Medical Journal
https://www.readbyqxmd.com/read/28577683/use-of-prasugrel-vs-clopidogrel-and-outcomes-in-patients-with-acute-coronary-syndrome-undergoing-percutaneous-coronary-intervention-in-contemporary-clinical-practice-results-from-the-prometheus-study
#12
Usman Baber, Samantha Sartori, Melissa Aquino, Annapoorna Kini, Samir Kapadia, Sandra Weiss, Craig Strauss, J Brent Muhlestein, Catalin Toma, Sunil V Rao, Anthony DeFranco, Kanhaiya L Poddar, Jaya Chandrasekhar, William Weintraub, Timothy D Henry, Sameer Bansilal, Brian A Baker, Elizabeth Marrett, Stuart Keller, Mark Effron, Stuart Pocock, Roxana Mehran
BACKGROUND AND OBJECTIVES: We sought to determine the frequency of use and association between prasugrel and outcomes in acute coronary syndrome patients undergoing percutaneous coronary intervention (PCI) in clinical practice. METHODS: PROMETHEUS was a multicenter observational registry of acute coronary syndrome patients undergoing PCI from 8 centers in the United States that maintained a prospective PCI registry for patient outcomes. The primary end points were major adverse cardiovascular events at 90days, a composite of all-cause death, nonfatal myocardial infarction, stroke, or unplanned revascularization...
June 2017: American Heart Journal
https://www.readbyqxmd.com/read/28577671/dual-antiplatelet-therapy-in-patients-with-diabetes-and-acute-coronary-syndromes-managed-without-revascularization
#13
Anthony J Dalby, Shmuel Gottlieb, Derek D Cyr, Erik Magnus Ohman, Darren K McGuire, Witold Ruzyllo, Deepak L Bhatt, Stephen D Wiviott, Kenneth J Winters, Keith A A Fox, Paul W Armstrong, Harvey D White, Dorairaj Prabhakaran, Matthew T Roe
OBJECTIVE: Patients with diabetes mellitus (DM) presenting with acute coronary syndrome (ACS) and undergoing percutaneous coronary intervention (PCI) derived enhanced benefit with dual antiplatelet therapy (DAPT) with prasugrel vs. clopidogrel. The risk profile and treatment response to DAPT for medically managed ACS patients with DM remains uncertain. METHODS: The TRILOGY ACS trial compared aspirin + prasugrel vs. aspirin + clopidogrel for up to 30months in non-ST-segment elevation (NSTE) ACS patients managed medically without revascularization...
June 2017: American Heart Journal
https://www.readbyqxmd.com/read/28577670/cangrelor-reduces-the-risk-of-ischemic-complications-in-patients-with-single-vessel-and-multi-vessel-disease-undergoing-percutaneous-coronary-intervention-insights-from-the-champion-phoenix-trial
#14
Freddy Abnousi, Vandana Sundaram, Celina M Yong, Jayne Prats, Efthymios N Deliargyris, Gregg W Stone, Christian W Hamm, Philippe Gabriel Steg, Charles Michael Gibson, Harvey D White, Matthew J Price, Philippe Généreux, Manisha Desai, Lingyao Yang, Victoria Y Ding, Robert A Harrington, Deepak L Bhatt, Kenneth W Mahaffey
OBJECTIVE: To examine the safety and efficacy of cangrelor in patients with single-vessel disease (SVD) and multi-vessel disease (MVD). BACKGROUND: Cangrelor, an intravenous, rapidly acting P2Y12 inhibitor, is superior to clopidogrel in reducing ischemic events among patients receiving percutaneous coronary intervention (PCI). METHODS: We studied a modified intention to treat population of patients with SVD and MVD from the CHAMPION PHOENIX trial...
June 2017: American Heart Journal
https://www.readbyqxmd.com/read/28576652/platelet-function-testing-in-patients-with-acute-ischemic-stroke-an-observational-study
#15
Francesca Rosafio, Nicoletta Lelli, Stefano Mimmi, Laura Vandelli, Guido Bigliardi, Maria Luisa Dell'Acqua, Livio Picchetto, Roberta Pentore, Diana Ferraro, Tommaso Trenti, Paolo Nichelli, Andrea Zini
BACKGROUND: The measurement of platelet reactivity in patients with stroke undergoing antiplatelet therapies is not commonly performed in clinical practice. We assessed the prevalence of therapy responsiveness in patients with stroke and further investigated differences between patients on prevention therapy at stroke onset and patients naive to antiplatelet medications. We also sought differences in responsiveness between etiological subtypes and correlations between Clopidogrel responsiveness and genetic polymorphisms...
May 30, 2017: Journal of Stroke and Cerebrovascular Diseases: the Official Journal of National Stroke Association
https://www.readbyqxmd.com/read/28576388/safety-and-efficacy-of-prasugrel-and-ticagrelor-in-acute-coronary-syndrome-results-of-a-real-world-multicenter-registry
#16
Manuel Almendro-Delia, Ángel García-Alcántara, M Victoria de la Torre-Prados, Antonio Reina-Toral, José Andrés Arboleda-Sánchez, Michel Butrón-Calderón, Alberto García-Guerrero, Rafael de la Chica-Ruiz Ruano, Rafael Hidalgo-Urbano, Juan C García-Rubira
INTRODUCTION AND OBJECTIVES: The incorporation of the new antiplatelet agents (NAA) prasugrel and ticagrelor into routine clinical practice is irregular and data from the "real world" remain scarce. We aimed to assess the time trend of NAA use and the clinical safety and efficacy of these drugs compared with those of clopidogrel in a contemporary cohort of patients with acute coronary syndromes (ACS). METHODS: A multicenter retrospective observational study was conducted in patients with ACS admitted to coronary care units and prospectively included in the ARIAM-Andalusia registry between 2013 and 2015...
May 30, 2017: Revista Española de Cardiología
https://www.readbyqxmd.com/read/28572281/recurrent-stroke-in-minor-ischemic-stroke-or-transient-ischemic-attack-with-metabolic-syndrome-and-or-diabetes-mellitus
#17
Weiqi Chen, Yuesong Pan, Jing Jing, Xingquan Zhao, Liping Liu, Xia Meng, Yilong Wang, Yongjun Wang
BACKGROUND: We aimed to determine the risk conferred by metabolic syndrome (METS) and diabetes mellitus (DM) to recurrent stroke in patients with minor ischemic stroke or transient ischemic attack from the CHANCE (Clopidogrel in High-risk patients with Acute Non-disabling Cerebrovascular Events) trial. METHODS AND RESULTS: In total, 3044 patients were included. Patients were stratified into 4 groups: neither, METS only, DM only, or both. METS was defined using the Chinese Diabetes Society (CDS) and International Diabetes Foundation (IDF) definitions...
June 1, 2017: Journal of the American Heart Association
https://www.readbyqxmd.com/read/28567087/antiplatelet-therapy-combinations-and-thrombogenicity-in-patients-with-non-valvular-atrial-fibrillation
#18
Yongwhi Park, Kye Hwan Kim, Min Gyu Kang, Jong-Hwa Ahn, Jeong Yoon Jang, Hyun Woong Park, Jin-Sin Koh, Jeong-Rang Park, Seok-Jae Hwang, Young-Hoon Jeong, Jin-Yong Hwang, Hye Ryun Lee, Choong Hwan Kwak
BACKGROUND AND OBJECTIVES: Combination antiplatelet therapy reduces the risk of ischemic stroke compared with aspirin monotherapy in non-valvular atrial fibrillation (NVAF) patients. The underlying mechanism, however, remains unclear. In addition, the association between platelet inhibition and thrombogenicity in NVAF has not been evaluated. SUBJECTS AND METHODS: We randomized 60 patients with NVAF that were taking 100 mg of aspirin daily (>1 month) to adding 75 mg of clopidogrel daily (CLPD group), 100 mg of cilostazol twice daily (CILO group), or 1000 mg of omega-3 polyunsaturated fatty acid twice daily (PUFA group)...
May 2017: Korean Circulation Journal
https://www.readbyqxmd.com/read/28545073/the-clinical-efficacy-and-safety-evaluation-of-ticagrelor-for-acute-coronary-syndrome-in-general-acs-patients-and-diabetic-patients-a-systematic-review-and-meta-analysis
#19
Qiutong Tan, Xin Jiang, Sichao Huang, Tiantian Zhang, Lin Chen, Siwen Xie, Enpan Mo, Jun Xu, Shaohui Cai
OBJECTIVE: In this study, a systematic evaluation was conducted to estimate the efficacy and safety of ticagrelor for treating acute coronary syndrome (ACS) in general ACS patients and a diabetes mellitus (DM) group. METHODS: A search of PubMed, Cochrane Central Register of Controlled Trials, Web of Science, CNKI databases was conducted to analyze relevant randomized controlled trails (RCTs) of ticagrelor treating ACS during 2007 to 2015. Article screening, quality accessing and data extracting was independently undertaken by two reviewers...
2017: PloS One
https://www.readbyqxmd.com/read/28538402/dissection-extending-from-extra-to-intracranial-arteries-a-case-report-of-progressive-ischemic-stroke
#20
Fu-Liang Zhang, Zhen-Ni Guo, Yang Liu, Yun Luo, Yi Yang
RATIONALE: Cervicocephalic artery dissections, once considered a rare disease, have become increasingly recognized as a cause of stroke in young and middle-aged individuals. Early diagnosis is mandatory because anticoagulation or antithrombotic therapy can help prevent primary or secondary ischemic events. However, the diagnosis is still a crucial challenge for radiologists and neurologists. PATIENT CONCERNS: We reported a rare case of 33-year-old patient with progressive ischemic stroke due to dissection from an intimal tear in the right proximal internal carotid artery to distal middle cerebral artery...
May 2017: Medicine (Baltimore)
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