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ANTIPLATELET AGENTS

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https://www.readbyqxmd.com/read/29339169/the-timing-of-p2y12-inhibitor-initiation-in-the-treatment-of-acs-does-the-evidence-exist-in-this-era
#1
REVIEW
Harsh Golwala, Deepak L Bhatt
The majority of acute coronary syndromes (ACS) are well characterized as a consequence of plaque rupture and subsequent thrombosis. Antiplatelet agents targeting inhibition of P2Y12 receptors on the platelets have shown to reduce future risk of cardiovascular events in this patient population. However, the timing of initiation of these agents, in particular, in patients managed with invasive strategy with percutaneous coronary interventions (PCI) is debatable. The data supporting pretreatment with antiplatelet agents prior to PCI in ACS patients dates to trials performed >15 years ago, wherein the time to PCI was >5 days, and henceforth, the utility of pretreatment with these agents in the contemporary era remains uncertain...
January 12, 2018: Progress in Cardiovascular Diseases
https://www.readbyqxmd.com/read/29338536/p2y12-receptor-inhibitors-an-evolution-in-drug-design-to-prevent-arterial-thrombosis
#2
Danny Kupka, Dirk Sibbing
P2Y12 inhibitors are a critical component of dual antiplatelet therapy (DAPT) - a combination of a P2Y12 receptor inhibitor and aspirin - which is the superior strategy to prevent arterial thrombosis in patients with acute coronary syndromes (ACS) and undergoing stent implantation. Areas covered: Basic science articles, clinical studies, and reviews from 1992-2017 were searched using Pubmed library to collet impactful literature. After an introduction to the purinergic receptor biology, this review summarizes current knowledge on P2Y12 receptor inhibitors including their specific pharmacodynamic as well as pharmacokinetic and drug interaction features...
January 17, 2018: Expert Opinion on Drug Metabolism & Toxicology
https://www.readbyqxmd.com/read/29336311/comparison-of-the-effects-of-p2y12-receptor-antagonists-on-platelet-function-and-clinical-outcomes-in-patients-undergoing-primary-pci-a-substudy-of-the-heat-ppci-trial
#3
Adeel Shahzad, Vikram Khanna, Ian Kemp, Matthew Shaw, Christine Mars, Robert Cooper, Keith Wilson, Nick Curzen, Rod H Stables
AIMS: The HEAT-PPCI trial compared bivalirudin and unfractionated heparin in patients undergoing Primary PCI. We report pre-specified, secondary analyses comparing the effects of P2Y12 inhibiting agents on platelet reactivity and clinical events. METHODS AND RESULTS: All patients received pre-procedural oral anti-platelet therapy. During the early stages of the trial, the P2Y12 inhibitor of choice was prasugrel with some use of clopidogrel. Later, routine therapy switched to ticagrelor...
January 16, 2018: EuroIntervention
https://www.readbyqxmd.com/read/29335786/anti-inflammatory-and-antiplatelet-effects-of-non-vitamin-k-antagonist-oral-anticoagulants-in-acute-phase-of-ischemic-stroke-patients
#4
Taizen Nakase, Junta Moroi, Tatsuya Ishikawa
BACKGROUND: Recently, non-vitamin K antagonist oral anticoagulants such as direct thrombin and direct factor Xa inhibitors have been prescribed for prevention of embolic stroke. While in Japan, argatroban, also a direct thrombin inhibitor, is available for the treatment of atherothrombotic stroke patients. This study aimed to explore whether there is any differences between direct thrombin and direct factor Xa inhibitors regarding the inhibiting effect against thrombogenesis in the clinical setting of acute ischemic stroke...
January 12, 2018: Clinical and Translational Medicine
https://www.readbyqxmd.com/read/29331946/management-of-patients-on-antithrombotic-agents-undergoing-emergency-and-elective-endoscopy-joint-asian-pacific-association-of-gastroenterology-apage-and-asian-pacific-society-for-digestive-endoscopy-apsde-practice-guidelines
#5
Francis K L Chan, Khean-Lee Goh, Nageshwar Reddy, Kazuma Fujimoto, Khek Yu Ho, Seiji Hokimoto, Young-Hoon Jeong, Takanari Kitazono, Hong Sik Lee, Varocha Mahachai, Kelvin K F Tsoi, Ming-Shiang Wu, Bryan P Yan, Kentaro Sugano
This Guideline is a joint official statement of the Asian Pacific Association of Gastroenterology (APAGE) and the Asian Pacific Society for Digestive Endoscopy (APSDE). It was developed in response to the increasing use of antithrombotic agents (antiplatelet agents and anticoagulants) in patients undergoing gastrointestinal (GI) endoscopy in Asia. After reviewing current practice guidelines in Europe and the USA, the joint committee identified unmet needs, noticed inconsistencies, raised doubts about certain recommendations and recognised significant discrepancies in clinical practice between different regions...
January 13, 2018: Gut
https://www.readbyqxmd.com/read/29329796/the-evolving-face-of-myocardial-reperfusion-in-acute-coronary-syndromes-a-primer-for-the-internist
#6
REVIEW
R Jay Widmer, Peter M Pollak, Malcolm R Bell, Bernard J Gersh, Nandan S Anavekar
Acute coronary syndromes (ACSs) account for a large proportion of disease burden in the United States and worldwide, and our understanding of ACS management continues to evolve. In this review we take a practical approach to evaluating and treating a patient with ACS, focusing on the optimal timing and methods of coronary reperfusion. Beginning with initial assessment and risk stratification, a provider managing the patient with ACS must be able to expeditiously decide on and implement the correct guideline-directed pathway to optimize outcomes...
January 9, 2018: Mayo Clinic Proceedings
https://www.readbyqxmd.com/read/29327938/glaucocalyxin-a-attenuates-the-activation-of-hepatic-stellate-cells-through-the-tgf-%C3%AE-1-smad-signaling-pathway
#7
Zhichao Dong, Qi Gao, Hao Guo
Glaucocalyxin A (GLA) is a biologically active ent-kauranoid diterpenoid isolated from Rabdosia japonica var. glaucocalyx. A large number of studies have shown that GLA possesses important pharmacological activities, such as anti-inflammatory, antitumor, antifibrosis, and antiplatelet activities. However, the role of GLA in the pathogenesis of liver fibrosis remains undefined. Therefore, the aim of this study was to investigate the effects of GLA on hepatic stellate cells (HSCs) activation/proliferation and migration in vitro and its possible mechanism in liver fibrosis...
January 12, 2018: DNA and Cell Biology
https://www.readbyqxmd.com/read/29326185/enhancing-prescribing-of-guideline-recommended-medications-for-ischaemic-heart-diseases-a-systematic-review-and-meta-analysis-of-interventions-targeted-at-healthcare-professionals
#8
Thang Nguyen, Hoa Q Nguyen, Niken N Widyakusuma, Thao H Nguyen, Tam T Pham, Katja Taxis
OBJECTIVES: Ischaemic heart diseases (IHDs) are a leading cause of death worldwide. Although prescribing according to guidelines improves health outcomes, it remains suboptimal. We determined whether interventions targeted at healthcare professionals are effective to enhance prescribing and health outcomes in patients with IHDs. METHODS: We systematically searched PubMed and EMBASE for studies published between 1 January 2000 and 31 August 2017. We included original studies of interventions targeted at healthcare professionals to enhance prescribing guideline-recommended medications for IHDs...
January 10, 2018: BMJ Open
https://www.readbyqxmd.com/read/29326015/ecchymosis-and-or-haematoma-formation-after-prophylactic-administration-of-subcutaneous-enoxaparin-in-the-abdomen-or-arm-of-the-critically-ill-patient
#9
R Jareño-Collado, M M Sánchez-Sánchez, M P Fraile-Gamo, N García-Crespo, S Barba-Aragón, H Bermejo-García, R Sánchez-Izquierdo, E I Sánchez-Muñoz, A López-López, S Arias-Rivera
INTRODUCTION: Ecchymosis and/or haematoma are the most common adverse events after subcutaneous administration of low molecular weight heparin. There is no strong recommendation as to the puncture site. OBJECTIVE: To evaluate the adverse events, ecchymosis and/or haematoma after the administration of prophylactic subcutaneous enoxaparin in the abdomen vs the arm in the critically ill patient. METHODOLOGY: A randomised, two-arm clinical trial (injection in the abdomen vs the arm), performed between July 2014 and January 2017, in an 18-bed, polyvalent intensive care unit...
January 8, 2018: Enfermería Intensiva
https://www.readbyqxmd.com/read/29325634/relationship-of-aging-and-incident%C3%A2-comorbidities-to-stroke-risk-in-patients%C3%A2-with-atrial-fibrillation
#10
Tze-Fan Chao, Gregory Y H Lip, Chia-Jen Liu, Yenn-Jiang Lin, Shih-Lin Chang, Li-Wei Lo, Yu-Feng Hu, Ta-Chuan Tuan, Jo-Nan Liao, Fa-Po Chung, Tzeng-Ji Chen, Shih-Ann Chen
BACKGROUND: When assessing ischemic stroke risk in patients with atrial fibrillation (AF), the CHA2DS2-VASc score is calculated based on the baseline risk factors, and the outcomes are determined after a follow-up period. However, the stroke risk in patients with AF does not remain static, and with time, patients get older and accumulate more comorbidities. OBJECTIVES: This study hypothesized that the "Delta CHA2DS2-VASc score," which reflects the change in score between baseline and follow-up, would be more predictive of ischemic stroke compared with the baseline CHA2DS2-VASc score...
January 16, 2018: Journal of the American College of Cardiology
https://www.readbyqxmd.com/read/29322692/patient-characteristics-associated-with-treatment-response-in-patients-receiving-salvianolate-injection-for-stable-angina
#11
Yana Qi, Chuan Yu, Li Tang, Sheyu Li, Xin Sun
OBJECTIVE: To explore patient characteristics associated with treatment response in patients receiving salvianolate injection for stable angina. METHODS: An analysis was conducted of data from a multicenter, phase IV clinical trial undertaken in China that enrolled 2150 patients hospitalized for stable angina from 50 hospitals. The treatment outcomes were changes of angina severity and nitroglycerin use between baseline and the last day of treatment. We used logistic regression models to explore patient characteristics associated with the treatment response...
January 11, 2018: Journal of Evidence-based Medicine
https://www.readbyqxmd.com/read/29321066/perioperative-management-of-antiplatelet-therapy-in-patients-undergoing-non-cardiac-surgery-following-coronary-stent-placement-a-systematic-review
#12
Christopher P Childers, Melinda Maggard-Gibbons, Jesus G Ulloa, Ian T MacQueen, Isomi M Miake-Lye, Roberta Shanman, Selene Mak, Jessica M Beroes, Paul G Shekelle
BACKGROUND: The correct perioperative management of antiplatelet therapy (APT) in patients undergoing non-cardiac surgery (NCS) is often debated by clinicians. American College of Cardiology (ACC) and American Heart Association (AHA) guidelines recommend postponing elective NCS at least 3 months after stent implantation. Regardless of the timing of surgery, ACC/AHA guidelines recommend continuing at least ASA throughout the perioperative period and ideally continuing dual APT (DAPT) therapy "unless surgery demands discontinuation...
January 10, 2018: Systematic Reviews
https://www.readbyqxmd.com/read/29319492/risk-of-complications-with-use-of-aspirin-during-renal-biopsy-a-systematic-review
#13
Vinayak Kumar, Matthew D Mitchell, Craig A Umscheid, Jeffrey S Berns, Jonathan J Hogan
BACKGROUND: Bleeding is a well-known complication of percutaneous renal biopsy (PRB). Thus, antiplatelet agents are routinely held for most patients undergoing elective PRB to decrease bleeding risk. MATERIALS AND METHODS: In this systematic review, we examine the association between antiplatelet use and bleeding during PRB. MEDLINE and EMBASE were searched from inception to December 2016 using terms that included "renal biopsy", "antiplatelet","aspirin", and "bleeding"...
January 10, 2018: Clinical Nephrology
https://www.readbyqxmd.com/read/29315941/thromboembolic-prophylaxis-protocol-with-warfarin-after-radiofrequency-catheter-ablation-of-infarct-related-ventricular-tachycardia
#14
Konstantinos C Siontis, Sina Jamé, Ghaith Sharaf Dabbagh, Rakesh Latchamsetty, Krit Jongnarangsin, Fred Morady, Frank M Bogun
INTRODUCTION: Ablation in the left ventricle (LV) is associated with a risk of thromboembolism. There are limited data on the use of specific thromboembolic prophylaxis strategies post-ablation. We aimed to evaluate a thromboembolic prophylaxis protocol after ventricular tachycardia (VT) ablation. METHODS AND RESULTS: The index procedures of 217 patients undergoing ablation for infarct-related VT with open irrigated-tip catheters were included. Patients with large LV endocardial ablation area (> 3 cm between ablation lesions) were started on low-dose, slowly escalating unfractionated heparin (UFH) infusion 8 hours after access hemostasis, followed by 3 months of anticoagulation...
January 9, 2018: Journal of Cardiovascular Electrophysiology
https://www.readbyqxmd.com/read/29309950/management-of-antiplatelet-therapy-in-patients-undergoing-elective-invasive-procedures-proposals-from-the-french-working-group-on-perioperative-hemostasis-gihp-and-the-french-study-group-on-thrombosis-and-hemostasis-gfht-in-collaboration-with-the-french-society
#15
Anne Godier, Pierre Fontana, Serge Motte, Annick Steib, Fanny Bonhomme, Sylvie Schlumberger, Thomas Lecompte, Nadia Rosencher, Sophie Susen, André Vincentelli, Yves Gruel, Pierre Albaladejo, Jean-Philippe Collet
The French Working Group on Perioperative Hemostasis (GIHP) and the French Study Group on Hemostasis and Thrombosis (GFHT) in collaboration with the French Society for Anesthesia and Intensive Care (SFAR) drafted up-to-date proposals for the management of antiplatelet therapy in patients undergoing elective invasive procedures. The proposals were discussed and validated by a vote; all proposals but one could be assigned with a high strength. The management of antiplatelet therapy is based on their indication and the procedure...
January 5, 2018: Anaesthesia, Critical Care & Pain Medicine
https://www.readbyqxmd.com/read/29304263/the-prevalence-of-adverse-ocular-hemorrhagic-events-in-patients-utilizing-oral-anticoagulant-and-antiplatelet-therapy-in-routine-clinical-practice
#16
Dattanand M Sudarshana, Eleni K Konstantinou, Sruthi Arepalli, Fabiana Q Silva, Andrew P Schachat, Justis P Ehlers, Rishi P Singh
BACKGROUND AND OBJECTIVE: Previous literature assessing ocular hemorrhagic complications of anticoagulant/antiplatelet medications in routine clinical practice is limited. This study evaluates the prevalence of spontaneous ocular hemorrhagic events associated with anticoagulation/antiplatelet therapy. PATIENTS AND METHODS: A retrospective study was performed to identify patients taking anticoagulants (rivaroxaban [Xarelto; Janssen Pharmaceuticals, Beerse, Belgium], bivalirudin [Angiomax; The Medicines Company, Parsippany, NJ], lepirudin [Refludan; Bayer HealthCare Pharmaceuticals, Berlin, Germany], dabigatran [Pradaxa; Boehringer Ingelheim, Ingelheim am Rhein, Germany], and argatroban) and antiplatelet agents (clopidogrel [Plavix; Bristol-Myers Squibb, New York City, NY], prasugrel [Effient; Lilly Medical, Indianapolis, IN], and ticagrelor [Brilinta; AstraZeneca, Cambridge, UK]) who presented for an eye examination...
January 1, 2018: Ophthalmic Surgery, Lasers & Imaging Retina
https://www.readbyqxmd.com/read/29302213/cilostazol-attenuates-kainic-acid-induced-hippocampal-cell-death
#17
Young-Seop Park, Zhen Jin, Eun Ae Jeong, Chin-Ok Yi, Jong Youl Lee, In Sung Park, Gu Seob Roh
Cilostazol is a selective inhibitor of type 3 phosphodiesterase (PDE3) and has been widely used as an antiplatelet agent. Cilostazol mediates this activity through effects on the cyclic adenosine monophosphate (cAMP) signaling cascade. Recently, it has attracted attention as a neuroprotective agent. However, little is known about cilostazol's effect on excitotoxicity induced neuronal cell death. Therefore, this study evaluated the neuroprotective effect of cilostazol treatment against hippocampal neuronal damage in a mouse model of kainic acid (KA)-induced neuronal loss...
January 2018: Korean Journal of Physiology & Pharmacology
https://www.readbyqxmd.com/read/29297508/current-and-future-antiplatelet-therapies-emphasis-on-preserving-haemostasis
#18
REVIEW
James D McFadyen, Mathieu Schaff, Karlheinz Peter
Antiplatelet drugs, such as aspirin, P2Y12 antagonists, and glycoprotein (GP) IIb/IIIa inhibitors, have proved to be successful in reducing the morbidity and mortality associated with arterial thrombosis. These agents are, therefore, the cornerstone of therapy for patients with acute coronary syndromes. However, these drugs all carry an inherent risk of bleeding, which is associated with adverse cardiovascular outcomes and mortality. Thus, the potential benefits of more potent, conventional antiplatelet drugs are likely be offset by the increased risk of bleeding...
January 3, 2018: Nature Reviews. Cardiology
https://www.readbyqxmd.com/read/29296881/recurrent-thrombosis-in-patients-with-antiphospholipid-antibodies-and-arterial-thrombosis-on-antithrombotic-therapy
#19
William G Jackson, Clara Oromendia, Ozan Unlu, Doruk Erkan, Maria T DeSancho
Management for patients with antiphospholipid syndrome (APS) and arterial thrombosis is controversial. There are no prospective data demonstrating the superiority of high- or moderate-intensity anticoagulation with vitamin K antagonists over antiplatelet agents. Using 2 antiphospholipid antibody databases (single center [New York Presbyterian Hospital] and multicenter [Antiphospholipid Syndrome Alliance for Clinical Trials and International Networking]), we retrospectively collected demographic and clinical data of patients with APS and arterial thrombosis...
November 28, 2017: Blood Advances
https://www.readbyqxmd.com/read/29296791/fibrin-and-d-dimer-bind-to-monomeric-gpvi
#20
Marie-Blanche Onselaer, Alexander T Hardy, Clare Wilson, Ximena Sanchez, Amir K Babar, Jeanette L C Miller, Callum N Watson, Stephanie K Watson, Arkadiusz Bonna, Helen Philippou, Andrew B Herr, Diego Mezzano, Robert A S Ariëns, Steve P Watson
Fibrin has recently been shown to activate platelets through the immunoglobulin receptor glycoprotein VI (GPVI). In the present study, we show that spreading of human platelets on fibrin is abolished in patients deficient in GPVI, confirming that fibrin activates human platelets through the immunoglobulin receptor. Using a series of proteolytic fragments, we show that D-dimer, but not the E fragment of fibrin, binds to GPVI and that immobilized D-dimer induces platelet spreading through activation of Src and Syk tyrosine kinases...
August 22, 2017: Blood Advances
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