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https://www.readbyqxmd.com/read/28938240/atrial-fibrillation-bleeding-and-coronary-intervention-current-recommendations
#1
Serdar Farhan, Roxana Mehran
The patient population with the need for oral anticoagulation to reduce stroke risk associated with atrial fibrillation (AF) and dual antiplatelet therapy to prevent stent thrombosis and myocardial infarction after percutaneous coronary intervention is increasing. However, patients treated with a triple therapy consisting of oral anticoagulation, aspirin, and a P2Y12 inhibitor have been demonstrated to be at high bleeding risk. The best combination of these agents and the duration of the different therapies are still uncertain...
September 21, 2017: Coronary Artery Disease
https://www.readbyqxmd.com/read/28931024/formal-comment-to-toyota-et-al-short-versus-prolonged-dual-antiplatelet-therapy-dapt-duration-after-coronary-stent-implantation-a-comparison-between-the-dapt-study-and-9-other-trials-evaluating-dapt-duration
#2
https://www.readbyqxmd.com/read/28931015/short-versus-prolonged-dual-antiplatelet-therapy-dapt-duration-after-coronary-stent-implantation-a-comparison-between-the-dapt-study-and-9-other-trials-evaluating-dapt-duration
#3
Toshiaki Toyota, Hiroki Shiomi, Takeshi Morimoto, Masahiro Natsuaki, Takeshi Kimura
AIMS: The Dual Antiplatelet Therapy (DAPT) study demonstrated that DAPT beyond 1-year after drug-eluting stent (DES) implantation, as compared with aspirin therapy alone, significantly reduced the risk of major cardiovascular and cerebrovascular events, which was mainly driven by the large risk reduction for myocardial infarction (MI). We sought to compare the largest DAPT study with other trials evaluating DAPT durations after DES implantation. METHODS AND RESULTS: By a systematic literature search, we identified 9 trials comparing prolonged- versus short-DAPT in addition to the DAPT study...
2017: PloS One
https://www.readbyqxmd.com/read/28923692/polymer-free-biolimus-a9-coated-stents-in-the-treatment-of-de-novo-coronary-lesions-with-short-dapt-9-month-angiographic-and-clinical-follow-up-of-the-prospective-multicenter-biofreedom-usa-clinical-trial
#4
Ron Waksman, Guy N Piegari, Ameer Kabour, Louis Cannon, John Wang, George Adams, Naresh Solankhi, Anthony Smeglin, Dean J Kereiakes, Roy Leiboff, Mia-Ashley Spad, Rebecca Torguson, Nina Chandra, Roshni Bastian, Jolanda DeGroot, Margaret W Kayo, Hans-Peter Stoll, Hector M Garcia-Garcia
BACKGROUND: BioFreedom is a polymer- and carrier-free drug-coated stent that delivers Biolimus A9 to the vessel wall. Our purpose was to evaluate the efficacy and safety of this DCS in patients with short-duration dual antiplatelet therapy. METHODS: The BioFreedom US IDE feasibility trial was a single-arm, open-label, prospective study of patients requiring stenting of de novo lesions. Patients received 3 months of DAPT, repeat angiography at 9 months, and clinical follow-up at multiple intervals...
July 31, 2017: Cardiovascular Revascularization Medicine: Including Molecular Interventions
https://www.readbyqxmd.com/read/28895303/coronary-angiography-with-or-without-percutaneous-coronary-intervention-in-patients-with-hemophilia-systematic-review
#5
Christian Boehnel, Hans Rickli, Lukas Graf, Micha T Maeder
OBJECTIVES: We aimed to summarize the evidence for periprocedural and long-term strategies to both minimize the bleeding risk and ensure sufficient anticoagulation and antiaggregation in hemophilia patients undergoing coronary angiography with or without percutaneous coronary interventions (PCI). BACKGROUND: Hemophilia patients undergoing coronary angiography and PCI are at risk of bleeding due to deficiency of the essential clotting factors VIII or IX combined with the need of peri-interventional anticoagulation and antiaggregation and dual antiplatelet therapy (DAPT) after PCI...
September 12, 2017: Catheterization and Cardiovascular Interventions
https://www.readbyqxmd.com/read/28855078/guided-de-escalation-of-antiplatelet-treatment-in-patients-with-acute-coronary-syndrome-undergoing-percutaneous-coronary-intervention-tropical-acs-a-randomised-open-label-multicentre-trial
#6
Dirk Sibbing, Dániel Aradi, Claudius Jacobshagen, Lisa Gross, Dietmar Trenk, Tobias Geisler, Martin Orban, Martin Hadamitzky, Béla Merkely, Róbert Gábor Kiss, András Komócsi, Csaba A Dézsi, Lesca Holdt, Stephan B Felix, Radoslaw Parma, Mariusz Klopotowski, Robert H G Schwinger, Johannes Rieber, Kurt Huber, Franz-Josef Neumann, Lukasz Koltowski, Julinda Mehilli, Zenon Huczek, Steffen Massberg
BACKGROUND: Current guidelines recommend potent platelet inhibition with prasugrel or ticagrelor for 12 months after an acute coronary syndrome managed with percutaneous coronary intervention (PCI). However, the greatest anti-ischaemic benefit of potent antiplatelet drugs over the less potent clopidogrel occurs early, while most excess bleeding events arise during chronic treatment. Hence, a stage-adapted treatment with potent platelet inhibition in the acute phase and de-escalation to clopidogrel in the maintenance phase could be an alternative approach...
August 25, 2017: Lancet
https://www.readbyqxmd.com/read/28853033/dual-antiplatelet-therapy-duration-reconciling-the-inconsistencies
#7
REVIEW
Francesco Costa, Stephan Windecker, Marco Valgimigli
Dual antiplatelet therapy (DAPT) prevents recurrent ischemic events after an acute coronary syndrome (ACS) as well as stent thrombosis (ST) in patients with prior stent implantation. Nevertheless, these benefits are counterbalanced by a significant bleeding hazard, which is directly related to the treatment duration. Although DAPT has been extensively studied in numerous clinical trials, optimal treatment duration is still debated, mostly because of apparent inconsistencies among studies. Shortened treatment duration of 6 or 3 months was shown to mitigate bleeding risk compared with consensus-grounded 12-month standard duration, without any apparent excess of ischemic events...
August 29, 2017: Drugs
https://www.readbyqxmd.com/read/28844033/state-of-the-art-duration-of-dual-antiplatelet-therapy-after-percutaneous-coronary-intervention-and-coronary-stent-implantation-past-present-and-future-perspectives
#8
Giuseppe Gargiulo, Marco Valgimigli, Davide Capodanno, John A Bittl
Evidence from studies published more than 10 years ago suggested that patients receiving first-generation drug-eluting stents (DES) needed dual antiplatelet therapy (DAPT) for at least 12 months. Current evidence from randomised controlled trials (RCT) reported within the past five years suggests that patients with stable ischaemic heart disease who receive newer-generation DES need DAPT for a minimum of three to six months. Patients who undergo stenting for an acute coronary syndrome benefit from DAPT for at least 12 months, but a Bayesian network meta-analysis confirms that extending DAPT beyond 12 months confers a trade-off between reduced ischaemic events and increased bleeding...
August 25, 2017: EuroIntervention
https://www.readbyqxmd.com/read/28838471/risk-of-early-adverse-events-after-clopidogrel-discontinuation-in-patients-undergoing-short-term-dual%C3%A2-antiplatelet%C3%A2-therapy-an-individual-participant-data-analysis
#9
Raffaele Piccolo, Fausto Feres, Alexandre Abizaid, Martine Gilard, Marie-Claude Morice, Myeong-Ki Hong, Hyo-Soo Kim, Antonio Colombo, Deepak L Bhatt, Tullio Palmerini, Gregg W Stone, Stephan Windecker, Marco Valgimigli
OBJECTIVES: The study sought to evaluate the presence of a clinically relevant rebound phenomenon after dual antiplatelet therapy (DAPT) discontinuation in randomized trials. BACKGROUND: It is currently unknown whether clopidogrel discontinuation after short-term DAPT is associated with an early hazard of ischemic events. METHODS: The authors performed an individual participant data analysis and aggregate meta-analysis. The primary outcome was major adverse cardiac and cerebrovascular events (MACCE), defined as the composite of cardiac death, myocardial infarction (MI), or stroke...
August 28, 2017: JACC. Cardiovascular Interventions
https://www.readbyqxmd.com/read/28823143/stent-thrombosis-and-optimal-duration-of-dual-antiplatelet-therapy-after-coronary-stenting-in-contemporary-practice
#10
REVIEW
Min Soo Cho, Duk-Woo Park
The introduction of drug-eluting stents (DES) in the practice of percutaneous coronary intervention (PCI) has substantially reduced angiographic and clinical restenosis but is associated with an increasing propensity for very late stent thrombosis (ST). Among several clinical, lesion, or procedure-related predictors of ST, early discontinuation of dual antiplatelet therapy (DAPT) is the most important factor for DES-associated late thrombosis; therefore, the optimal duration of DAPT is a major issue to be critically considered in the current DES era...
September 2017: Korean Journal of Internal Medicine
https://www.readbyqxmd.com/read/28818058/evaluation-of-therapy-management-and-outcome-in-takotsubo-syndrome
#11
Nadine Abanador-Kamper, Lars Kamper, Judith Wolfertz, Witali Pomjanski, Anamaria Wolf-Pütz, Melchior Seyfarth
BACKGROUND: To date there is no validated evidence for standardized treatment of patients with Takotsubo syndrome (TTS). Medication therapy after final TTS diagnosis remains unclear. Previous data on patient outcome is ambivalent. Aim of this study was to evaluate medication therapy in TTS and to analyze patient outcome. METHODS: Within an observational retrospective cohort study we analyzed our medical records and included 72 patients with TTS that underwent cardiovascular magnetic resonance imaging (CMR) after a median of 2 days interquartile range (IQR 1-3...
August 17, 2017: BMC Cardiovascular Disorders
https://www.readbyqxmd.com/read/28806755/acquired-von-willebrand-syndrome-in-cardiogenic-shock-patients-on-mechanical-circulatory-microaxial-pump-support
#12
Ulrike Flierl, Jörn Tongers, Dominik Berliner, Jan-Thorben Sieweke, Florian Zauner, Christoph Wingert, Christian Riehle, Johann Bauersachs, Andreas Schäfer
Early use of mechanical circulatory support, e.g. veno-arterial extracorporeal membrane oxygenation (ECMO) or left ventricular unloading by microaxial pump in refractory cardiogenic shock is recommended in current guidelines. Development of acquired von Willebrand Syndrome (AVWS) in patients with left ventricular assist devices (LVADs) and ECMO has been reported. There is an increasing number of patients treated with the Impella® CP microaxial pump for left ventricular unloading. However, the prevalence of AVWS in these high risk patients is unknown and needs to be determined...
2017: PloS One
https://www.readbyqxmd.com/read/28798016/bayesian-analysis-a-practical-approach-to-interpret-clinical-trials-and-create-clinical-practice-guidelines
#13
John A Bittl, Yulei He
Bayesian analysis is firmly grounded in the science of probability and has been increasingly supplementing or replacing traditional approaches based on P values. In this review, we present gradually more complex examples, along with programming code and data sets, to show how Bayesian analysis takes evidence from randomized clinical trials to update what is already known about specific treatments in cardiovascular medicine. In the example of revascularization choices for diabetic patients who have multivessel coronary artery disease, we combine the results of the FREEDOM trial (Future Revascularization Evaluation in Patients with Diabetes Mellitus: Optimal Management of Multivessel Disease) with prior probability distributions to show how strongly we should believe in the new Class I recommendation ("should be done") for a preference of bypass surgery over percutaneous coronary intervention...
August 2017: Circulation. Cardiovascular Quality and Outcomes
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
#14
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/28780077/individualized-antiplatelet-therapy-after-drug-eluting-stent-deployment-implication-of-clinical-trials-of-different-durations-of-dual-antiplatelet-therapy
#15
REVIEW
Masato Nakamura, Norihiro Kougame, Raisuke Iijima, Tsuyoshi Ono, Nobutaka Ikeda, Masahide Tokue, Fumiyuki Hayashi, Mami Watanabe, Hiroki Takenaka, Ryo Fukui, Hidehiko Hara
At present, there is consensus that prolonged dual antiplatelet therapy (DAPT) is effective to reduce cardiovascular events at the expense of bleeding complication events. A causal relationship of prolonged DAPT with an increase in mortality remains debatable, however, it appears to be obvious that bleeding complications are associated with an increase in cardiac events. Thus, individualized optimal DAPT duration balancing the risk and benefit of DAPT should be applied. In addition, strategy to minimize bleeding complications is highly recommended...
August 2, 2017: Journal of Cardiology
https://www.readbyqxmd.com/read/28764572/individualizing-dual-antiplatelet-therapy-duration-after-percutaneous-coronary-intervention-from-randomized-control-trials-to-personalized-medicine
#16
Usman A Tahir, Robert W Yeh
Improved stent technologies have lead to reduced minimum durations of dual antiplatelet therapy (DAPT) to prevent stent thrombosis. However, the anti-ischemic benefits seen in extended DAPT in both stent and non-stent related lesions have called into question the optimum duration of DAPT after stent placement. Areas covered: We review the evidence for varying durations of DAPT after drug eluting stent placement including for patients on oral anticoagulation; decision tools available for clinicians to optimize patient selection for extended therapy and insight into application of these risk assessment tools in clinical practice...
August 9, 2017: Expert Review of Cardiovascular Therapy
https://www.readbyqxmd.com/read/28762022/optimal-duration-of-dual-antiplatelet-therapy-after-percutaneous-coronary-intervention-or-after-acute-coronary-syndrome-practical-lessons-from-a%C3%A2-review
#17
REVIEW
J M Ten Berg, B Zwart, A W J van 't Hof, A Liem, J Waltenberger, R J de Winter, J W Jukema
To prevent recurrent ischaemic events, dual antiplatelet therapy (DAPT) is the standard of care after percutaneous coronary intervention and in the treatment of acute coronary syndrome. Recent evidence supports an adjusted DAPT duration in selected patients.The current paper aims to encourage cardiologists to actively search for patients benefiting from either shorter or prolonged duration DAPT and proposes an algorithm to identify patients who are likely to benefit from such an alternative strategy.Individualised DAPT duration should be considered in high-risk anatomic and/or clinical subgroups or in patients at increased haemorrhagic risk with low ischaemic risk...
July 31, 2017: Netherlands Heart Journal
https://www.readbyqxmd.com/read/28761678/polymer-free-sirolimus-eluting-stents-in-a-large-scale-all-comers-population
#18
Florian Krackhardt, Viktor Kočka, Matthias W Waliszewski, Andreas Utech, Meik Lustermann, Martin Hudec, Martin Studenčan, Markus Schwefer, Jiangtao Yu, Myung Ho Jeong, Taehoon Ahn, Wan Azman Wan Ahmad, Michael Boxberger, André Schneider, Matthias Leschke
OBJECTIVE: The objective of this study was to assess the safety and efficacy of a polymer-free sirolimus coated, ultrathin strut drug-eluting stent (PF-SES) in an unselected patient population with a focus on acute coronary syndrome (ACS). Furthermore, stable coronary artery disease (CAD) with short (≤6 months) versus long (>6 months) dual antiplatelet therapy (DAPT) were also studied. METHODS: Patients who received PF-SES were investigated in an unselected large-scale international, single-armed, multicenter, 'all comers' observational study...
2017: Open Heart
https://www.readbyqxmd.com/read/28750704/should-we-still-have-bare-metal-stents%C3%A2-available-in-our-catheterization%C3%A2-laboratory
#19
REVIEW
Antonio Colombo, Francesco Giannini, Carlo Briguori
The introduction of bare-metal stents (BMS) has represented a major advancement over plain old balloon angioplasty in the management of coronary artery disease. However, the high rates of target lesion revascularization associated with use of BMS have led to the development of drug-eluting stents, which require prolonged dual antiplatelet therapy due to the increased risk of late and very late stent thrombosis. The improvements in newer-generation drug-eluting stents have translated into better safety and efficacy compared with earlier generation and BMS, thus allowing shorter dual antiplatelet therapy duration...
August 1, 2017: Journal of the American College of Cardiology
https://www.readbyqxmd.com/read/28748156/the-optimal-duration-of-dual-antiplatelet-therapy-after-implantation-of-drug-eluting-coronary-stents-an-unanswered-question
#20
EDITORIAL
Cristina Aurigemma, Francesco Burzotta, Carlo Trani
No abstract text is available yet for this article.
June 2017: Cardiovascular Diagnosis and Therapy
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