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Antithrombotic therapy

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https://www.readbyqxmd.com/read/29045310/risk-of-stroke-after-transcatheter-prosthetic-aortic-valve-implant-with-aortic-bioprosthesis-subclinical-thrombosis-and-possible-therapeutic-implications
#1
Giuseppe Di Pasquale, Gloria V Coutsoumbas, Silvia Zagnoni
: Many factors could increase the risk of stroke after transcatheter prosthetic aortic valve implant, mainly related to the procedure itself, or to the type of valvular prosthesis, or to the presence of atrial fibrillation. There is a wide variability in the antithrombotic treatment utilized in clinical practice, as far as the choice of drugs (anticoagulant, single or dual antiplatelet treatment), and its optimal duration. The most popular therapeutic strategy, also recommended by the Scientific Societies, is dual antiplatelet (aspirin and clopidogrel) for the first 3-6 months then switching to single antiplatelet (usually aspirin), limiting oral anticoagulant therapy only to those patients with other primary indication to the treatment...
October 16, 2017: Journal of Cardiovascular Medicine
https://www.readbyqxmd.com/read/29044795/ahns-series-do-you-know-your-guidelines-perioperative-antithrombotic-management-in-head-and-neck-surgery
#2
Annika Meyer, Neil Gross, Marita Teng
Head and neck surgeons are commonly faced with surgical patients who have underlying medical problems requiring antithrombotic therapy. It is difficult to achieve a balance between minimizing the risk of thromboembolism and hemorrhage in the perioperative period. Data from randomized, controlled trials are limited, and procedure-specific bleed rates are also difficult to pinpoint. The decision is made more difficult when patients with moderate-to-high risk for thromboembolic events undergo procedures that are high risk for bleeding...
October 16, 2017: Head & Neck
https://www.readbyqxmd.com/read/29043079/acute-coronary-syndromes-in-the-elderly
#3
REVIEW
Niels Engberding, Nanette K Wenger
The clinical evidence for treatment of acute coronary syndrome (ACS) in the elderly is less robust than in patients younger than 75 years. The elderly have the highest incidence of cardiovascular disease and frequently present with ACS. This number can be expected to increase over time because society is aging. Older adults often sustain unfavorable outcomes from ACS because of atypical presentation and delay in recognition. In addition, elderly patients commonly do not receive optimal guideline-directed ACS treatment...
2017: F1000Research
https://www.readbyqxmd.com/read/29042825/antithrombotics-in-trauma-management-strategies-in-the-older-patients
#4
REVIEW
Henna Wong, Nicola Lovett, Nicola Curry, Ku Shah, Simon J Stanworth
The ageing population has resulted in a change in the demographics of trauma, and older adult trauma now accounts for a growing number of trauma admissions. The management of older adult trauma can be particularly challenging, and exhibits differences to that of the younger age groups affected by trauma. Frailty syndromes are closely related with falls, which are the leading cause of major trauma in older adults. Comorbid disease and antithrombotic use are more common in the older population. Physiological changes that occur with ageing can alter the expected clinical presentation of older persons after injury and their susceptibility to injury...
2017: Journal of Blood Medicine
https://www.readbyqxmd.com/read/29042008/risky-business-investigating-outcomes-of-patients-undergoing-urgent-laparoscopic-appendectomy-on-antithrombotic-therapy
#5
Christopher Pearcy, Khalid Almahmoud, Theresa Jackson, Cassie Hartline, Anthony Cahill, Lara Spence, Dennis Kim, Oluwabukola Olatubosun, S Rob Todd, Eric M Campion, Clay Cothren Burlew, Justin Regner, Richard Frazee, David Michaels, Sharmila Dissanaike, Collin Stewart, Neal Foley, Paul Nelson, Vaidehi Agrawal, Michael S Truitt
No abstract text is available yet for this article.
October 5, 2017: American Journal of Surgery
https://www.readbyqxmd.com/read/29037012/medical-treatment-of-intracranial-atherosclerosis-an-update
#6
REVIEW
Jong S Kim, Oh Young Bang
For patients with symptomatic intracranial atherosclerosis (ICAS), antithrombotic agents are the mainstay of therapy. Anticoagulation (warfarin) is not widely used since it is not more effective than aspirin and carries a high risk of bleeding. New oral anticoagulants are showing promise, but their use has not been investigated in appropriate clinical trials. Since the recurrent stroke risk is high with aspirin monotherapy, dual antiplatelets are considered in the early stage of symptomatic ICAS. Based on the Clopidogrel in High-Risk Patients with Acute Nondisabling Cerebrovascular Events (CHANCE) and Stenting and Aggressive Medical Management for Preventing Recurrent Stroke in Intracranial Stenosis (SAMMPRIS) results, aspirin plus clopidogrel has been recommended...
September 2017: Journal of Stroke
https://www.readbyqxmd.com/read/29033031/the-next-challenges-for-optimal-reperfusion-in-the-era-of-mechanical-thrombectomy
#7
REVIEW
M Mazighi
The therapeutic management of acute ischemic stroke has changed tremendously over the past few years. Mechanical thrombectomy in addition to intravenous tissue plasminogen activator (t-PA) is currently the standard of care for patients experiencing acute ischemic stroke as a consequence of large vessel occlusion of the anterior circulation. Yet, despite strong evidence supporting such a therapeutic approach, several issues remain a source of debate, such as the need for intravenous t-PA, the optimal target for blood pressure levels and the opportunity for additional antithrombotic therapies to improve reperfusion...
October 12, 2017: Revue Neurologique
https://www.readbyqxmd.com/read/29029944/-antithrombotic-treatment-consensus-protocol-anticoagulation-and-antiplatelet-therapy-during-the-perioperative-and-periprocedural-period-in-neurosurgery
#8
Fuat Arikan Abelló, Luis Ley Urzaiz, José Fernández Alén, Rubén Martín Láez
The use of antithrombotic medication (antiplatelet and/or anticoagulant therapy) is widespread. Currently, the management of neurosurgical patients receiving this type of therapy continues to be a problem of special importance. Patients receiving antithrombotic treatment may need neurosurgical care because of bleeding secondary to such treatment, non-haemorrhagic neurosurgical lesions requiring urgent attention, or simply elective neurosurgical procedures. In addition, the consequences of reintroducing early (bleeding or rebleeding) or late (thrombotic or thromboembolic) anticoagulation can be devastating...
October 10, 2017: Neurocirugía
https://www.readbyqxmd.com/read/29023526/antithrombotic-therapy-strategies-for-atrial-fibrillation-patients-undergoing-percutaneous-coronary-intervention-a-systematic-review-and-network-meta-analysis
#9
Xiaoxuan Gong, Shaowen Tang, Jiangjin Li, Xiwen Zhang, Xiaoyi Tian, Shuren Ma
OBJECTIVE: The aim of this systematic review and network meta-analysis was to evaluate the comparative efficacy and safety of antiplatelet agents, vitamin K antagonist (VKA) and non-VKA oral anticoagulants (NOACs) in patients with atrial fibrillation (AF) undergoing percutaneous coronary intervention (PCI). METHODS: PubMed, EMBASE, and the Cochrane Central Register of Controlled Trials were searched to identify clinical trials comparing antiplatelet drugs with VKA and NOACs or their combination in AF patients undergoing PCI with a mean/median follow-up of at least 12 months...
2017: PloS One
https://www.readbyqxmd.com/read/29020333/thrombo-embolic-prevention-after-transcatheter-aortic-valve-implantation
#10
Pascal Vranckx, Stephan Windecker, Robert C Welsh, Marco Valgimigli, Roxana Mehran, George Dangas
Transcatheter aortic valve implantation (TAVI) has emerged as a valuable treatment alternative to surgical aortic valve replacement among patients with symptomatic aortic stenosis at increased surgical risk. The rapid technological evolution from early to current-generation TAVI systems with low-profile delivery catheters, bioprosthetic valves with proven midterm durability, and improved positioning and retrieval features have made important contributions to the widespread clinical use of this minimal invasive therapy...
July 25, 2017: European Heart Journal
https://www.readbyqxmd.com/read/29018133/carotid-web-intimal-fibromuscular-dysplasia-has-high-stroke-recurrence-risk-and-is-amenable-to-stenting
#11
Diogo C Haussen, Jonathan A Grossberg, Mehdi Bouslama, Gustavo Pradilla, Samir Belagaje, Nicolas Bianchi, Jason W Allen, Michael Frankel, Raul G Nogueira
BACKGROUND AND PURPOSE: Carotid webs have been increasingly recognized as a cause of recurrent stroke, but evidence remains scarce. We aim to report the clinical outcomes and first series of carotid stenting in a cohort of patients with strokes from symptomatic carotid webs. METHODS: Prospective and consecutive data of patients <65 years old with cryptogenic stroke admitted within September 2014 to May 2017. Carotid web was defined by a shelf-like/linear filling defect in the posterior internal carotid artery bulb by computed tomographic angiography...
October 10, 2017: Stroke; a Journal of Cerebral Circulation
https://www.readbyqxmd.com/read/29016832/contemporary-stroke-prevention-strategies-in-11%C3%A2-096-european-patients-with-atrial-fibrillation-a-report-from-the-eurobservational-research-programme-on-atrial-fibrillation-eorp-af-long-term-general-registry
#12
Giuseppe Boriani, Marco Proietti, Cécile Laroche, Laurent Fauchier, Francisco Marin, Michael Nabauer, Tatjana Potpara, Gheorghe-Andrei Dan, Zbigniew Kalarus, Igor Diemberger, Luigi Tavazzi, Aldo P Maggioni, Gregory Y H Lip
Aims: Contemporary data regarding atrial fibrillation (AF) management and current use of oral anticoagulants (OACs) for stroke prevention are needed. Methods and results: The EURObservational Research Programme on AF (EORP-AF) Long-Term General Registry analysed consecutive AF patients presenting to cardiologists in 250 centres from 27 European countries. From 2013 to 2016, 11 096 patients were enrolled (40.7% female; mean age 69 ± 11 years). At discharge, OACs were used in 9379 patients (84...
September 14, 2017: Europace: European Pacing, Arrhythmias, and Cardiac Electrophysiology
https://www.readbyqxmd.com/read/28994833/the-efficacy-and-safety-of-endovascular-recanalization-of-occluded-large-cerebral-arteries-during-the-subacute-phase-of-cerebral-infarction-a-case-series-report
#13
Kangning Chen, Xianhua Hou, Zhenhua Zhou, Guangjian Li, Qu Liu, Li Gui, Jun Hu, Shugui Shi
BACKGROUND: Intravenous tissue plasminogen activator with or without mechanical thrombectomy during the acute phase are approved therapies for ischaemic stroke. Due to the short treatment time window (<6 hours) and often treatment failure, these patients would still have an intracranial arterial occlusion (IAO). It is unclear whether these patients can benefit from subsequent interventional recanalizationof their occluded artery in the subacute phase. In this retrospective study, we have examined the efficacy and safety in patients who have received either percutaneous transluminal angioplasty (PTA) or percutaneous transluminal angioplasty and stenting (PTAS) for IAO in the subacute phase of their stroke...
September 2017: Stroke and Vascular Neurology
https://www.readbyqxmd.com/read/28985259/effectiveness-and-safety-of-oral-anticoagulants-in-older-patients-with-atrial-fibrillation-a-systematic-review-and-meta-regression-analysis
#14
Ying Bai, Shi-Dong Guo, Hai Deng, Alena Shantsila, Laurent Fauchier, Chang-Sheng Ma, Gregory Y H Lip
Background and objective: the study analysed the effectiveness and safety of warfarin use compared with warfarin non-use and non-vitamin K antagonist oral anticoagulants (NOACs) in atrial fibrillation (AF) patients aged ≥65 years. Methods: after searching PubMed and the Cochrane Library, 26 studies were included, with 10 comparing warfarin with warfarin non-use and 16 comparing warfarin with NOACs, in older AF patients (≥65 years). Results: warfarin use was superior to no antithrombotic therapy [relative risk (RR) 0...
September 8, 2017: Age and Ageing
https://www.readbyqxmd.com/read/28982562/prosthetic-mitral-surgical-valve-in-transcatheter-aortic-valve-replacement%C3%A2-recipients-a-multicenter-analysis
#15
Ignacio J Amat-Santos, Carlos Cortés, Luis Nombela Franco, Antonio J Muñoz-García, Jose Suárez De Lezo, Enrique Gutiérrez-Ibañes, Vicenç Serra, Mariano Larman, Raúl Moreno, Jose M De La Torre Hernandez, Rishi Puri, Pilar Jimenez-Quevedo, José M Hernández García, Juan H Alonso-Briales, Bruno García, Dae-Hyun Lee, Paol Rojas, Teresa Sevilla, Renier Goncalves, Silvio Vera, Itziar Gómez, Josep Rodés-Cabau, José A San Román
OBJECTIVES: The aim of this study was to determine the prognosis and specific complications of patients with prosthetic mitral valves (PMVs) undergoing transcatheter aortic valve replacement (TAVR). BACKGROUND: TAVR is performed relatively often in patients with PMVs, but specific risks are not well described. METHODS: A multicenter analysis was conducted, including patients with severe symptomatic aortic stenosis who underwent TAVR at 10 centers...
October 9, 2017: JACC. Cardiovascular Interventions
https://www.readbyqxmd.com/read/28982518/risky-business-investigating-outcomes-of-patients-undergoing-urgent-laparoscopic-appendectomy-on-antithrombotic-therapy
#16
Christopher Pearcy, Khalid Almahmoud, Theresa Jackson, Cassie Hartline, Anthony Cahill, Lara Spence, Dennis Kim, Oluwabukola Olatubosun, S Rob Todd, Eric M Campion, Clay Cothren Burlew, Justin Regner, Richard Frazee, David Michaels, Sharmila Dissanaike, Collin Stewart, Neal Foley, Paul Nelson, Vaidehi Agrawal, Michael S Truitt
INTRODUCTION: The literature regarding outcomes in patients on irreversible antithrombotic therapy (IAT) undergoing urgent laparoscopic appendectomy is limited. The aim of this multicenter retrospective study was to examine the impact of prehospital IAT on outcomes in this population. METHODS: From 2010 to 2014, seven institutions from the Southwest Surgical Multicenter Trials (SWSC MCT) group conducted a retrospective study to evaluate the clinical course of all patients on IAT who underwent urgent/emergent laparoscopic appendectomy...
September 19, 2017: American Journal of Surgery
https://www.readbyqxmd.com/read/28982497/characterization-of-the-average-daily-ischemic-and-bleeding-risk-after-primary-pci-for-stemi
#17
RANDOMIZED CONTROLLED TRIAL
Gennaro Giustino, Roxana Mehran, George D Dangas, Ajay J Kirtane, Björn Redfors, Philippe Généreux, Sorin J Brener, Jayne Prats, Stuart J Pocock, Efthymios N Deliargyris, Gregg W Stone
BACKGROUND: The risk of recurrent ischemic and bleeding events after primary percutaneous coronary intervention (PCI) for ST-segment elevation myocardial infarction (STEMI) may not be uniform over time, which may affect the benefit-to-risk ratio of guideline-recommended antithrombotic therapies in different intervals. OBJECTIVES: This study sought to characterize the average daily ischemic rates (ADIRs) and average daily bleeding rates (ADBRs) within the first year after primary PCI for STEMI...
October 10, 2017: Journal of the American College of Cardiology
https://www.readbyqxmd.com/read/28982317/recent-developments-in-separation-of-low-molecular-weight-heparin-anticoagulants
#18
Radosław Sadowski, Renata Gadzała-Kopciuch, Bogusław Buszewski
The general function of anticoagulants is to prevent blood clotting and growing of the existing clots in blood vessels. In recent years, there has been a significant improvement in developing methods of prevention as well as pharmacologic and surgical treatment of thrombosis. For over the last two decades, low molecular weight heparins (LMWHs) have found their application in the antithrombotic diseases treatment. These types of drugs are widely used in clinical therapy. Despite the biological and medical importance of LMWHs, they have not been completely characterized in terms of their chemical structure...
October 5, 2017: Current Medicinal Chemistry
https://www.readbyqxmd.com/read/28982306/optimal-intensity-of-warfarin-therapy-in-patients-with-mechanical-aortic-valves
#19
Kazuhiko Kido, Jennifer Ball
OBJECTIVE: To review the current guidelines and published literature in order to identify the evidence-based international normalized ratio (INR) goal in patients with a mechanical aortic valve. DATA SOURCES: Medline/PubMed, Cochrane and Google Scholar database searches for relevant articles from 1946 through March 2017 were executed using the key words "mechanical aortic valve" and "antithrombotic therapy or anticoagulation therapy or warfarin." STUDY SELECTION AND DATA EXTRACTION: All English-language observational and interventional studies assessing INR goals in patients with a mechanical aortic valve were evaluated...
January 1, 2017: Journal of Pharmacy Practice
https://www.readbyqxmd.com/read/28981961/contemporary-use-of-oral-antithrombotic-agents-focus-on-dual-and-triple-therapeutic-approaches
#20
Antoine T Jenkins, Alexander Kantorovich, Luba Burman
Atherosclerotic cardiovascular disease (ASCVD) represents a long-standing health care burden in most industrialized countries. Management of ASCVD is multifaceted, and utilization of antithrombotic agents is a key component of care in order to reduce vascular events. Minimizing thrombotic risk can be accomplished via antiplatelet or anticoagulant drugs; however, combination therapy is warranted for some indications. Although reducing thrombotic complications is important, it is equally vital to consider the safety of combination regimens...
October 5, 2017: Pharmacotherapy
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