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Antithrombotic therapy

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https://www.readbyqxmd.com/read/29652672/early-discontinuation-of-prasugrel-or-clopidogrel-in-acute-coronary-syndromes-insights-from-the-trilogy-acs-trial
#1
Andrew T Yan, Matthew T Roe, Megan Neely, Derek D Cyr, Harvey White, Keith A A Fox, Dorairaj Prabhakaran, Paul W Armstrong, Erik M Ohman, Shaun G Goodman
BACKGROUND: In the Targeted Platelet Inhibition to Clarify the Optimal Strategy to Medically Manage Acute Coronary Syndromes (TRILOGY ACS) trial of patients with non-ST-segment elevation acute coronary syndrome managed medically without revascularization, treated with prasugrel versus clopidogrel for less than or equal to 30 months after index acute coronary syndrome, post-hoc analyses showed a divergence of treatment effect in favor of prasugrel after 12 months. Potential influential factors, including a potential late treatment effect after early study drug discontinuation in the intention-to-treat analysis, have not been explored...
April 12, 2018: Coronary Artery Disease
https://www.readbyqxmd.com/read/29650125/restenosis-stent-thrombosis-and-bleeding-complications-navigating-between-scylla-and-charybdis
#2
REVIEW
Juan Torrado, Leo Buckley, Ariel Durán, Pedro Trujillo, Stefano Toldo, Juan Valle Raleigh, Antonio Abbate, Giuseppe Biondi-Zoccai, Luis A Guzmán
The field of interventional cardiology has significantly evolved over 40 years by overcoming several challenges. The introduction of first-generation drug-eluting stents significantly reduced the rates of restenosis, but at the expense of an increase of late stent thrombosis. Prolonged antithrombotic therapy reduced rates of stent thrombosis, but at the cost of increased bleeding. Although the advent of second-generation drug-eluting stents subsequently reduced the incidence of late stent thrombosis, its permanent nature prevents full recovery of vascular structure and function with accordant risk of very late stent failure...
April 17, 2018: Journal of the American College of Cardiology
https://www.readbyqxmd.com/read/29644411/noac-monotherapy-in-patients-with-concomitant-indications-for-oral-anticoagulation-undergoing-transcatheter-aortic-valve-implantation
#3
Nicolas A Geis, Christina Kiriakou, Emmanuel Chorianopoulos, Lorenz Uhlmann, Hugo A Katus, Raffi Bekeredjian
AIMS: Antithrombotic therapy after transcatheter aortic valve implantation (TAVI) is highly controversial and guideline recommendations are not evidence based. We assessed efficacy and safety of non-vitamin K antagonist oral anticoagulant (NOAC) monotherapy in patients with concomitant indications for OAC undergoing TAVI. METHODS: Among more than 1300 TAVI patients since 2008, 154 patients were identified who received postinterventional NOAC monotherapy. Outcomes were compared to 172 patients treated with vitamin K antagonist (VKA) monotherapy...
April 11, 2018: Clinical Research in Cardiology: Official Journal of the German Cardiac Society
https://www.readbyqxmd.com/read/29629551/totally-thoracoscopic-left-atrial-occlusion-concomitant-to-endoscopic-atraumatic-coronary-artery-bypass-grafting-eacab
#4
Piotr Suwalski, Anna Witkowska
Atrial fibrillation, as the most prevalent arrhythmia, has more impact on morbidity and mortality than any other rhythm disorder. It is often concomitant with structural heart diseases like coronary artery disease. The worst complication of atrial fibrillation is stroke, but the double or triple antithrombotic therapy especially in fragile and elderly patients is associated with significant risk of bleeding. The left atrial appendage occlusion may reduse both the risk of stroke and drug intake. Here we present, to our knowledge, the first description of a simultaneous totally thoracoscopic 3D augmented coronary artery bypass grafting and left atrial appendage occlusion...
March 15, 2018: Multimedia Manual of Cardiothoracic Surgery: MMCTS
https://www.readbyqxmd.com/read/29627809/antithrombotic-therapy-in-patients-receiving-saphenous-vein-coronary-artery-bypass-grafts-a-protocol-for-a-systematic-review-and-network-meta-analysis
#5
Karla Solo, Janet Martin, Shahar Lavi, Conrad Kabali, Ava John-Baptiste, Immaculate F Nevis, Tawfiq Choudhury, Mamas A Mamas, Rodrigo Bagur
INTRODUCTION: The current evidence for the prevention of saphenous vein graft failure (SVGF) after coronary artery bypass graft (CABG) surgery consists of direct head-to-head comparison of treatments (including placebo) in randomised-controlled trials (RCTs) and observational studies. However, summarising the evidence using traditional pairwise meta-analyses does not allow the inclusion of data from treatments that have not been compared head to head. Exclusion of such comparisons could impact the precision of pooled estimates in a meta-analysis...
April 7, 2018: BMJ Open
https://www.readbyqxmd.com/read/29611483/management-of-antithrombotic-therapy-in-patients-with-coronary-artery-disease-or-atrial-fibrillation-who-underwent-abdominal-surgical-operations
#6
Dimitrios Schizas, Maria Kariori, Konstantinos Dean Boudoulas, Gerasimos Siasos, Nikolaos Patelis, Charalampos Kalantzis, Moldovan Carmen-Maria, Manolis Vavuranakis
BACKGROUND: Patients treated with antithrombotic therapy that require abdominal surgical procedures has progressively increased overtime. The management of antithrombotics during both the peri- and post- operative period is of crucial importance. METHODS: The goal of this review is to present current data concerning the management of antiplatelets in patients with coronary artery disease and of anticoagulants in patients with atrial fibrillation who had to undergo abdominal surgical operations...
April 2, 2018: Current Pharmaceutical Design
https://www.readbyqxmd.com/read/29611444/combination-oral-antithrombotic-therapy-for-the-treatment-of-myocardial-infarction-recent-developments
#7
Udaya S Tantry, Eliano P Navarese, Aung Myat, Rahul Chaudhary, Paul A Gurbel
There have been significant new developments in the treatment of patients with myocardial infarction with respect to oral antithrombotic agents over the past decade. Recent studies have explored the potential utility of targeting the dual pathway inhibition of platelet function with single or dual antiplatelet agents and the thrombin pathway with direct thrombin inhibitors or factor Xa inhibitors. Areas covered: In this review, the authors focus on the recent developments of oral antithrombotic agents including antiplatelet and antithrombin agents...
April 3, 2018: Expert Opinion on Pharmacotherapy
https://www.readbyqxmd.com/read/29611427/impact-of-known-or-new-onset-atrial-fibrillation-on-2-year-cardiovascular-event-rate-in-patients-with-acute-coronary-syndromes-results-from-the-prospective-epicor-registry
#8
Uwe Zeymer, Lieven Annemans, Nicolas Danchin, Stuart Pocock, Simon Newsome, Frans Van de Werf, Jesús Medina, Héctor Bueno
BACKGROUND: Atrial fibrillation (AF) is associated with increased morbidity in acute coronary syndrome patients, but impact on outcomes beyond 1 year is unclear. METHODS: This was a post-hoc analysis from the long-tErm follow-uP of antithrombotic management patterns In acute CORonary syndrome patients (EPICOR) registry (NCT01171404), a prospective, observational study conducted in Europe and Latin America, which enrolled acute coronary syndrome survivors at discharge...
April 1, 2018: European Heart Journal. Acute Cardiovascular Care
https://www.readbyqxmd.com/read/29609264/-long-term-prognosis-of-coronary-artery-disease-with-atrial-fibrillation-after-percutaneous-coronary-intervention
#9
H H Wang, J J Xu, Y Song, X F Tang, P Jiang, R Liu, X Y Zhao, Z Gao, Y Zhang, L Song, L J Gao, J Chen, Y J Yang, R L Gao, S B Qiao, B Xu, J Q Yuan
Objective: To investigate the long-term prognosis of coronary artery disease with atrial fibrillation (AF) after percutaneous coronary intervention (PCI). Methods: A total of 10 724 patients with PCI were enrolled in 2013, and 2-year clinical outcomes in patients with AF (AF group) and without AF (non-AF group) were compared. Results: A total of 113 patients were with AF (1.1%), and 8 out of them were on triple antithrombotic therapy (9.5%), and AF group patients were with more complications. The 2-year follow-up results showed that the all-cause mortality in AF group was significantly higher than that in non-AF group (9...
March 20, 2018: Zhonghua Yi Xue za Zhi [Chinese medical journal]
https://www.readbyqxmd.com/read/29607737/dual-antiplatelet-therapy-after-percutaneous-left-atrial-appendage-occlusion-single-center-experience-with-the-amplatzer-cardiac-plug
#10
Philippe B Bertrand, Melanie Habran, Karlijn Kenis, Julie Lecomte, Linde Moonen, Didier Stroobants, Edouard Benit
BACKGROUND: Percutaneous left atrial appendage occlusion (LAAO) is an alternative to anticoagulation in atrial fibrillation patients at high bleeding risk. Dual antiplatelet therapy (DAPT) is generally recommended in the months following the procedure to prevent thrombotic complications. The aim of this study was to evaluate the safety and efficacy of DAPT after LAAO in a single-centre population of high bleeding risk patients. METHODS: All patients who received DAPT after LAAO using the Amplatzer Cardiac Plug at Jessa Hospital (Hasselt, BE) between February 2011 and October 2016 were included...
April 1, 2018: Acta Cardiologica
https://www.readbyqxmd.com/read/29602462/dual-antithrombotic-plus-adjunctive-antiinflammatory-therapy-to-improve-cardiovascular-outcome-in-atrial-fibrillation-patients-with-concurrent-acute-coronary-syndrome-a-triple-pathway-strategy
#11
Gerald Chi, Adeel Jamil, Miroslav Radulovic, Umer Jamil, Muhammad A Balouch, Jolanta Marszalek, Zahra Karimi, Seyedmahdi Pahlavani, Mehrian Jafarizade, Husnain Shaukat, Sunny Kumar, Arzu Kalayci
The concurrence of atrial fibrillation and acute coronary syndrome poses a conundrum in the antithrombotic management as intensification of anticoagulation or antiplatelet therapy inevitably comes at the price of an increased bleeding risk. Various antithrombotic combinations have been attempted to prevent the recurrent cardiovascular events, however, there has been limited success in effective risk reduction for this high risk population. Given the overarching effect of interleukin 1β-driven inflammation on the arrhythmogenesis, thrombogenesis, and hypercoagulability, we hypothesize that the triple-pathway strategy (i...
May 2018: Medical Hypotheses
https://www.readbyqxmd.com/read/29601145/comparative-efficacy-and-safety-of-low-intensity-warfarin-therapy-in-preventing-unprovoked-recurrent-venous-thromboembolism-a-systematic-review-and-meta-analysis
#12
REVIEW
Rong Jiang, Yu Shi, Rui Zhang, Bigyan Pudasain, Lan Wang, Qin-Hua Zhao, Ping Yuan, Jian Guo, Chang-Tai Zhu, Jin-Ming Liu
Background:Although there exists potential risk of bleeding, extended "lifelong" conventional-intensity (international normalized ratio (INR): 2.0-3.0) warfarin anticoagulation is recommended for unprovoked venous thromboembolism (VTE) patients due to risk of recurrent VTE. Whether long-term low-intensity (INR: 1.5-2.0) warfarin therapy reduced the risk of major bleeding without substantially lowered antithrombotic efficacy is not well understood. The aim of this study was to perform a systematic review and meta-analysis to evaluate the risk-benefits of low-intensity warfarin therapy...
March 30, 2018: Clinical Respiratory Journal
https://www.readbyqxmd.com/read/29599096/antithrombotic-therapy-trends-in-non-valvular-atrial-fibrillation-patients-undergoing-percutaneous-coronary-stent-implantation-results-from-a-survey-among-fellows-at-the-japanese-college-of-cardiology
#13
Daisuke Fukamachi, Atsushi Hirayama, Katsumi Miyauchi, Satoshi Yasuda, Hisao Ogawa, Hiroshi Ito, Hiroyuki Daida
BACKGROUND: Antithrombotic therapy with oral anticoagulants (OAC) in patients with atrial fibrillation (AF) after stent implantation, where dual antiplatelet therapy (DAPT) is also recommended, is not established. Antithrombotic therapies prescribed vary widely among cardiologists and may change year by year, according to the accumulation of new evidence. METHODS: A questionnaire-based survey concerning the antithrombotic therapy prescribed for OAC-treated AF patients who underwent stent implantation was conducted from 2014 to 2016...
March 26, 2018: Journal of Cardiology
https://www.readbyqxmd.com/read/29589672/the-synergy-stent-in-high-bleeding-risk-patients-why-design-matters
#14
Mauro Chiarito, Davide Cao, Francesco Cannata, Cristina Panico, Bernhard Reimers, Giulio G Stefanini
Antithrombotic management after percutaneous coronary intervention is based on dual antiplatelet therapy (DAPT), that has unequivocally shown to reduce the risk of recurrent ischemic events at cost of an important risk of bleeding. In order to balance ischemic and bleeding risks, DAPT duration should be based on patients and lesions features as well as stent type. Based on these considerations, patients at high bleeding risk (HBR) undergoing PCI represent a challenging subgroup. The Synergy stent (Boston Scientific, Marlborough, MA, USA) is a new-generation everolimus-eluting stent with a biodegradable polymer coating, presenting several features that have the potential to reduce acute and long-term thrombogenicity and the subsequent need for DAPT...
March 28, 2018: Minerva Cardioangiologica
https://www.readbyqxmd.com/read/29584740/panax-quinquefolius-saponins-combined-with-dual-antiplatelet-drug-therapy-alleviate-gastric-mucosal-injury-and-thrombogenesis-through-the-cox-pg-pathway-in-a-rat-model-of-acute-myocardial-infarction
#15
Na Kou, Mei Xue, Lin Yang, Ming-Xuan Zang, Hua Qu, Ming-Ming Wang, Yu Miao, Bin Yang, Da-Zhuo Shi
OBJECTIVES: Previous studies have found that Panax quinquefolius saponins (PQS) combined with dual antiplatelet therapy (DAPT) of aspirin and clopidogrel enhances antithrombotic effects while reducing gastric mucosal injury induced by DAPT. We investigated the effects of the combined drug therapy (PQS+DAPT) through the COX/PG pathways. METHODS: Acute myocardial infarction (AMI) was induced in Wistar rats by ligation of the left anterior descending (LAD) coronary artery, and the animals were randomly divided into Model, DAPT, and PQS+DAPT groups...
2018: PloS One
https://www.readbyqxmd.com/read/29582698/a-new-category-stent-with-novel-polyphosphazene-surface-modification
#16
Hiroyoshi Mori, Hiroyuki Jinnouchi, Chahal Diljon, Sho Torii, Atsushi Sakamoto, Frank D Kolodgie, Renu Virmani, Aloke V Finn
The COBRA-PzF™ (CeloNova BioSciences, Inc., TX, USA) is a new type of coronary stent composed of a cobalt chromium metallic backbone surrounded by a nanothin layer of Polyzene-F (PzF) without any added drug. Evidence from basic studies supports antithrombotic and anti-inflammatory properties for the PzF surface coating. Preclinical studies support the thromboresistance of PzF coated surfaces and clinical studies have shown good outcomes for patients receiving this device with very low rates of stent thrombosis...
March 27, 2018: Future Cardiology
https://www.readbyqxmd.com/read/29582213/management-of-antithrombotic-therapy-in-adults-with-immune-thrombocytopenia-itp-a-survey-of-itp-specialists-and-general-hematologist-oncologists
#17
Allyson M Pishko, Mudi Misgav, Adam Cuker, Douglas B Cines, James N George, Sara K Vesely, Deirdra R Terrell
While patients with immune thrombocytopenia (ITP) and low platelet counts are at risk for bleeding, they are not protected against arterial and venous thrombotic events. Frequently, hematologists are asked to consult on a patient with ITP requiring an antiplatelet (AP) agent or anticoagulant (AC). No direct evidence exists to guide hematologists in weighing the risk of thrombosis against the risk of bleeding in patients with ITP. Therefore, we performed a survey to determine the preferred management of AP/AC therapy in ITP patients...
March 26, 2018: Journal of Thrombosis and Thrombolysis
https://www.readbyqxmd.com/read/29580268/the-impact-of-direct-oral-anticoagulants-in-traumatic-brain-injury-patients-greater-than-60-years-old
#18
Oliver Prexl, Martin Bruckbauer, Wolfgang Voelckel, Oliver Grottke, Martin Ponschab, Marc Maegele, Herbert Schöchl
BACKGROUND: Traumatic brain injury (TBI) is the leading cause of death among trauma patients. Patients under antithrombotic therapy (ATT) carry an increased risk for intracranial haematoma (ICH) formation. There is a paucity of data about the role of direct oral anticoagulants (DOACs) among TBI patients. METHODS: In this retrospective study, we investigated all TBI patients ≥60-years-old who were admitted to the intensive care unit (ICU) from January 2014 until May 2017...
March 27, 2018: Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine
https://www.readbyqxmd.com/read/29577768/antithrombotic-therapy-in-patients-with-atrial-fibrillation-undergoing-percutaneous-coronary-intervention-where-are-we-now
#19
Ryan G D'Angelo, Thaddeus McGiness, Laura H White
OBJECTIVE: To synthesize the literature and provide guidance to practitioners regarding double therapy (DT) and triple therapy (TT) in patients with atrial fibrillation (AF) requiring percutaneous coronary intervention (PCI). DATA SOURCES: PubMed and MEDLINE (January 2000 to February 2018) were searched using the following terms: atrial fibrillation, myocardial infarction, acute coronary syndrome, percutaneous coronary intervention, anticoagulation, dual-antiplatelet therapy, clopidogrel, aspirin, ticagrelor, prasugrel, and triple therapy...
March 1, 2018: Annals of Pharmacotherapy
https://www.readbyqxmd.com/read/29576519/percutaneous-closure-of-patent-foramen-ovale-vs-medical-treatment-for-patients-with-history-of-cryptogenic-stroke-a-systematic-review-and-meta-analysis-of-randomized-controlled-trials
#20
Leonidas Palaiodimos, Damianos G Kokkinidis, Robert T Faillace, T Raymond Foley, George D Dangas, Matthew J Price, Ioannis Mastoris
BACKGROUND: Patients with history of cryptogenic stroke are more likely to have a patent foramen ovale (PFO) and should be managed with antithrombotic agents, while the alternative option is percutaneous closure of PFOs. Our aim was to perform a meta-analysis of randomized controlled trials (RCTs) comparing percutaneous closure vs. medical treatment for patients with PFO and prior cryptogenic stroke. METHODS: Medline, Scopus and Cochrane databases were reviewed...
March 2, 2018: Cardiovascular Revascularization Medicine: Including Molecular Interventions
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