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clopidogrel and drug-eluting stents

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https://www.readbyqxmd.com/read/29352151/effects-of-genetic-variants-on-platelet-reactivity-and-one-year-clinical-outcomes-after-percutaneous-coronary-intervention-a-prospective-multicentre-registry-study
#1
Hyung Joon Joo, Sung Gyun Ahn, Jae Hyoung Park, Ji Young Park, Soon Jun Hong, Seok-Yeon Kim, WoongGil Choi, HyeonCheol Gwon, Young-Hyo Lim, Weon Kim, Woong Chol Kang, Yun-Hyeong Cho, Yong Hoon Kim, JungHan Yoon, WonYong Shin, Myeong-Ki Hong, Scot Garg, Yangsoo Jang, Do-Sun Lim
Clopidogrel is the mainstay for antiplatelet treatment after percutaneous coronary intervention (PCI). The relationship of platelet reactivity and genetic polymorphism with clinical outcomes with newer-generation drug-eluting stents is unclear. We analysed 4,587 patients for the most powerful single-nucleotide polymorphisms (CYP2C19, CYP2C9, ABCB1, PON1, and P2Y12) related to on-treatment platelet reactivity (OPR). The optimal cut-off value of high OPR for major adverse thrombotic events was 266. CYP2C19 was significantly associated with high OPR and the number of CYP2C19*R (*2 or *3) alleles was proportional to the increased risk of high OPR...
January 19, 2018: Scientific Reports
https://www.readbyqxmd.com/read/29349545/risk-of-discontinuation-of-clopidogrel-after-1-month-following-bare-metal-stents-a-propensity-score-adjusted-comparison-with-continued-administration-of-clopidogrel-after-drug-eluting-stents
#2
Christian M Valina, Sebastian Merz, Nikolaus Löffelhardt, Michael Amann, Miroslaw Ferenc, Christian Stratz, Franz-Josef Neumann, Willibald Hochholzer
In patients at high risk for bleeding undergoing percutaneous coronary intervention (PCI) the use of bare-metal-stent (BMS) is considered an option that allows discontinuation of clopidogrel after 4 weeks. We sought to investigate the risk of early discontinuation of clopidogrel in patients with BMS as compared with a 6-month course of clopidogrel after DES in patients with or without high on-treatment platelet reactivity (HTPR). In 765 consecutive patients undergoing PCI after loading with clopidogrel 600 mg, HTPR was tested by optical aggregometry and defined as residual platelet reactivity > 14%...
January 18, 2018: Journal of Thrombosis and Thrombolysis
https://www.readbyqxmd.com/read/29343478/treatment-of-gastrointestinal-bleeding-with-idarucizumab-in-a-patient-receiving-dabigatran
#3
Jennifer Mourafetis, Norman Doctor, Simon Leung
PURPOSE: A case report describing use of idarucizumab for dabigatran reversal without the use of hemostatic agents in a patient who developed acute upper gastrointestinal (GI) bleeding while receiving triple antithrombotic therapy is presented. SUMMARY: A 77-year-old man with a complex cardiac history presented to the emergency room with chief complaints of black tarry stools and low blood pressures for 4 days. His past medical history included recent percutaneous coronary intervention (PCI) and drug-eluting stent (DES) placement, atrial fibrillation, hypertension, hyperlipidemia, coronary artery disease, coronary artery bypass graft surgery, stage 3 chronic kidney disease, and cholecystectomy...
January 17, 2018: American Journal of Health-system Pharmacy: AJHP
https://www.readbyqxmd.com/read/29334682/body-mass-index-and-plasma-p-selectin-before-coronary-stenting-predict-high-residual-platelet-reactivity-at-6-months-on-dual-antiplatelet-therapy
#4
Elena Z Golukhova, Marina V Grigoryan, Mariya N Ryabinina, Naida I Bulaeva, Victor L Serebruany
BACKGROUND: High residual platelet reactivity (HRPR) during dual antiplatelet therapy (DAPT) may impact clinical outcomes following percutaneous coronary interventions (PCI). However, whether any biomarkers assessed before PCI at DAPT loading may predict delayed maintenance HRPR is not clear. OBJECTIVE: The aim of this study was to determine whether conventional clinical or laboratory indices at loading before stenting may predict HRPR at 6 months of maintenance DAPT...
January 16, 2018: Cardiology
https://www.readbyqxmd.com/read/29312662/is-there-a-safe-time-to-stop-clopidogrel-in-patients-on-dual-antiplatelet-therapy-after-a-percutaneous-coronary-intervention-and-placement-of-drug-eluting-stents
#5
EDITORIAL
Nureddin Almaddah, Rami N Khouzam
No abstract text is available yet for this article.
December 2017: Journal of Thoracic Disease
https://www.readbyqxmd.com/read/29279531/dual-antiplatelet-therapy-guided-by-cyp2c19-polymorphisms-after-implantation-of-second-generation-drug-eluting-stents-for-management-of-acute-coronary-syndrome
#6
Takuya Ozawa, Masayoshi Suda, Ryutaro Ikegami, Toshiki Takano, Takayuki Wakasugi, Takao Yanagawa, Komei Tanaka, Kazuyuki Ozaki, Satoru Hirono, Tohru Minamino
Prasugrel, a novel P2Y12 receptor inhibitor, is administered to patients with acute coronary syndrome (ACS) after percutaneous coronary intervention (PCI), but it can increase the risk of bleeding. The Japanese exhibit weaker responses to clopidogrel than other races because of CYP2C19 polymorphisms; thus, it is unclear whether these patients should continue dual antiplatelet therapy (DAPT) using prasugrel or switch to clopidogrel in the chronic phase. Here we evaluated the clinical outcomes of DAPT guided by CYP2C19 polymorphisms after implantation of second-generation drug-eluting stents (DESs) for ACS management...
December 27, 2017: International Heart Journal
https://www.readbyqxmd.com/read/29275879/cost-effectiveness-of-different-durations-of-dual-antiplatelet-use-after-percutaneous-coronary-intervention
#7
Yaron Arbel, Maria C Bennell, Shaun G Goodman, Harindra C Wijeysundera
BACKGROUND: There is uncertainty regarding the optimal duration of dual-antiplatelet therapy (DAPT) after percutaneous coronary intervention (PCI). Our goal was to evaluate the cost-effectiveness of different durations of DAPT. METHODS: We created a probabilistic patient-level Markov microsimulation model to assess the discounted lifetime costs and quality-adjusted life years (QALYs) of short duration (3-6 months: short-duration group) vs standard therapy (12 months: standard-duration group) vs prolonged therapy (30-36 months: long-duration group) in patients undergoing PCI...
January 2018: Canadian Journal of Cardiology
https://www.readbyqxmd.com/read/29273207/comparison-of-1-year-outcomes-of-triple-aspirin%C3%A2-%C3%A2-clopidogrel%C3%A2-%C3%A2-cilostazol-versus-dual-antiplatelet-therapy-aspirin%C3%A2-%C3%A2-clopidogrel%C3%A2-%C3%A2-placebo-after-implantation-of-second-generation-drug-eluting-stents-into-one-or-more-coronary-arteries-from-the-decrease
#8
Cheol Hyun Lee, Jong-Young Lee, Gyung-Min Park, Seung-Whan Lee, Hyun-Sook Kim, Young Jin Choi, Chang-Wook Nam, Jang Hyun Cho, Won-Yong Shin, Jae Bin Seo, Si Wan Choi, Jae-Hwan Lee, Pil-Ki Min, Sung-Ho Her, Pil Hyung Lee, Jung-Min Ahn, Duk-Woo Park, Soo-Jin Kang, Young-Hak Kim, Cheol Whan Lee, Seong-Wook Park, Seung-Jung Park
This study sought to evaluate the impact of triple antiplatelet therapy on clinical outcomes in patients treated with second-generation drug-eluting stents (DES) for coronary artery disease. There are limited data regarding the impact of triple antiplatelet therapy in patients who underwent implantation of second-generation DES. We planned to randomly assign 2,110 patients treated with second-generation DES to triple (aspirin, clopidogrel, and cilostazol) and dual (aspirin, clopidogrel, and placebo) antiplatelet therapy groups...
November 24, 2017: American Journal of Cardiology
https://www.readbyqxmd.com/read/29243114/effect-of-cytochrome-p450-2c19-polymorphism-on-adverse-cardiovascular-events-after-drug-eluting-stent-implantation-in-a-large-hakka-population-with-acute-coronary-syndrome-receiving-clopidogrel-in-southern-china
#9
Zhixiong Zhong, Jingyuan Hou, Qifeng Zhang, Bin Li, Cunren Li, Zhidong Liu, Min Yang, Wei Zhong, Xuebo He, Hesen Wu, Miaocai Zhong, Pingsen Zhao
BACKGROUND AND OBJECTIVES: The objective of this study is to evaluate the effects of cytochrome P450 2C19 (CYP2C19) polymorphism on adverse cardiovascular events (MACE) in Hakka patients with acute coronary syndrome (ACS) receiving clopidogrel who had undergone coronary drug-eluting stent placement after percutaneous coronary intervention (PCI) in southern China. METHODS: Genotyping of CYP2C19 and MACE of 934 ACS patients with PCI on clopidogrel maintenance therapy were analyzed...
December 14, 2017: European Journal of Clinical Pharmacology
https://www.readbyqxmd.com/read/29240976/clopidogrel-plus-aspirin-versus-aspirin-alone-for-preventing-cardiovascular-events
#10
REVIEW
Alessandro Squizzato, Marta Bellesini, Andrea Takeda, Saskia Middeldorp, Marco Paolo Donadini
BACKGROUND: Aspirin is the prophylactic antiplatelet drug of choice for people with cardiovascular disease. Adding a second antiplatelet drug to aspirin may produce additional benefit for people at high risk and people with established cardiovascular disease. This is an update to a previously published review from 2011. OBJECTIVES: To review the benefit and harm of adding clopidogrel to aspirin therapy for preventing cardiovascular events in people who have coronary disease, ischaemic cerebrovascular disease, peripheral arterial disease, or were at high risk of atherothrombotic disease, but did not have a coronary stent...
December 14, 2017: Cochrane Database of Systematic Reviews
https://www.readbyqxmd.com/read/29216314/clinical-outcomes-in-patients-treated-for-coronary-in-stent-restenosis-with-drug-eluting-balloons-impact-of-high-platelet-reactivity
#11
Adrienn Tornyos, Dániel Aradi, Iván G Horváth, Attila Kónyi, Balázs Magyari, Tünde Pintér, András Vorobcsuk, Dániel Tornyos, András Komócsi
BACKGROUND: The impact of high platelet reactivity (HPR) on clinical outcomes after elective percutaneous coronary interventions (PCI) with drug-eluting balloons (DEB) due to in-stent restenosis (ISR) is unknown. OBJECTIVE: We sought to evaluate the prognostic importance of HPR together with conventional risk factors in patients treated with DEB. METHODS: Patients treated with DEB due to ISR were enrolled in a single-centre, prospective registry between October 2009 and March 2015...
2017: PloS One
https://www.readbyqxmd.com/read/29162782/recurrent-early-coronary-stent-thrombosis-under-chronic-disseminated-intravascular-coagulation
#12
Yusuke Oba, Satoshi Hoshide, Tadayuki Mitama, Hajime Shinohara, Takahiro Komori, Tomoyuki Kabutoya, Yasushi Imai, Nobuhiko Ogata, Kazuomi Kario
A 62-year-old Japanese man presented with chest pain indicating that acute myocardial infarction had occurred. Eleven years earlier, he underwent a splenectomy due to idiopathic portal hypertension. Coronary angiography revealed diffuse stenosis, with calcification in the left anterior descending coronary artery (LAD). We performed a primary percutaneous coronary intervention (PCI). We deployed two drug-eluting stents with sufficient minimal cross-sectional stent area by intravascular ultrasound and thrombolysis in myocardial infarction (TIMI) 3 flow...
November 22, 2017: International Heart Journal
https://www.readbyqxmd.com/read/29151439/clopidogrel-or-ticagrelor-in-acute-coronary-syndrome-patients-treated-with-newer-generation-drug-eluting-stents-change-dapt
#13
Paolo Zocca, Liefke C van der Heijden, Marlies M Kok, Marije M Löwik, Marc Hartmann, Martin G Stoel, J W Louwerenburg, Frits H A F de Man, Gerard C M Linssen, Iris L Knottnerus, Carine J M Doggen, K Gert van Houwelingen, Clemens von Birgelen
AIMS: Acute coronary syndrome (ACS) guidelines have been changed, favouring more potent antiplatelet drugs. We aimed to evaluate the safety and efficacy of a ticagrelor- instead of a clopidogrel-based primary dual antiplatelet (DAPT) regimen in ACS patients treated with newer-generation drug-eluting stents (DES). METHODS AND RESULTS: CHANGE DAPT (clinicaltrials.gov: NCT03197298) assessed 2,062 consecutive real-world ACS patients, treated by percutaneous coronary intervention (PCI), the primary composite endpoint being net adverse clinical and cerebral events (NACCE: all-cause death, any myocardial infarction, stroke or major bleeding)...
November 20, 2017: EuroIntervention
https://www.readbyqxmd.com/read/29118299/the-effect-of-cilostazol-on-the-angiographic-outcome-of-drug-eluting-coronary-stents-angiographic-analysis-of-the-cilon-t-influence-of-cilostazol-based-triple-antiplatelet-therapy-on-ischemi-complication-after-drug-eluting-stent-implantation-trial
#14
Jung-Won Suh, Seung-Pyo Lee, KyungWoo Park, Hyun-Jae Kang, Bon-Kwon Koo, Young-Seok Cho, Tae-Jin Youn, In-Ho Chae, Dong-Ju Choi, Seung-Woon Rha, Jang-Ho Bae, Taek-Geun Kwon, Jang-Whan Bae, Myeong-Chan Cho, Hyo-Soo Kim
It is not clear if anti-restonotic effect of cilostazol is consistent for different types of drug-eluting stents (DES).The purpose of this study was to compare the anti-proliferative effect of cilostazol between DAT and TAT with consideration of confounding influences of DES type.Nine hundred and fifteen patients were randomized to either dual antiplatelet therapy (DAT; aspirin and clopidogrel) or triple antiplatelet therapy (TAT; aspirin, clopidogrel, and cilostazol) in the previous CILON-T trial. After excluding 70 patients who received both or neither stents, we analyzed 845 patients who received exclusively PES or ZES, and compared in-stent late loss at 6 months between both antiplatelet regimens (DAT versus TAT)...
November 8, 2017: International Heart Journal
https://www.readbyqxmd.com/read/29096571/elevated-creatine-kinase-due-to-potential-drug-interaction-with-ticagrelor-and-atorvastatin
#15
Janna C Beavers
PURPOSE: Ticagrelor and atorvastatin are commonly used medications in the management of acute coronary syndrome and percutaneous intervention. This is a report of a patient case of a potential drug interaction leading to the use of alternative therapy. CASE REPORT: A 58-year-old male presented for cardiac catheterization following an abnormal stress test. He underwent placement of a drug-eluting stent and was started on ticagrelor. Three months later, he was noted to have elevated creatine kinase (CK), thought to be related to a potential drug-drug interaction between ticagrelor and atorvastatin...
January 1, 2017: Journal of Pharmacy Practice
https://www.readbyqxmd.com/read/29043405/-focused-update-on-dual-antiplatelet-treatment-esc-guidelines-2017
#16
A Schäfer, J Bauersachs
Dual antiplatelet treatment (DAPT) is a cornerstone of maintenance medication of patients following elective percutaneous coronary interventions or an acute coronary syndrome (ACS), e. g. ST elevation myocardial infarction, non-ST elevation myocardial infarction and unstable angina. In recent years the inclusion of P2Y12 inhibition in addition to low-dose acetylsalicylic acid has been intensively debated. Following the introduction of the modern generation of drug-eluting stents for elective coronary interventions, the duration of the necessary DAPT has been clearly reduced...
December 2017: Herz
https://www.readbyqxmd.com/read/29035427/differences-in-the-korea-acute-myocardial-infarction-registry-compared-with-western-registries
#17
REVIEW
Doo Sun Sim, Myung Ho Jeong
The Korea Acute Myocardial Infarction Registry (KAMIR) is the first nationwide registry that reflects current therapeutic approaches and acute myocardial infarction (AMI) management in Korea. The results of the KAMIR demonstrated different risk factors and responses to medical and interventional treatments. The results indicated that the incidence of ST-elevation myocardial infarction (STEMI) was relatively high, and that the prevalence of dyslipidemia was relatively low with higher triglyceride and lower high-density lipoprotein cholesterol levels...
September 18, 2017: Korean Circulation Journal
https://www.readbyqxmd.com/read/29026708/identification-of-risk-factors-influencing-in-stent-restenosis-with-acute-coronary-syndrome-presentation
#18
Jae Young Cho
Although the angiographic rates of in-stent restenosis (ISR) at later months have reduced dramatically with the introduction of drug-eluting stents (DESs), some patients with ISR after implantation of DES present with acute coronary syndrome (ACS). Here, we sought to identify parameters influencing the likelihood of restenosis with ACS presentation after DES implantation. Stented patients (n=3,817) with DESs in the Korea University Anam Hospital percutaneous coronary intervention registry were reviewed retrospectively for inclusion...
September 2017: Chonnam Medical Journal
https://www.readbyqxmd.com/read/28867009/sex-differences-in-the-effect-of-diabetes-mellitus-on-platelet-reactivity-and-coronary-thrombosis-from-the-assessment-of-dual-antiplatelet-therapy-with-drug-eluting-stents-adapt-des-study
#19
Gennaro Giustino, Björn Redfors, Roxana Mehran, Ajay J Kirtane, Usman Baber, Philippe Généreux, Bernhard Witzenbichler, Franz-Josef Neumann, Giora Weisz, Akiko Maehara, Michael J Rinaldi, D Christopher Metzger, Timothy D Henry, David A Cox, Peter L Duffy, Ernest L Mazzaferri, Bruce R Brodie, Thomas D Stuckey, George D Dangas, Sorin J Brener, M Ozgu Ozan, Gregg W Stone
BACKGROUND: Whether the consequences of diabetes mellitus (DM) are worse for women than for men treated with drug-eluting stents (DES) and antiplatelet therapy remain unclear. METHODS: Patients from the Assessment of Dual Antiplatelet Therapy With Drug-Eluting Stents study were stratified according to sex and DM status. We investigated the sex-specific effect of DM on high on-clopidogrel platelet reactivity (HPR), defined as a P2Y12 reaction units ≥208, and the adjusted association of DM on the 2-year risk for coronary thrombotic events (CTE), defined as spontaneous myocardial infarction or definite or probable stent thrombosis...
November 1, 2017: International Journal of Cardiology
https://www.readbyqxmd.com/read/28841230/rationale-and-design-of-the-drug-eluting-stents-vs-bare-metal-stents-in-saphenous-vein-graft-angioplasty-diva-trial
#20
Emmanouil S Brilakis, Subhash Banerjee, Robert Edson, Kendrick Shunk, Steven Goldman, David R Holmes, Deepak L Bhatt, Sunil V Rao, Mark W Smith, Mike Sather, Cindy Colling, Biswajit Kar, Lori Nielsen, Todd Conner, Todd Wagner, Bavana V Rangan, Beverly Ventura, Ying Lu, Mark Holodniy, Mei-Chiung Shih
VA Cooperative Studies Program #571 (DIVA) was designed to evaluate the efficacy of drug-eluting stents (DES) for reducing aortocoronary saphenous vein bypass graft (SVG) failure when compared with bare-metal stents (BMS) in participants undergoing stenting of de novo SVG lesions. Participants undergoing clinically indicated stenting of de novo SVG lesions were randomized in a 1:1 ratio to DES or BMS. Randomization was stratified by presence/absence of diabetes mellitus and the number of target SVG lesions (1 vs ≥2) within each participating site...
August 25, 2017: Clinical Cardiology
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