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clopidogrel and drug-eluting stents

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https://www.readbyqxmd.com/read/27894260/high-platelet-reactivity-affects-the-clinical-outcomes-of-patients-undergoing-percutaneous-coronary-intervention
#1
Jun-Jie Zhang, Xiao-Fei Gao, Zhen Ge, Nai-Liang Tian, Zhi-Zhong Liu, Song Lin, Fei Ye, Shao-Liang Chen
BACKGROUND: The association of platelet reactivity and clinical outcomes, especially stent thrombosis, was not so clear. We sought to investigate whether high platelet reactivity affects clinical outcomes of patients with drug eluting stents (DESs) implantation. METHODS: All enrolled individuals treated with DESs implantation were evaluated by PL-11, using sequentially platelet counting method. The primary end point was the occurrence of definite and probable stent thrombosis at 2 years...
November 29, 2016: BMC Cardiovascular Disorders
https://www.readbyqxmd.com/read/27846735/perioperative-management-of-dual-anti-platelet-therapy
#2
Tyler D Webster, Prashant Vaishnava, Kim A Eagle
Dual anti-platelet therapy denotes a regimen of aspirin plus a P2Y12 receptor inhibitor, clopidogrel, prasugrel, or ticagrelor. Such therapy is a cornerstone of medical management following acute coronary syndromes and is imperative following percutaneous coronary interventions. While there is uncertainty about the optimal duration of dual antiplatelet therapy following percutaneous coronary intervention, the new 2016 American College of Cardiology/American Heart Association Guidelines suggest that for patients with stable ischemic heart disease at least six months of such therapy following a drug eluting stent and one month following a bare metal stent should be implemented...
November 16, 2016: Hospital Practice (Minneapolis)
https://www.readbyqxmd.com/read/27789517/early-cessation-of-adenosine-diphosphate-receptor-inhibitors-among-acute-myocardial-infarction-patients-treated-with-percutaneous-coronary-intervention-insights-from-the-translate-acs-study-treatment-with-adenosine-diphosphate-receptor-inhibitors-longitudinal
#3
Emil L Fosbøl, Christine Ju, Kevin J Anstrom, Marjorie E Zettler, John C Messenger, Ron Waksman, Mark B Effron, Brian A Baker, David J Cohen, Eric D Peterson, Tracy Y Wang
BACKGROUND: Guidelines recommend the use of adenosine diphosphate receptor inhibitor (ADPri) therapy for 1 year postacute myocardial infarction; yet, early cessation of therapy occurs frequently in clinical practice. METHODS AND RESULTS: We examined 11 858 acute myocardial infarction patients treated with percutaneous coronary intervention discharged alive on ADPri therapy from 233 United States TRANSLATE-ACS study (Treatment With Adenosine Diphosphate Receptor Inhibitors: Longitudinal Assessment of Treatment Patterns and Events After Acute Coronary Syndrome) participating hospitals to determine the prevalence of early ADPri cessation (within 1 year), patient-reported reasons for cessation, and associated risk of major adverse cardiovascular events at 1 year...
November 2016: Circulation. Cardiovascular Interventions
https://www.readbyqxmd.com/read/27663414/factors-associated-with-initial-prasugrel-versus-clopidogrel-selection-for-patients-with-acute-myocardial-infarction-undergoing-percutaneous-coronary-intervention-insights-from-the-treatment-with-adp-receptor-inhibitors-longitudinal-assessment-of-treatment
#4
Amit N Vora, Eric D Peterson, Lisa A McCoy, Mark B Effron, Kevin J Anstrom, Douglas E Faries, Marjorie E Zettler, Gregg C Fonarow, Brian A Baker, Gregg W Stone, Tracy Y Wang
BACKGROUND: Few studies have examined how antiplatelet therapies are selected during the routine care of acute myocardial infarction patients, particularly relative to the patient's estimated mortality and bleeding risks. METHODS AND RESULTS: We examined patients presenting with acute myocardial infarction treated with percutaneous coronary intervention at 233 US hospitals in the TRANSLATE-ACS observational study from April 2010 to October 2012. We developed a multivariable logistic regression model to identify factors associated with prasugrel selection...
September 23, 2016: Journal of the American Heart Association
https://www.readbyqxmd.com/read/27650615/the-diagnostic-utility-of-the-point-of-care-cyp2c19-genotyping-assay-in-patients-with-acute-coronary-syndrome-dosing-clopidogrel-comparison-with-platelet-function-test-and-snp-genotyping
#5
Jae-Lim Choi, Bo-Ram Kim, Kwang-Sook Woo, Kyeong-Hee Kim, Jeong-Man Kim, Moo-Hyun Kim, Jin-Yeong Han
BACKGROUND: Clopidogrel is a widely used antiplatelet agent for dual antiplatelet therapy and metabolized by CYP2C19. The polymorphism of CYP2C19 is associated with the therapeutic effect of clopidogrel. METHODS: A total of 119 patients diagnosed with acute coronary syndrome (ACS) and underwent percutaneous coronary intervention (PCI) with drug-eluting stents was enrolled. Polymorphisms of CYP2C19 *2,*3,*17 were determined by the Spartan RX CYP2C19 and confirmed by SNP genotyping assay...
September 2016: Annals of Clinical and Laboratory Science
https://www.readbyqxmd.com/read/27641219/short-and-long-term-efficacy-and-safety-of-triple-vs-dual-antithrombotic-therapy-in-patients-with-drug-eluting-stent-implantation-and-an-indication-for-oral-anticoagulation-a-meta-analysis
#6
Yong Cao, Xiao-Yan Tian, Ran Zhang, Jia-Qi Zhao, Meng Zhang, Yun-Tao Cheng, Chuan-Fang Li, Gen-Li Liu, Yi An
BACKGROUND: The optimal antithrombotic regimen after coronary stenting in patients taking oral anticoagulants (OACs) is still unclear. Therefore, this meta-analysis focused on the short- and long-term efficacy and safety of triple therapy (TT: OAC, aspirin, and thienopyridine) and dual therapy (DT: OAC plus single antiplatelet drug or aspirin plus thienopyridine). METHODS: We searched PubMed, Embase, the Cochrane Library, Wangfang database, and Google Scholar up to December 1, 2015 (January 1, 2000 - December 2015), from randomized and nonrandomized studies comparing TT and DT in patients with OACs undergoing drug-eluting stent (DES) implantation...
December 2016: International Journal of Clinical Pharmacology and Therapeutics
https://www.readbyqxmd.com/read/27624287/six-versus-twelve-months-clopidogrel-therapy-after-drug-eluting-stenting-in-patients-with-acute-coronary-syndrome-an-isar-safe-study-subgroup-analysis
#7
Raphaela Lohaus, Jonathan Michel, Katharina Mayer, Anna Lena Lahmann, Robert A Byrne, 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, Adnan Kastrati, Stefanie Schulz-Schüpke
In patients presenting with acute coronary syndrome (ACS) the optimal duration of dual-antiplatelet therapy after drug-eluting stent (DES) implantation remains unclear. At 6 months after intervention, patients receiving clopidogrel were randomly assigned to either a further 6-month period of placebo or clopidogrel. The primary composite endpoint was death, myocardial infarction, stent thrombosis, stroke, or major bleeding 9 months after randomization. The ISAR-SAFE trial was terminated early due to low event rates and slow recruitment...
September 14, 2016: Scientific Reports
https://www.readbyqxmd.com/read/27621487/anticoagulant-and-antiplatelet-prescribing-patterns-for-patients-with-atrial-fibrillation-after-percutaneous-coronary-intervention
#8
Erin A Woods, Margaret L Ackman, Michelle M Graham, Sheri L Koshman, Rosaleen M Boswell, Arden R Barry
BACKGROUND: Current guidelines recommend triple antithrombotic therapy (TAT), defined as acetylsalicylic acid (ASA), clopidogrel, and warfarin, for patients with nonvalvular atrial fibrillation who have undergone percutaneous coronary intervention with stent implantation. The choice of anticoagulant/antiplatelet therapy in this population is ambiguous and complex, and prescribing patterns are not well documented. OBJECTIVE: To characterize local prescribing patterns for anticoagulant/antiplatelet therapy after percutaneous coronary intervention in patients with nonvalvular atrial fibrillation...
July 2016: Canadian Journal of Hospital Pharmacy
https://www.readbyqxmd.com/read/27595509/efficacy-and-safety-of-dual-antiplatelet-therapy-after-complex-pci
#9
Gennaro Giustino, Alaide Chieffo, Tullio Palmerini, Marco Valgimigli, Fausto Feres, Alexandre Abizaid, Ricardo A Costa, Myeong-Ki Hong, Byeong-Keuk Kim, Yangsoo Jang, Hyo-Soo Kim, Kyung Woo Park, Martine Gilard, Marie-Claude Morice, Fadi Sawaya, Gennaro Sardella, Philippe Genereux, Bjorn Redfors, Martin B Leon, Deepak L Bhatt, Gregg W Stone, Antonio Colombo
BACKGROUND: Optimal upfront dual antiplatelet therapy (DAPT) duration after complex percutaneous coronary intervention (PCI) with drug-eluting stents (DES) remains unclear. OBJECTIVES: This study investigated the efficacy and safety of long-term (≥12 months) versus short-term (3 or 6 months) DAPT with aspirin and clopidogrel according to PCI complexity. METHODS: The authors pooled patient-level data from 6 randomized controlled trials investigating DAPT durations after PCI...
October 25, 2016: Journal of the American College of Cardiology
https://www.readbyqxmd.com/read/27579410/getting-out-of-a-pccl-percutaneous-cholecystolithotomy-as-a-salvage-treatment-option-for-gallstone-removal-in-patients-deemed-unfit-for-standard-surgical-approaches
#10
Adam C Calaway, Michael S Borofsky, Casey A Dauw, James E Lingeman
Definitive management of acute cholecystitis or symptomatic cholelithiasis in exceedingly high-risk patients remains a clinical dilemma. In certain cases, treatment through a percutaneous approach following standard techniques and principles similar to those of percutaneous nephrolithotomy may be considered. However, one potential challenge, particularly among a high-risk population, is the possible necessity to stay on obligate anticoagulation for pre-existing medical reasons. To date, there have been no prior reports documenting the role of this procedure in patients on systemic anticoagulation, particularly clopidogrel...
2016: Journal of Endourology Case Reports
https://www.readbyqxmd.com/read/27577194/pericardial-tamponade-due-to-haemorrhagic-pericardial-effusion-as-a-complication-of-prasugrel-a-case-report
#11
Fathima Aaysha Cader, M Maksumul Haq, Sahela Nasrin, Md Rezaul Karim
BACKGROUND: Striking an adequate balance between bleeding risks and prevention of stent thrombosis can be challenging in the setting of percutaneous coronary intervention (PCI) with drug eluting stents (DES) in acute myocardial infarction (MI). This is more pronounced in patients treated with both low molecular weight heparin (LMWH) and dual antiplatelet therapy (DAPT). Prasugrel, a second generation thienopyridine with more potent platelet inhibition capability, is associated with significant bleeding risks...
August 30, 2016: BMC Cardiovascular Disorders
https://www.readbyqxmd.com/read/27555873/simultaneous-two-vessel-subacute-stent-thrombosis-caused-by-clopidogrel-resistance-from-cyp2c19-polymorphism
#12
Ashwad Afzal, Bimal Patel, Neel Patel, Sudhakar Sattur, Vinod Patel
Clopidogrel resistance from CYP2C19 polymorphism has been associated with stent thrombosis in patients undergoing percutaneous coronary intervention with drug-eluting stents. We present a case of a 76-year-old male who received drug-eluting stents to the right coronary artery and left anterior descending artery for non-ST elevation myocardial infarction and was discharged on dual antiplatelet therapy with aspirin and clopidogrel. He subsequently presented with chest pain from anterior, anteroseptal, and inferior ST segment elevation myocardial infarction...
2016: Case Reports in Medicine
https://www.readbyqxmd.com/read/27539687/cigarette-smoking-does-not-enhance-clopidogrel-responsiveness-after-adjusting-verifynow-p2y12-reaction-unit-for-the-influence-of-hemoglobin-level
#13
Yun Gi Kim, Jung-Won Suh, Si-Hyuck Kang, Jin Joo Park, Chang-Hwan Yoon, Young-Seok Cho, Tae-Jin Youn, In-Ho Chae, Dong-Ju Choi, Hyo-Soo Kim
OBJECTIVES: The authors performed this analysis to examine whether the enhanced clopidogrel responsiveness in current smokers is maintained after adjusting the influence of hemoglobin on VerifyNow P2Y12 reaction unit (PRU). BACKGROUND: PRU is consistently reported to be lower in current smokers. However, PRU has a significant inverse relationship with hemoglobin level, and smokers have higher hemoglobin levels. Because the association between PRU and hemoglobin is likely to be an in vitro phenomenon, we hypothesized that the observed difference in PRU between nonsmokers and current smokers is the result of confounding effect of hemoglobin rather than true difference in platelet reactivity...
August 22, 2016: JACC. Cardiovascular Interventions
https://www.readbyqxmd.com/read/27527508/cost-effectiveness-of-percutaneous-coronary-intervention-with-cobalt-chromium-everolimus-eluting-stents-versus-bare-metal-stents-results-from-a-patient-level-meta-analysis-of-randomized-trials
#14
Nicole Ferko, Giuseppe Ferrante, James T Hasegawa, Tanya Schikorr, Ireena M Soleas, John B Hernandez, Manel Sabaté, Christoph Kaiser, Salvatore Brugaletta, Jose Maria de la Torre Hernandez, Soeren Galatius, Angel Cequier, Franz Eberli, Adam de Belder, Patrick W Serruys, Marco Valgimigli
BACKGROUND: Second-generation drug eluting stents (DES) may reduce costs and improve clinical outcomes compared to first-generation DES with improved cost-effectiveness when compared to bare metal stents (BMS). We aimed to conduct an economic evaluation of a cobalt-chromium everolimus eluting stent (Co-Cr EES) compared with BMS in percutaneous coronary intervention (PCI). OBJECTIVE: To conduct a cost-effectiveness analysis (CEA) of a cobalt-chromium everolimus eluting stent (Co-Cr EES) versus BMS in PCI...
August 16, 2016: Catheterization and Cardiovascular Interventions
https://www.readbyqxmd.com/read/27523437/predictors-for-side-branch-failure-during-provisional-strategy-of-coronary-intervention-for-bifurcation-lesions-from-the-korean-bifurcation-registry
#15
Jae-Bin Seo, Dong-Ho Shin, Kyung Woo Park, Bon-Kwon Koo, Hyeon-Cheol Gwon, Myung-Ho Jeong, In-Whan Seong, Seung Woon Rha, Ju-Young Yang, Seung-Jung Park, Jung Han Yoon, Kyoo-Rok Han, Jong-Sun Park, Seung-Ho Hur, Seung-Jea Tahk, Hyo-Soo Kim
The most favored strategy for bifurcation lesion is stenting main vessel with provisional side branch (SB) stenting. This study was performed to elucidate predictors for SB failure during this provisional strategy. The study population was patients from 16 centers in Korea who underwent drug-eluting stent implantation for bifurcation lesions with provisional strategy (1,219 patients and 1,236 lesions). On multivariate analysis, the independent predictors for SB jailing after main vessel stenting were SB calcification, large SB reference diameter, severe stenosis of SB, and not taking clopidogrel...
September 15, 2016: American Journal of Cardiology
https://www.readbyqxmd.com/read/27494368/use-of-prasugrel-in-the-setting-of-clopidogrel-hypersensitivity-case-report-and-systematic-review-of-the-literature
#16
Henry Siu, Antony Kaliyadan, David L Fischman, Evan Nardone, David Poll, Michael P Savage
Allergic reactions to clopidogrel soon after coronary stent implantation pose an important and challenging clinical problem. We describe a 44-year-old man who developed a diffuse maculopapular rash four days after initiation of clopidogrel with drug-eluting coronary stent placement. An initial treat-through strategy was unsuccessful due to patient intolerance to corticosteroids. Because of persistent hypersensitivity, clopidogrel was substituted with prasugrel which was continued successfully for one year without reaction...
August 5, 2016: Platelets
https://www.readbyqxmd.com/read/27446331/clinical-outcomes-of-various-continued-antiplatelet-therapies-in-patients-who-were-administered-dapt-following-the-implantation-of-drug-eluting-stents-and-developed-gastrointestinal-hemorrhage
#17
Yujie Guo, Jinru Wei
Although an increasing number of patients accept dual antiplatelet therapy (DAPT) following implantation of drug-eluting stents (DES) for coronary heart disease (CHD), the proportion of patients with DAPT who subsequently develop gastrointestinal hemorrhage continues to increase. To ensure the clinical outcomes from DES, it is important to formulate a novel continued antiplatelet therapy for patients who were administered DAPT and subsequently develop gastrointestinal hemorrhage following DES implantation. The present study aimed to evaluate the effects of continued aspirin, clopidogrel or DAPT use on the incidence of clinical adverse events and gastrointestinal rebleeding in patients who received DAPT and subsequently developed gastrointestinal hemorrhage following implantation of DES for CHD...
August 2016: Experimental and Therapeutic Medicine
https://www.readbyqxmd.com/read/27379610/fractional-flow-reserve-guided-coronary-angioplasty-using-paclitaxel-coated-balloons-without-stent-implantation-feasibility-safety-and-6-month-results-by-angiography-and-optical-coherence-tomography
#18
Tudor C Poerner, Corinna Duderstadt, Björn Goebel, Daniel Kretzschmar, Hans R Figulla, Sylvia Otto
BACKGROUND: Percutaneous coronary interventions (PCI) with drug-coated balloons (DCB) might be a promising trade-off between balloon angioplasty and drug-eluting stents, since DCB inhibit neointimal proliferation and limit duration of dual antiplatelet therapy. We investigated the safety, feasibility, and 6-month results of fractional flow reserve (FFR)-guided use of the paclitaxel-coated SeQuent Please(®) balloon without stenting for elective PCI of de novo lesions. METHODS AND RESULTS: In 46 patients (54 lesions) with stable symptomatic coronary artery disease (CAD), a FFR-guided POBA (plain old balloon angioplasty) was performed...
July 5, 2016: Clinical Research in Cardiology: Official Journal of the German Cardiac Society
https://www.readbyqxmd.com/read/27368038/cyp2c19-loss-of-function-alleles-are-not-associated-with-clinical-outcome-of-clopidogrel-therapy-in-patients-treated-with-newer-generation-drug-eluting-stents
#19
Ik Jun Choi, Yoon-Seok Koh, Mahn-Won Park, Sung Ho Her, Yun-Seok Choi, Chul-Soo Park, Hun-Jun Park, Pum-Joon Kim, Wook-Sung Chung, Ho-Sook Kim, Jae-Gook Shin, Ki-Bae Seung, Kiyuk Chang
CYP2C19 loss-of-function (LOF) alleles adversely affect clinical outcome of clopidogrel therapy. Recent introduction of a newer-generation drug-eluting stent (DES) has significantly reduced the occurrence of stent thrombosis.The aim of this study was to evaluate the impact of CYP2C19 LOF alleles on clinical outcome in patients treated with the newer-generation DES.The effects of CYP2C19 genotypes were evaluated on clinical outcome of clopidogrel therapy in 2062 patients treated with percutaneous coronary intervention using either first-generation DES (sirolimus- and paclitaxel-eluting stent, n = 1349) or newer-generation DES (everolimus- and zotarolimus-eluting stent, n = 713)...
June 2016: Medicine (Baltimore)
https://www.readbyqxmd.com/read/27354859/management-of-antithrombotic-therapy-during-cardiac-implantable-device-surgery
#20
REVIEW
Ahmed AlTurki, Riccardo Proietti, David H Birnie, Vidal Essebag
Anticoagulants are commonly used drugs that are frequently encountered during device placement. Deciding when to halt or continue the use of anticoagulants is a balance between the risks of thromboembolism versus bleeding. Patients taking warfarin with a high risk of thromboembolism should continue to take their warfarin without interruption during device placement while ensuring their international normalized ratio remains below 3. For patients who are taking warfarin and have low risk of thromboembolism, either interrupted or continued warfarin may be used, with no evidence to clearly support either strategy...
June 2016: Journal of Arrhythmia
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