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antiplatelete therapy

Jean Terrier, Jean-Luc Reny, Pierre Fontana
Antithrombotic drugs are regularly prescribed for the treatment and prevention of venous or arterial thromboembolic events. The co-prescription of an anticoagulant and antiplatelet drug is frequent in daily practice even if evidence of benefit associated with such an association is limited, while the increased bleeding risk is well established. The aim of this article is to review the situations where antiplatelet drugs are indicated in patients already treated with long-term anticoagulants. The perspective of adapting and personalizing antithrombotic therapy according to each patient's characteristics is also discussed...
December 5, 2018: Revue Médicale Suisse
Babikir Kheiri, Mohammed Osman, Ahmed Abdalla, Tarek Haykal, Bakr Swaid, Sahar Ahmed, Adam Chahine, Mustafa Hassan, Ghassan Bachuwa, Mohammed Al Qasmi, Deepak L Bhatt
Recurrent stroke is common immediately following a transient ischemic attack (TIA) or ischemic stroke. Dual antiplatelet therapy (DAPT) with clopidogrel and aspirin may provide greater protection against subsequent stroke than monotherapy. Electronic databases were searched for randomized clinical trials (RCTs) comparing DAPT with monotherapy in ischemic stroke/TIA. Sixteen RCTs with a total of 29,032 patients were included. Compared with monotherapy, DAPT was associated with significantly lower rates of any stroke (risk ratio [RR] 0...
December 3, 2018: Journal of Thrombosis and Thrombolysis
Simon Correa, Marc P Bonaca, Benjamin M Scirica, Sabina A Murphy, Erica L Goodrich, David A Morrow, Michelle L O'Donoghue
Patients with renal disease are often undertreated with antiplatelet therapy due to concerns about bleeding. Vorapaxar blocks platelet activation via the PAR-1 receptor and reduces cardiovascular events in patients with stable atherosclerosis, but with increased bleeding. We examined the efficacy and safety of vorapaxar in patients with impaired renal function. TRA2°P-TIMI 50 randomized patients with stable atherosclerosis to vorapaxar or. We analyzed patients with eGFR assessed who qualified with a history of MI or PAD (without stroke or TIA) (n = 19,932)...
December 3, 2018: Journal of Thrombosis and Thrombolysis
Takahisa Fujikawa, Kenji Ando
AIM: To elucidate the effect of antithrombotic therapy (ATT) on bleeding and thromboembolic complications during or after laparoscopic digestive surgery. METHODS: Published articles or internationally accepted abstracts between 2000 and 2017 were searched from PubMed, Cochrane Database, and Google Scholar, and studies involving laparoscopic digestive surgery and antiplatelet therapy (APT) and/or anticoagulation therapy (ACT) were included after careful review of each study...
November 26, 2018: World Journal of Clinical Cases
Wipharak Bunmark, Peerawat Jinatongthai, Prin Vathesatogkit, Ammarin Thakkinstian, Christopher M Reid, Wanwarang Wongcharoen, Nathorn Chaiyakunapruk, Surakit Nathisuwan
Background: Patients undergoing percutaneous coronary intervention (PCI) who require anticoagulant therapy are at increased risk of bleeding. The optimal regimen for these patients is uncertain. This study aimed to compare safety and efficacy of antithrombotic regimens used in patients undergoing PCI with concomitant anticoagulant therapy. Methods: A systematic review and network meta-analysis was performed among studies comparing antithrombotic regimens for anticoagulated patients undergoing PCI. The primary outcome of interest was major bleeding...
2018: Frontiers in Pharmacology
Lisa Dannenberg, Philipp Mourikis, David Naguib, Saif Zako, Carolin Helten, René M'Pembele, Kajetan Trojovsky, Daniel Konsek, Georg Wolff, Maximilian Brockmeyer, Volker Schulze, Bodo Levkau, Thomas Hohlfeld, Tobias Zeus, Malte Kelm, Amin Polzin
BACKGROUND: The optimal antithrombotic strategy after interventional left atrial appendage closure (LAAC) is controversial. Dual antiplatelet therapy with aspirin and clopidogrel is the most frequently used regiment. However, pharmacodynamic response to antiplatelet medication differs significantly between individuals. Therefore, we aimed to analyse pharmacodynamic response to aspirin and clopidogrel after LAAC. METHODS: In this study, we included 129 patients undergoing interventional LAAC...
January 15, 2019: International Journal of Cardiology
Naoki Ohnishi, Yuichiro Fujieda, Ryo Hisada, Hiroyuki Nakamura, Masaru Kato, Kenji Oku, Toshiyuki Bohgaki, Olga Amengual, Shinsuke Yasuda, Tatsuya Atsumi
Objective: Warfarin is regarded as the standard treatment for preventing thrombotic events in APS, but the recurrence rate is still high. Dual antiplatelet therapy (DAPT) has been shown to be effective for the prevention of acute coronary syndrome or stroke. The objective of this study was to evaluate the efficacy of DAPT for the prevention of thrombosis recurrence in APS patients with history of arterial thrombosis. Methods: This retrospective cohort study of APS patients was conducted at Hokkaido University Hospital between 1990 and 2016...
November 30, 2018: Rheumatology
Makoto Mori, Kayoko Shioda, Syed Usman Bin Mahmood, Abeel A Mangi, James J Yun, Arnar Geirsson
Background: Dual antiplatelet therapy (DAPT) in patients presenting with acute coronary syndrome (ACS) undergoing CABG is recommended to prevent recurrent ischemic events. The benefit of DAPT post-CABG in patients with stable ischemic heart disease (SIHD) is unknown. The aim of this study was to evaluate the utilization rate of DAPT and associated outcomes in patients with SIHD undergoing CABG via a secondary analysis of Bypass Angioplasty Revascularization Investigation 2 Diabetes (BARI 2D) trial data...
September 2018: Annals of Cardiothoracic Surgery
Adam Chakos, Dean Jbara, Kamal Singh, Tristan D Yan, David H Tian
Background: Numerous agents have been trialed following coronary artery bypass grafting (CABG) to maintain long-term graft patency. While clear evidence exists for the use of aspirin in maintaining graft patency, the role of dual-antiplatelet therapy in CABG patients is not as well established. This network meta-analysis aimed to compare the short-term post-CABG graft patency outcomes for patients with none, one or two antiplatelet agents. Methods: Electronic databases were queried for randomized controlled trials comparing CABG graft patency rates at three months and beyond using various antiplatelet agents or placebo...
September 2018: Annals of Cardiothoracic Surgery
Fiachra McHugh, Khalid Ahmed, Antoinette Neylon, Faisal Sharif, Darren Mylotte
Transcatheter aortic valve implantation (TAVI) is now the accepted standard of care for patients with symptomatic severe aortic stenosis at elevated risk for conventional surgical valve replacement. Currently, societal guidelines propose the use of dual antiplatelet therapy for the prevention of thromboembolic events after TAVI in patients without an indication for oral anticoagulation. This strategy is empiric and largely based on expert consensus extrapolated from the arena of percutaneous coronary intervention...
November 2018: Journal of Thoracic Disease
Sergio Perez, Torin P Thielhelm, Mauricio G Cohen
Concomitant coronary artery disease (CAD) and aortic stenosis occur in approximately 60-75% of patients referred for surgical or transcatheter aortic valve replacement (TAVR). Current guidelines support simultaneous surgical aortic valve replacement and bypass surgery with a class IIa recommendation, based on observational, non-randomized data. With the inception of TAVR, this strategy has been challenged, as observational studies have not shown significant outcome differences in patients with and without CAD treated with TAVR...
November 2018: Journal of Thoracic Disease
Tawseef Dar, Bharath Yarlagadda, Prasad Gunasekaran, Dhanunjaya Lakkireddy, Mark A Wiley
Ventricular free wall rupture (VFWR) is a rare entity and is mostly related to post myocardial infarction (MI) complications usually involving left ventricle. In traumatic chest injuries, the right ventricle (RV) is more commonly involved due to its anatomic and structural vulnerability, as in our case. Survival, although rare, has almost always been secondary to urgent surgical repair, which is the current standard of care for such cases. However, extremely tenuous hemodynamic parameters preclude urgent surgical interventions in most of these cases...
August 2018: Journal of Atrial Fibrillation
Sara R Vazquez
Oral anticoagulants are commonly prescribed but high risk to cause adverse events. Skilled drug interaction management is essential to ensure safe and effective use of these therapies. Clinically relevant interactions with warfarin include drugs that modify cytochrome 2C9, 3A4, or both. Drugs that modify p -glycoprotein may interact with all direct oral anticoagulants, and modifiers of cytochrome 3A4 may interact with rivaroxaban and apixaban. Antiplatelet agents, nonsteroidal anti-inflammatory drugs, and serotonergic agents, such as selective serotonin reuptake inhibitors, can increase risk of bleeding when combined with any oral anticoagulant, and concomitant use should be routinely assessed...
November 30, 2018: Hematology—the Education Program of the American Society of Hematology
Serge Korjian, Yazan Daaboul, François Laliberté, Qi Zhao, Roxana Mehran, Christoph Bode, Jonathan Halperin, Freek W A Verheugt, Gregory Y H Lip, Marc Cohen, Eric D Peterson, Keith A A Fox, C Michael Gibson, Duane S Pinto
The PIONEER AF-PCI trial demonstrated that in atrial fibrillation patients who underwent intracoronary stenting, either rivaroxaban 15 mg daily plus P2Y12 inhibitor monotherapy (Group 1) or 2.5 mg rivaroxaban twice daily plus dual antiplatelet therapy (DAPT) (Group 2) was associated with fewer recurrent hospitalizations, primarily for bleeding and cardiovascular events, compared with standard-of-care vitamin K antagonist and DAPT (Group 3). Associated costs are unknown. This study estimates costs associated with rivaroxaban strategies compared with vitamin K antagonist and DAPT...
November 6, 2018: American Journal of Cardiology
Nikolaos Spinthakis, Mohamed Farag, Ying X Gue, Manivannan Srinivasan, David M Wellsted, Diana A Gorog
Although used routinely to reduce thrombotic events in patients with coronary disease, the effects of P2Y12 inhibitors on thrombus stability and endogenous fibrinolysis are largely unknown. Blood taken from patients pre- and post-aspirin (n = 20) and on aspirin alone and on dual antiplatelet therapy comprising aspirin plus clopidogrel (n = 20), ticagrelor (n = 20) or cangrelor (n = 20), was tested using the Global Thrombosis Test. The number of "rebleeds" or drops (D) after early platelet-rich thrombus formation (occlusion time, OT), and before final lasting occlusion, was used as an inverse measure of thrombus stability...
November 24, 2018: Thrombosis Research
L I Pyshkina, A R Abieva, A N Yasamanova, N A Darvish, P R Kamchatnov, A A Kabanov, A A Tyazhelnikov, E V Silina, S N Shurygin, Z H Osmaeva
AIM: To study the state of cerebral hemodynamics and platelet hemostasis in patients with carotid stenosis (CS). MATERIAL AND METHODS: The prospective study included 123 patients with atherosclerotic CS. The 1st group included 53 patients (mean age 52±12.5 yrs) who underwent carotid endarterectomy (CEA); the 2nd group - 70 patients who were treated conservatively (mean age 58.5±15.9 yrs). The state of blood flow through the main arteries of the head (Doppler flowmetry), platelet aggregation induced by adrenaline, the frequency of acute cardiovascular events that occurred during 12 months were evaluated...
2018: Zhurnal Nevrologii i Psikhiatrii Imeni S.S. Korsakova
C Daugaard, A B Pedersen, N R Kristensen, S P Johnsen
Hip fracture surgery is associated with high risk of bleeding and mortality. The patients often have cardiovascular comorbidity, which requires antithrombotic treatment. This study found that preoperative use of oral anticoagulants was not associated with transfusion or mortality following hip fracture surgery, whereas increased risk may exist for antiplatelet drugs. INTRODUCTION: Hip fracture surgery is associated with high bleeding risk and mortality; however, data on operative outcomes of hip fracture patients admitted while on antithrombotic therapy is sparse...
November 29, 2018: Osteoporosis International
Xuelei Zhang, Gang Luo, Dapeng Mo, Ning Ma, Feng Gao, Jingyu Zhang, Zhongrong Miao
PURPOSE: To investigate the predictors for good outcome of endovascular therapy (EVT) for patients with acute vertebrobasilar artery occlusion (VBAO) due to intracranial atherosclerosis stenosis (ICAS). METHODS: From April 2012 to February 2018, patients with VBAO due to ICAS who received EVT were retrospectively analyzed. ICAS was defined as fixed stenosis of >70%, or a degree of fixed stenosis >50% in addition to either perfusion impairment or evidence to re-occlusion...
November 29, 2018: Clinical Neuroradiology
Annunziata Nusca, Edoardo Bressi, Iginio Colaiori, Marco Miglionico, Germano Di Sciascio
Transcatheter interventions for valvular and structural heart diseases are rapidly expanding due to greater operators' experience and development of new generation devices associated with increased procedural safety. They represent the standard strategy for patients with prohibitive risk for open surgery. These procedures are associated with a significant occurrence of both thrombotic and bleeding complications, thus in this setting, even more than in other percutaneous procedures, the balance between thrombotic and bleeding risk is critical...
October 2018: Cardiovascular Diagnosis and Therapy
Rosetta Melfi, Elisabetta Ricottini
Atherosclerotic cardiovascular (CV) disease represents one of leading cause of mortality and morbidity in Western countries. An increased risk of CV events was identified in patients with peripheral arterial diseases (PADs), which include all arterial diseases, other than coronary arteries and the aorta. In particular, lower extremity artery disease (LEAD) and/or carotid artery disease present growing incidence in general population and a consequent increase in mortality and morbidity. Medical treatment, including antiplatelet therapy, is a cornerstone in management of these patients, even when they are treated with endovascular or surgical procedures...
October 2018: Cardiovascular Diagnosis and Therapy
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