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antiplatelete therapy

Zhiyuan Yang, Zhouliang Xie, Xueliang Pei, Xiaoqiang Quan, Deguang Feng
The guiding value of thrombelastography (TEG) on the selection of surgical timing for patients scheduled for coronary artery bypass grafting (CABG) was investigated. A total of 90 subjects with acute coronary syndrome (ACS) treated between February 2014 and December 2016 in Henan Provincial People's Hospital were recruited. The patients received dual antiplatelet therapy (DAPT) and were scheduled for CABG. Subjects were randomly allocated into two groups, TEG group (n=45) and non-TEG group (n=45). Patients in the TEG group withheld medications at 24 h prior to surgery and received TEG examination...
August 2018: Experimental and Therapeutic Medicine
Federico Fortuni, Marco Ferlini, Sergio Leonardi, Filippo Angelini, Gabriele Crimi, Alberto Somaschini, Stefano Cornara, Antonella Potenza, Stefano De Servi, Luigi Oltrona Visconti, Gaetano Maria De Ferrari
BACKGROUND AND AIMS: There is contrasting evidence regarding the optimal antithrombotic regimen after percutaneous coronary stent implantation in patients on oral anticoagulants. A systematic review and meta-analysis was performed to explore the comparative efficacy and safety of dual (an antiplatelet plus an oral anticoagulant) versus triple therapy (dual antiplatelet therapy plus an oral anticoagulant). METHODS: We searched the literature for randomized controlled trials (RCTs) or observational studies (OSs) addressing this issue...
August 9, 2018: International Journal of Cardiology
Nitin Madhukar Bhorkar, Tasneem Saleh Dhansura, Urmila Bhaktiprasad Tarawade, Sanket Sharad Mehta
Coagulopathy either from the use of anticoagulant, antiplatelet, or thrombolytic medications or from underlying medical conditions is considered one of the major risk factors for epidural hematoma formation related to epidural catheter placement or removal. The American Society of Regional Anesthesia and Pain Medicine (ASRA) has laid down guidelines regarding timing of neuraxial blockade or removal of neuraxial catheters in patients receiving either antithrombotic or thrombolytic therapy. We present a case of acute onset of paraplegia because of an epidural hematoma following removal of the epidural catheter in a patient who was given the first dose of antithrombotic therapy after the removal of the epidural catheter as per the ASRA guidelines...
July 2018: Indian Journal of Critical Care Medicine
Christopher R Williams, Angela Jellison, Luke Martin, Chong Zhang, Angela P Presson, Larry W Kraiss, Benjamin S Brooke
OBJECTIVE: Optimizing medical management through glucose control, smoking cessation, and drug therapy (ie, antiplatelet and statin agents) is recommended as first-line therapy for patients with claudication. The aims of this study were to determine how frequently veterans with claudication received optimal medical management (OMM) before undergoing elective open lower extremity bypass procedures nationwide and whether preoperative OMM was associated with improved surgical outcomes. METHODS: We reviewed all patients within the Veterans Affairs (VA) Surgical Quality Improvement Program database who underwent elective open lower extremity bypass procedures for claudication at nationwide VA medical centers from 2005 until 2015...
August 11, 2018: Journal of Vascular Surgery
Christopher Alan Hilditch, Waleed Brinjikji, Joanna Schaafsma, Chun On Anderson Tsang, Patrick Nicholson, Ronit Agid, Timo Krings, Vitor M Pereira
BACKGROUND AND PURPOSE: Extracranial internal carotid artery (ICA) dissection is an important cause of ischemic stroke in younger adults. The optimal medical and surgical strategies for managing these lesions have not been well established. We report a case series of extracranial ICA reconstruction using overlapping flow-diverter stents as a rescue therapy for the treatment of symptomatic ICA dissection in patients presenting with recurrent ischemic stroke and/or severe hemispheric hypoperfusion who failed medical management...
August 13, 2018: Clinical Neuroradiology
Kornelia Kreiser, Isabell Gröber, Claus Zimmer, Katharina Storck
BACKGROUND: Carotid blowout syndrome due to tumor infiltration, fistulas, and therapy-related necrosis can occur as late as years after the treatment. Reporting our experiences with preventive and acute treatment with stent grafts and discussing different ways of antiplatelet therapy. METHODS: We reviewed all patients between 2010 and 2016 who underwent stent graft placement and analyzed outcome, complications, and antiplatelet regime. RESULTS: Seventeen patients were treated in 24 sessions (n = 7 threatened, n = 5 imminent, and n = 12 acute bleeding)...
August 13, 2018: Head & Neck
Mitchell L Schubert
PURPOSE OF REVIEW: The present review summarizes the past year's literature, both clinical and basic science, regarding potential adverse effects of proton pump inhibitors. RECENT FINDINGS: Proton pump inhibitors are amongst the most widely prescribed and overprescribed medications worldwide. Although generally considered well tolerated, epidemiologic studies mining large databases have reported a panoply of purported serious adverse effects associated with proton pump inhibitors, including chronic kidney disease, cognitive decline, myocardial infarction, stroke, bone fracture and even death...
August 9, 2018: Current Opinion in Gastroenterology
Daisuke Akagi, Katsuyuki Hoshina, Atsushi Akai, Kota Yamamoto
The prevalence of arteriosclerosis obliterans (ASO) and critical limb ischemia (CLI) is currently increasing, and arterial reconstruction is often attempted to salvage the limb. Some patients cannot undergo attempted revascularization because of contraindications, and they only receive conservative treatment. In this study, we investigate the comorbidities and survival rates of patients with CLI who receive conservative treatment. Thirty-five patients with CLI due to ASO, who had not undergone revascularization surgery (C group), were enrolled...
August 11, 2018: International Heart Journal
Muhammad Azharuddin, Mridul Gupta, Mihir Maniar
Rectus sheath hematoma (RSH) is a rare complication that usually occurs in patients receiving anticoagulation therapy. It can mimic an acute abdomen and be life-threatening. RSH can develop even with prophylactic dose of heparin. Early recognition is necessary to decrease morbidity and mortality. RSH should be considered in anticoagulated patients who develop sudden onset of abdominal pain. RSH is usually managed conservatively, but sometimes requires surgery. Patients who are taking antiplatelet require careful monitoring with the use of anticoagulation (AC)...
June 8, 2018: Curēus
Zhonghua Wu, Ao-Fei Liu, Ji Zhou, Yiqun Zhang, Kai Wang, Chen Li, Hancheng Qiu, Wei-Jian Jiang
OBJECTIVE: To investigate the safety of triple antiplatelet therapy (TAT) with cilostazol in patients undergoing stenting for extracranial and/or intracranial artery stenosis. METHODS: A prospectively collected database was reviewed to identify patients who underwent stenting for extracranial and/or intracranial artery stenosis and showed resistance to aspirin and/or clopidogrel as assessed by pre-stenting thromboelastography (TEG) testing. Patients were assigned to a TAT group and a dual antiplatelet therapy (DAT) group...
August 12, 2018: Journal of Neurointerventional Surgery
Vítor Ferreira, Cristiana Freixo, João Gonçalves, Gabriela Teixeira, Inês Antunes, Carlos Veiga, Daniel Mendes, Joana Martins, Rui Almeida
BACKGROUND: Optimal antithrombotic therapy after lower limb infra-inguinal revascularization remains a controversial topic. The use of anticoagulants, alone or in combination with antiplatelet drugs, can potentially improve patency rate and limb salvage, particularly in patients with risk factors for early thrombosis. Bleeding is the main complication of long term anticoagulant use. New oral anticoagulants can represent an attractive alternative to the standard vitamin K-antagonists. OBJECTIVE: evaluate the effectovemess (bypass occlusion and major amputation) and safety (major bleeding and all-cause mortality) of rivaroxaban compared to acenocoumarol after infra-inguinal lower limb surgical revascularization...
August 9, 2018: Annals of Vascular Surgery
Jie-Ya Wang, Yan-Jiao Zhang, He Li, Xiao-Lei Hu, Mu-Peng Li, Pei-Yuan Song, Qi-Lin Ma, Li-Ming Peng, Xiao-Ping Chen
BACKGROUND: Dual antiplatelet therapy (DAPT) with aspirin and clopidogrel is a recommended treatment for coronary artery disease (CAD) patients undergoing percutaneous coronary intervention (PCI) to reduce the rate of ischemic events and stent thrombosis. However, high on-treatment platelet reactivity (HTPR) during clopidogrel therapy for some patients may lead to outcome failure and occurrence of cardiovascular events. Amounts of studies have proved that genetic factors may contribute to HTPR...
August 7, 2018: Gene
Juan A Giménez-Bastida, William E Boeglin, Olivier Boutaud, Michael G Malkowski, Claus Schneider
Aspirin (acetylsalicylic acid) inhibits prostaglandin (PG) synthesis by transfer of its acetyl group to a serine residue in the cyclooxygenase (COX) active site. Acetylation of Ser530 inhibits catalysis by preventing access of arachidonic acid substrate in the COX-1 isoenzyme. Acetylated COX-2, in contrast, gains a new catalytic activity and forms 15 R hydroxy-eicosatetraenoic acid (15 R-HETE) as alternate product. Here we show that acetylated COX-2 also retains COX activity, forming predominantly 15 R-configuration PGs (70 or 62% 15 R, respectively, determined using radiolabeled substrate or LC-MS analysis)...
August 10, 2018: FASEB Journal: Official Publication of the Federation of American Societies for Experimental Biology
Shaojie Chen, Felix K Weise, Kr Julian Chun, Boris Schmidt
Interventional left atrial appendage occlusion (LAAO) has emerged as a valid alternative to oral anticoagulation (OAC) therapy for the prevention of ischemic stroke and systemic embolism in patients with non-valvular atrial fibrillation (AF). Areas covered: Antithrombotic therapy following interventional LAAO is critical in balancing the risk of thromboembolism and bleeding during the endothelialization of the implanted devices. In this article, the most recent clinical trials are reviewed and the current real-world antithrombotic strategies following LAAO device implantation are discussed...
August 10, 2018: Expert Review of Cardiovascular Therapy
Fabio Ramponi, Michael Seco, James B Edelman, Andrew G Sherrah, Paul G Bannon, R John L Brereton, Michael K Wilson, Michael P Vallely
Coronary surgery performed on an arrested heart, using one internal mammary artery and a saphenous vein carries two main potential drawbacks: the known failure rate of vein grafts and the relatively high rate of neurologic injury. To address these concerns, we describe a technique that achieves complete revascularization without manipulating the ascending aorta (anaortic, off-pump) and utilizing total arterial grafts. All patients undergo thorough preoperative investigation, including bilateral carotid, vertebral and subclavian artery Duplex ultrasounds...
July 2018: Annals of Cardiothoracic Surgery
Yoshito Kadoya, Kan Zen, Yohei Oda, Satoaki Matoba
A 60-year-old man with a history of Raynaud's phenomenon presented with bilateral intermittent claudication and an ulcer on his right toe. The ankle-brachial index of the right and left legs was 0.77 and 0.75, respectively. Laboratory data showed prolongation of the activated partial thromboplastin time and a positive result on the lupus anticoagulant test. Computed tomography angiography revealed isolated infrarenal aortic stenosis with irregular surface and noncalcified plaques. Intravascular ultrasonography examination demonstrated a noncalcified, irregular, and mobile plaque, suggestive of abdominal aortic thrombosis...
August 9, 2018: Vascular and Endovascular Surgery
Suh Min Kim, In Mok Jung
PURPOSE: Arterial involvement of Behcet disease is often found in the form of a rapidly expanding aneurysm. We report a case of successful treatment of a ruptured popliteal artery aneurysm with a stent-graft insertion. CASE REPORT: A 55-year-old male patient was admitted because of pain and swelling in the right leg that had persisted for 15 days. Computed tomography (CT) angiographyshowed a contained rupture of a large right popliteal artery aneurysm. Laboratory tests showed elevated erythrocyte sedimentation rate (ESR) and C-reactive protein level...
August 6, 2018: Annals of Vascular Surgery
Donny Hanjaya-Putra, Carolyn Haller, Xiaowei Wang, Erbin Dai, Bock Lim, Liying Liu, Patrick Jaminet, Joy Yao, Amy Searle, Thomas Bonnard, Christoph E Hagemeyer, Karlheinz Peter, Elliot L Chaikof
Despite advances in antithrombotic therapy, the risk of recurrent coronary/cerebrovascular ischemia or venous thromboembolism remains high. Dual pathway antithrombotic blockade, using both antiplatelet and anticoagulant therapy, offers the promise of improved thrombotic protection; however, widespread adoption remains tempered by substantial risk of major bleeding. Here, we report a dual pathway therapeutic capable of site-specific targeting to activated platelets and therapeutic enrichment at the site of thrombus growth to allow reduced dosing without compromised antithrombotic efficacy...
August 9, 2018: JCI Insight
Dominik Rath, Meinrad Gawaz
Catheter-based interventions have revolutionized treatment of both coronary artery disease and aortic valve disease. Yet, these procedures are accompanied by thromboembolic and bleeding complications. Antiplatelet agents and anticoagulants with tolerable risk of bleeding complications are required to protect from recurrent thromboembolic events. Although guidelines for antithrombotic treatment in patients undergoing percutaneous coronary intervention (PCI) and transcatheter aortic valve replacement (TAVR) are available, scarce evidence exists regarding therapeutic recommendations for patients at high risk for thromboembolic events or major bleeding...
August 8, 2018: Hämostaseologie
Nataša Gašperšič, Marjan Zaletel, Jan Kobal, Polona Žigon, Saša Čučnik, Snežna Sodin Šemrl, Matija Tomšič, Aleš Ambrožič
Testing for antiphospholipid antibodies could be an important part in determining the cause of a cerebrovascular event (CVE). Currently, it is also unknown whether antiphospholipid antibodies represent a risk factor for the development of a CVE and whether the selected therapy options are efficacious. So, this study aimed at (1) determining the frequency of patients experiencing a CVE and fulfilling the laboratory criterion for an antiphospholipid syndrome (APS), (2) investigating whether the persistent presence of antiphospholipid antibodies represented a risk factor for a CVE, and (3) focusing on the efficacy of the selected treatment strategy in the first year after the CVE...
August 7, 2018: Clinical Rheumatology
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