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Shokoufeh Hajsadeghi, Mandana Chitsazan, Mitra Chitsazan, Negar Salehi, Ahmad Amin, Arash Amin Bidokhti, Nima Babaali, Armin Bordbar, Maral Hejrati, Samar Moghadami
OBJECTIVES: A growing body of clinical and laboratory evidence indicates that inflammation plays a crucial role in atherosclerosis. In the present study, we compared the effects of clopidogrel and prasugrel on high-sensitivity C-reactive protein (hs-CRP) in patients undergoing percutaneous coronary intervention (PCI). METHODS: The present randomized, double-blind clinical trial included 120 patients who underwent PCI. Eligible patients were randomly assigned 2:1 to one of the two groups: 80 patients in the first group received clopidogrel (Plavix(®); loading dose and maintenance dose of 300 and 75 mg daily, respectively) and 40 patients in the second group received prasugrel (Effient(®); loading dose and maintenance dose of 60 and 10 mg, respectively) for 12 weeks...
2016: Clinical Medicine Insights. Cardiology
Andre E Ghantous, Elie M Ferneini
Most patients with coronary artery disease and peripheral vascular disease are on long-term antiplatelet therapy and dual therapy. Achieving a balance between ischemic and bleeding risk remains an important factor in managing patients on antiplatelet therapy. For most outpatient surgical procedures, maintenance and continuation of this therapy are recommended. Consultation with the patient's cardiologist, physician, and/or vascular surgeon is always recommended before interrupting or withholding this treatment modality...
November 2016: Oral and Maxillofacial Surgery Clinics of North America
Adesuwa Olomu, William Hart-Davidson, Zhehui Luo, Karen Kelly-Blake, Margaret Holmes-Rovner
BACKGROUND: Use of Shared Decision-Making (SDM) and Decision Aids (DAs) has been encouraged but is not regularly implemented in primary care. The Office-Guidelines Applied to Practice (Office-GAP) intervention is an application of a previous model revised to address guidelines based care for low-income populations with diabetes and coronary heart disease (CHD). OBJECTIVE: To evaluate Office-GAP Program feasibility and preliminary efficacy on medication use, patient satisfaction with physician communication and confidence in decision in low-income population with diabetes and coronary heart disease (CHD) in a Federally Qualified Healthcare Center (FQHC)...
2016: BMC Health Services Research
Corinna C Zygourakis, Ethan Winkler, Lawrence Pitts, Lisa Hannegan, Benjamin Franc, Michael T Lawton
OBJECTIVE Postoperative head CT scanning is performed routinely at the authors' institution on all neurosurgical patients after elective aneurysm clippings. The goal of this study was to determine how often these scans influence medical management and to quantify the associated imaging costs. METHODS The authors reviewed the medical records and accounting database of 304 patients who underwent elective (i.e., nonruptured) aneurysm clipping performed by 1 surgeon (M.T.L.) from 2010 to 2014 at the University of California, San Francisco...
April 29, 2016: Journal of Neurosurgery
Xiao Fang, Jacques G Baillargeon, Daniel C Jupiter
BACKGROUND: Management of perioperative antiplatelet medications in gastrointestinal (GI) surgery is challenging. The risk of intraoperative and postoperative bleeding is associated with perioperative use of antiplatelet medication. However, cessation of these drugs may be unsafe for patients who are required to maintain antiplatelet use due to cardiovascular conditions. The objective of this systematic review was to compare the risk of intraoperative or postoperative bleeding among patients who had GI surgery while on continuous antiplatelet therapy (aspirin, clopidogrel, or dual therapy) with the risk among those not taking continuous antiplatelet medication...
May 2016: Journal of the American College of Surgeons
Mohsen Sadeghi-Ghahrody, Seyed Hamid Yousefi-Malekshah, Hamidreza Karimi-Sari, Hamid Yazdanpanah, Mohammad Saeid Rezaee-Zavareh, Mohammadhosein Yavarahmadi
The risk of perioperative bleeding is high in patients who take aspirin and clopidogrel after a percutaneous coronary intervention, and whether to stop the drugs is a matter of concern for dentists. The aim of this study was to answer the specific question: should aspirin and clopidogrel bisulphate (Plavix®) be discontinued during a conventional forceps extraction? We studied 64 patients during the first year after percutaneous insertion of coronary stents who were taking aspirin (ASA) 80mg and clopidogrel (Plavix(®)) 75mg, and 50 healthy patients who were to have a conventional forceps extraction at this polyclinic in 2013-2014 and acted as controls...
June 2016: British Journal of Oral & Maxillofacial Surgery
Bincy Jose, Peter McCluskey, Niamh Gilmartin, Martin Somers, Dermot Kenny, Antonio J Ricco, Nigel J Kent, Lourdes Basabe-Desmonts
We report the development of a microfluidic device for the rapid assay in whole blood of interfacial platelet-protein interactions indicative of the efficacy of antiplatelet drugs, for example, aspirin and Plavix, two of the world's most widely used drugs, in patients with cardiovascular disease (CVD). Because platelet adhesion to surface-confined protein matrices is an interfacial phenomenon modulated by fluid shear rates at the blood/protein interface, and because such binding is a better indicator of platelet function than platelet self-aggregation, we designed, fabricated, and characterized the performance of a family of disposable, self-powered microfluidic chips with well-defined flow and interfacial shear rates suitable for small blood volumes (≤200 μL)...
March 22, 2016: Langmuir: the ACS Journal of Surfaces and Colloids
Shokoufeh Hajsadeghi, Mandana Chitsazan, Mitra Chitsazan, Negar Salehi, Ahmad Amin, Majid Maleki, Nima Babaali, Seifollah Abdi, Maryam Mohsenian
BACKGROUND: The crucial role of inflammation in the development and progression of atherosclerosis has been previously described. However, there is insufficient data available to demonstrate the changes in high sensitivity C-reactive protein (hs-CRP) during clopidogrel therapy. OBJECTIVES: In the present study, we aimed to assess the changes in the inflammatory marker of coronary heart disease, i.e., hs-CRP during clopidogrel therapy, in patients undergoing percutaneous coronary intervention (PCI)...
February 2016: Research in Cardiovascular Medicine
Victor L Serebruany, Moo H Kim, Daniel F Hanley
BACKGROUND AND PURPOSE: Vorapaxar, a novel platelet thrombin protease-activated receptor 1 blocker, is currently approved for post-myocardial infarction and peripheral artery disease indications on top of clopidogrel or/and aspirin. We sought to summarize the conflicting stroke data after vorapaxar for justifying a secondary stroke prevention trial. METHODS: Analyses of the stroke data after vorapaxar yielded from thrombin-receptor antagonist vorapaxar in acute coronary syndromes (TRACER) and TRA2P clinical trials, and affiliated Food and Drug Administration (FDA) reviews...
August 2016: International Journal of Stroke: Official Journal of the International Stroke Society
James M Bardes, Jason Turner, Patrick Bonasso, Gerald Hobbs, Alison Wilson
Patients that suffer a mild traumatic brain injury (TBI) with intracranial hemorrhage are commonly admitted to an intensive care unit with repeat imaging in 12 to 24 hours. This is costly to the health-care system. This study aimed to evaluate this practice and to identify criteria to triage patients to lower levels of monitored care. A retrospective review was performed at a university-based Level I trauma center. Patients with mild TBI were included. Data were collected on demographics, neurological status at 6, 12, and 24 hours, CT scan results, and medical or surgical interventions were required...
January 2016: American Surgeon
Xiaoyue Mona Guo, Pramod Bonde
Ruptured mycotic aneurysms occur infrequently in current clinical practice, and a pneumococcal etiology is even more rare. This case report describes a patient who initially presented with catheter lab activation for an acute ST-elevation myocardial infarction, receiving a full Plavix load. She was subsequently found to have a ruptured aortic aneurysm and underwent emergency surgical repair, with intraoperative findings of an aorta seeded with Streptococcus pneumonia. A retrospective evaluation of her history revealed clues of a previous upper respiratory infection and long-standing back pain...
February 2015: Aorta (Stamford, Conn.)
Chia-En Hsieh, Chen-Te Chou, Chia-Cheng Lin, Chia-Bang Chen, Kuo-Hua Lin, Ping-Yi Lin, Yao-Li Chen
OBJECTIVES: We present a patient with portal vein thrombosis due to chronic cholangitis after undergoing a living-donor liver transplant. CASE PRESENTATION: A 52-year-old woman with a history of hepatitis B virus-related liver cirrhosis underwent a living-donor liver transplant. After the surgery, the patient had recurrent episodes of cholangitis because of common and intrahepatic bile duct stricture. Biliary stricture because of cholangitis eventually resulted in acute portal vein thrombosis...
January 20, 2016: Experimental and Clinical Transplantation
Victor L Serebruany, Moo Hyun Kim, Seth D Fortmann, Dan F Hanley
Vorapaxar, a novel antiplatelet thrombin protease-activated receptor 1 (PAR-1) inhibitor, has been evaluated in the successful TRA2P trial and failed TRACER trial. The drug is currently approved for post myocardial infarction and peripheral artery disease indications on top of clopidogrel and/or aspirin. The stroke data after vorapaxar are mixed, dominated with heavy excess of intracranial bleeding risks and slightly worsened second stroke rates, but show less primary ischemic strokes. Fortunately, these conflicting data do not belong purely to vorapaxar per se but rather, reflect unreasonably aggressive strategies, including predominantly triple antiplatelet therapy, utilized in both Trial to Assess the Effects of SCH 530348 in Preventing Heart Attack and Stroke in Patients with Arteriosclerosis (TRA2P) and especially in Thrombin-Receptor Antagonist Vorapaxar in Acute Coronary Syndromes (TRACER)...
2015: Expert Review of Neurotherapeutics
Xi-Ling Jiang, Snehal Samant, Joshua P Lewis, Richard B Horenstein, Alan R Shuldiner, Laura M Yerges-Armstrong, Lambertus A Peletier, Lawrence J Lesko, Stephan Schmidt
Clopidogrel (Plavix®), is a widely used antiplatelet agent, which shows high inter-individual variability in treatment response in patients following the standard dosing regimen. In this study, a physiology-directed population pharmacokinetic/pharmacodynamic (PK/PD) model was developed based on clopidogrel and clopidogrel active metabolite (clop-AM) data from the PAPI and the PGXB2B studies using a step-wise approach in NONMEM (version 7.2). The developed model characterized the in vivo disposition of clopidogrel, its bioactivation into clop-AM in the liver and subsequent platelet aggregation inhibition in the systemic circulation reasonably well...
January 20, 2016: European Journal of Pharmaceutical Sciences
Celenne Morfin Zepeda, Kristen H Coffey
PATIENT: 66-year-old ethnic Egyptian man. CHIEF COMPLAINT: Hematuria. HISTORY OF PRESENT ILLNESS: The patient had a history of multiple episodes of gross hematuria for the past 5 years. Because the hematuria usually resolved on its own, he did not seek medical attention during that time. Bladder cancer was suspected. PAST MEDICAL HISTORY: The patient had a history of coronary artery disease, hypertension, nephrolithiasis, congestive heart failure, lifelong smoking, and ischemic cardiomyopathy...
2015: Laboratory Medicine
Timothy John Barreiro, Denis D Asiimwe, David Gemmel, Patrick Brine
A 53-year-old man with a history of diabetic foot ulcer, osteomyelitis, coronary artery disease, hypertension and hyperlipidaemia, presented with chest pain of 3 weeks duration. Eleven days earlier, the patient had had a drug-eluting stent (DES) placed in a branch of the right coronary artery (RCA) after similar chest pain, leading to the findings of a positive nuclear stress test. Since discharge, he was not compliant with taking clopidegrel (Plavix), a concern for in-stent thrombosis with recurrent myocardial ischaemia; but work up was negative and medications were restarted...
2015: BMJ Case Reports
Osama Ahmed, Christopher Storey, Piyush Kalakoti, Jai Deep Thakur, Shihao Zhang, Anil Nanda, Bharat Guthikonda, Hugo Cuellar
OBJECT: Treatment of complex intracranial aneurysms with Pipeline embolization device (PED) (ev3/Covidien Vascular Therapies) has gained recent popularity. One application of PEDs that is not well described in the literature is the utility and long-term safety in treatment of vertebrobasilar fusiform (VBF) aneurysms. Despite the advancements in endovascular therapy, VBF aneurysms continue to challenging pathology. The authors provide long-term follow-up of VBF aneurysms treated with PEDs...
August 2015: Interventional Neuroradiology
N Ahmed, A Soroush, Y-H Kuo, J M Davis
BACKGROUND: A fall from a standing position (FFS) is a low impact injury; however, in certain patient populations it can result in serious, complex injuries associated with significant morbidity and mortality. OBJECTIVES: The purpose of the study was to identify the patient population, risk factors and outcomes of intracranial bleed (ICB) after a fall from a standing position. METHODS: Data of all patients from the trauma database at State designated Trauma Center were analyzed who FFS...
June 2015: European Journal of Trauma and Emergency Surgery: Official Publication of the European Trauma Society
Abdel Naser Zaid, Rowa' Al Ramahi, Rana Bustami, Ayman Mousa, Sewar Khasawneh
OBJECTIVE: The aim of this study was to evaluate the bioequivalence of two drug products, generic clopidogrel bisulfate 75 mg film-coated tablets versus the reference Plavix(®) clopidogrel bisulfate 75 mg film-coated tablets. METHODS: Bioequivalence of tablets was tested by comparisons against the reference brand product in accordance with the requirements of the Declaration of Helsinki, the current Good Clinical Practice Guidelines, and the International Conference on Harmonization...
2015: Drug Design, Development and Therapy
B K Kishore, N G Carlson, C M Ecelbarger, D E Kohan, C E Müller, R D Nelson, J Peti-Peterdi, Y Zhang
Lithium still retains its critical position in the treatment of bipolar disorder by virtue of its ability to prevent suicidal tendencies. However, chronic use of lithium is often limited by the development of nephrogenic diabetes insipidus (NDI), a debilitating condition. Lithium-induced NDI is due to resistance of the kidney to arginine vasopressin (AVP), leading to polyuria, natriuresis and kaliuresis. Purinergic signalling mediated by extracellular nucleotides (ATP/UTP), acting via P2Y receptors, opposes the action of AVP on renal collecting duct (CD) by decreasing the cellular cAMP and thus AQP2 protein levels...
June 2015: Acta Physiologica
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