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Aspirin and clopidogrel

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https://www.readbyqxmd.com/read/28230176/antithrombotic-therapy-for-patients-with-stemi-undergoing-primary-pci
#1
REVIEW
Francesco Franchi, Fabiana Rollini, Dominick J Angiolillo
Antithrombotic therapy, including antiplatelet and anticoagulant agents, is the cornerstone of pharmacological treatment to optimize clinical outcomes in patients with ST-segment elevation myocardial infarction (STEMI) undergoing primary percutaneous coronary intervention (PPCI). Intravenous anticoagulant drugs available for PPCI include the indirect thrombin inhibitors unfractionated heparin and low-molecular-weight heparin, and the direct thrombin inhibitor bivalirudin. Intravenous antiplatelet drugs mainly include glycoprotein IIb/IIIa inhibitors and the P2Y12-receptor inhibitor cangrelor...
February 23, 2017: Nature Reviews. Cardiology
https://www.readbyqxmd.com/read/28229159/platelet-turnover-predicts-outcome-after-coronary-intervention
#2
Matthias K Freynhofer, Liana Iliev, Veronika Bruno, Miklos Rohla, Florian S Egger, Thomas W Weiss, Wolfgang Hübl, Martin Willheim, Johann Wojta, Kurt Huber
Elevated platelet turnover contributes to high platelet reactivity. High platelet reactivity after percutaneous coronary intervention (PCI) is associated with major adverse cardiovascular events (MACE). The purpose of this study was to determine the prognostic value of platelet turnover and function with regard to MACE after PCI with stent implantation. In this prospective observational study, 486 consecutive patients after PCI on aspirin and clopidogrel were included to determine platelet turnover (mean platelet volume (MPV), reticulated platelet fraction (RPF)) and platelet function (multiple electrode aggregometry (MEA), vasodilator-stimulated phosphoprotein-phosphorylation (VASP-P) assay)...
February 23, 2017: Thrombosis and Haemostasis
https://www.readbyqxmd.com/read/28228427/myocardial-infarction-risk-after-discontinuation-of-thienopyridine-therapy-in-the-randomized-dapt-study
#3
Ada C Stefanescu Schmidt, Dean J Kereiakes, Donald E Cutlip, Robert W Yeh, Ralph B D'Agostino, Joseph M Massaro, Wen-Hua Hsieh, Laura Mauri
Background -Thienopyridine plus aspirin beyond one year after coronary stenting (PCI) reduces myocardial infarction (MI) risk and increases bleeding risk compared with aspirin alone. The hazard associated with late thienopyridine discontinuation and risk factors for MI after discontinuation are poorly defined. Methods -In the Dual Antiplatelet Therapy (DAPT) Study, after PCI and 12 months of thienopyridine (clopidogrel or prasugrel) plus aspirin, eligible patients remained on aspirin and were randomized to continued thienopyridine vs...
February 22, 2017: Circulation
https://www.readbyqxmd.com/read/28224612/clopidogrel-paclitaxel-drug-drug-interaction-a-pharmacoepidemiologic-study
#4
K Agergaard, M Mau-Sørensen, T B Stage, T L Jørgensen, R E Hassel, K D Steffensen, J W Pedersen, M L H Milo, S H Poulsen, A Pottegård, J Hallas, K Brøsen, T K Bergmann
Paclitaxel is mainly eliminated by CYP2C8 in the liver. CYP2C8 is strongly inhibited by the clopidogrel metabolite acyl-β-D-glucuronide. To determine if this interaction has clinical relevance, we identified 48 patients treated with clopidogrel and paclitaxel using databases and a prescription register. Peripheral sensory neuropathy was retrospectively evaluated from medical charts and compared to that of 88 age and sex matched controls treated with paclitaxel and low dose aspirin. By a cumulative dose of 1500 mg paclitaxel, 35% of the patients had developed severe neuropathy...
February 22, 2017: Clinical Pharmacology and Therapeutics
https://www.readbyqxmd.com/read/28222991/perioperative-clopidogrel-is-associated-with-increased-bleeding-and-blood-transfusion-at-the-time-of-lower-extremity-bypass
#5
Douglas W Jones, Marc L Schermerhorn, Benjamin S Brooke, Mark F Conrad, Philip P Goodney, Mark C Wyers, David H Stone
OBJECTIVE: Controversy persists surrounding the perceived bleeding risk associated with perioperative clopidogrel use in patients undergoing lower extremity bypass (LEB). The purpose of this study was to examine the LEB bleeding risk and clinical sequelae associated with clopidogrel. METHODS: All LEBs in the Vascular Quality Initiative (VQI) from 2008 to 2014 were studied. The exposure was perioperative clopidogrel. Primary outcomes were blood transfusion, estimated blood loss ≥500 mL, and reoperation for bleeding...
February 17, 2017: Journal of Vascular Surgery
https://www.readbyqxmd.com/read/28213047/the-effect-of-combined-aspirin-and-clopidogrel-treatment-on-cancer-incidence
#6
Avi Leader, Ravit Zelikson-Saporta, David Pereg, Galia Spectre, Uri Rozovski, Pia Raanani, Doron Hermoni, Michael Lishner
BACKGROUND: Multiple studies have shown an association between aspirin treatment and a reduction in newly diagnosed cancer. Conversely, there are conflicting clinical and laboratory data regarding the effect of combined clopidogrel and aspirin therapy on cancer incidence, including analyses suggesting an increased cancer risk. No large scale cohort study has been performed to address this issue in a heterogeneous real-world scenario. We investigated the effect of clopidogrel and aspirin on cancer incidence compared to aspirin alone and no antiplatelet therapy...
February 14, 2017: American Journal of Medicine
https://www.readbyqxmd.com/read/28184261/dual-antiplatelet-therapy-and-non-cardiac-surgery-evolving-issues-and-anesthetic-implications
#7
REVIEW
Jong Wook Song, Sarah Soh, Jae-Kwang Shim
Dual antiplatelet therapy (DAPT) consisting of aspirin plus a P2Y12 inhibitor (clopidogrel, prasugrel, or ticagrelor) is imperative for the treatment of acute coronary syndrome, particularly during the re-endothelialization period after percutaneous coronary intervention (PCI). When patients undergo surgery during this period, the consequences of stent thrombosis are far more serious than those of bleeding complications, except in cases of intracranial surgery. The recommendations for perioperative DAPT have changed with emerging evidence regarding the improved efficacy of non-first-generation drug (everolimus, zotarolimus)-eluting stents (DES)...
February 2017: Korean Journal of Anesthesiology
https://www.readbyqxmd.com/read/28181944/management-of-a-patient-requiring-intrathecal-drain-insertion-and-removal-in-the-setting-of-concomitant-dual-antiplatelet-therapy-with-clopidogrel-and-aspirin-a-case-report
#8
Christopher W Connors, Janie D Nguyen
We report a case of deliberate intrathecal catheter insertion and removal in the setting of continuous dual-antiplatelet therapy with clopidogrel and aspirin. A patient with recently sited bare metal intracerebral stents developed severe symptomatic hydrocephalus and required temporary cerebrospinal fluid diversion. The risks of intracerebral in-stent thrombosis or delayed intervention precluded following guidelines for the management of clopidogrel in neuraxial procedures. Options to mitigate the risk of and facilitate the early detection of epidural hematoma are discussed when neuraxial instrumentation is indicated in the setting of clopidogrel and aspirin therapy...
February 8, 2017: A & A Case Reports
https://www.readbyqxmd.com/read/28180001/assessment-of-platelet-function-in-patients-receiving-tirofiban-early-after-primary-coronary-intervention
#9
REVIEW
Péter Kupó, Dániel Aradi, Adrienn Tornyos, Margit Tőkés-Füzesi, András Komócsi
BACKGROUND: Following percutaneous coronary intervention, combined antiplatelet therapy is necessary. Platelet function testing (PFT) has prognostic value and may be applied in the risk assessment of acute coronary syndrome. In case of combined antiplatelet therapy, PFT may require special laboratory methods, as different antiplatelet agents may influence test results. MATERIALS AND METHODS: Platelet functions were measured in stent thrombosis-segment elevation myocardial infarction patients receiving aspirin, clopidogrel, and tirofiban...
December 2016: Interventional Medicine & Applied Science
https://www.readbyqxmd.com/read/28166651/dipeptidyl-peptidase-4-inhibitor-associated-risk-of-bleeding
#10
Md Motiur Rahman, Michael J Scalese, Richard A Hansen
BACKGROUND: Dipeptidyl peptidase-4 (DPP-4) inhibitors improve glycemic control, and sitagliptin has been associated with a reduction in cardiovascular events. In vivo data suggest reduced platelet activation, and aggregation may play a role, and therefore, increased bleeding risk is possible. OBJECTIVE: Comparatively assess bleeding risks associated with DPP-4 inhibitors against standard treatment. METHODS: Exploratory analyses of adverse event reports (AERs) from the US Food and Drug Administration Adverse Event Reporting System (FAERS) database (2004-2012 periods) were conducted...
February 1, 2017: Annals of Pharmacotherapy
https://www.readbyqxmd.com/read/28161565/dual-antiplatelet-therapy-does-not-increase-the-risk-of-bleeding-after-carotid-endarterectomy-results-of-a-prospective-study
#11
Giulio Illuminati, Fabrice Schneider, Giulia Pizzardi, Federica Masci, Francesco G Calio, Jean-Baptiste Ricco
BACKGROUND: The purpose of this study was to evaluate the risk of bleeding and other postoperative complications of carotid endarterectomy (CEA) in patients receiving dual antiplatelet therapy (DAPT). METHODS: From January 2005 to December 2015, 188 consecutive patients undergoing CEA and receiving DAPT (aspirin 100 mg + clopidogrel 75 mg) were enrolled in a prospective study. All of them underwent coronary artery stenting with drug-eluting stents during the 6 months preceding CEA...
February 1, 2017: Annals of Vascular Surgery
https://www.readbyqxmd.com/read/28154807/hypersensitivity-to-ticagrelor-and-low-response-to-clopidogrel-a-case-report
#12
Jing Dai, Shuzheng Lyu, Changjiang Ge
Ticagrelor is widely used to treat acute coronary syndrome. Hypersensitivity reaction of ticagrelor is rarely recognized. A low response to clopidogrel, which occurs in up to 23% of patients, is an independent risk factor for stent thrombosis. Management of patients with a low response to clopidogrel and ticagrelor hypersensitivity who are undergoing antithrombotic therapy remains to be a challenge. Herein, we report a patient with low response to clopidogrel and ticagrelor hypersensitivity, who was successfully managed using aspirin and warfarin...
January 2017: Asia Pacific Allergy
https://www.readbyqxmd.com/read/28150852/novel-role-of-platelet-reactivity-in-adverse-left-ventricular-remodelling-after-st-segment-elevation-myocardial-infarction-the-remodeling-trial
#13
Yongwhi Park, Udaya S Tantry, Jin-Sin Koh, Jong-Hwa Ahn, Min Gyu Kang, Kye Hwan Kim, Jeong Yoon Jang, Hyun Woong Park, Jeong-Rang Park, Seok-Jae Hwang, Ki-Soo Park, Choong Hwan Kwak, Jin-Yong Hwang, Paul A Gurbel, Young-Hoon Jeong
The role of platelet-leukocyte interaction in the infarct myocardium still remains unveiled. We aimed to determine the linkage of platelet activation to post-infarct left ventricular remodelling (LVR) process. REMODELING was a prospective, observational, cohort trial including patients (n = 150) with ST-segment elevation myocardial infarction (STEMI) undergoing primary percutaneous coronary intervention. Patients were given aspirin plus clopidogrel therapy (600 mg loading and 75 mg daily). Platelet reactivity (PRU: P2Y12 Reaction Units) was assessed with VerifyNow P2Y12 assay on admission...
February 2, 2017: Thrombosis and Haemostasis
https://www.readbyqxmd.com/read/28145783/the-budget-impact-of-using-enteric-coated-aspirin-325mg-immediate-release-omeprazole-40mg-to-prevent-recurrent-cardiovascular-events
#14
Wenjie Zhang, Yi Han, John G Fort, David Schofield, James P Tursi
OBJECTIVE: Aspirin (acetylsalicylic acid; ASA) is commonly used for secondary prevention of cardiovascular (CV) events but may be associated with gastrointestinal (GI) adverse events, which can reduce adherence. Use of ASA co-therapy with proton pump inhibitors in patients at risk may be suboptimal. PA32540 (Yosprala(TM)) is a coordinated-delivery tablet combining EC-ASA 325 mg and immediate-release omeprazole 40 mg. The objective of this flexible budget impact model was to project the financial consequences of introducing PA32540 325 mg/40 mg to prevent recurrent CV events while reducing ASA-associated GI events in US adults...
February 1, 2017: Journal of Medical Economics
https://www.readbyqxmd.com/read/28142297/pannexin1-single-nucleotide-polymorphism-and-platelet-reactivity-in-a-cohort-of-cardiovascular-patients
#15
Florian B Stierlin, Filippo Molica, Jean-Luc Reny, Brenda R Kwak, Pierre Fontana
Pannexin1 (Panx1), a membrane channel-forming protein permitting the passage of small-sized molecules, such as ATP, is expressed in human platelets. Recently, we showed that inhibiting Panx1 affects collagen-induced platelet aggregation but not aggregation triggered by other agonists. We also found that a single nucleotide polymorphism (SNP; rs1138800) in the Panx1 gene encoded for a gain-of-function channel (Panx1-400C) and was associated with enhanced collagen-induced platelet reactivity. Here, we assessed the association of this SNP with platelet reactivity in a cohort of 758 stable cardiovascular patients from the ADRIE study treated with aspirin and/or clopidogrel...
December 2017: Cell Communication & Adhesion
https://www.readbyqxmd.com/read/28141599/gastrointestinal-hemorrhage-related-to-fluoxetine-in-a-patient-with-stroke
#16
Tze Chao Wee
We report on a patient who developed massive gastrointestinal hemorrhage related to the use of fluoxetine in combination with aspirin and clopidogrel. A 58-year-old man was admitted with a posterior circulation infarct with significant weakness in all four limbs and dysarthria. Aspirin and clopidogrel were started. Fluoxetine was started for pharmacological neurostimulation to promote motor recovery and for low mood. He developed gastrointestinal hemorrhage a week after fluoxetine was started. Fluoxetine was suspended and investigations failed to reveal the source of the bleeding...
January 30, 2017: American Journal of Physical Medicine & Rehabilitation
https://www.readbyqxmd.com/read/28139897/oral-antiplatelet-agents-for-the-management-of-acute-coronary-syndromes-a-review-for-nurses-and-allied-healthcare-professionals
#17
REVIEW
Tania Gesheff, Cescelle Barbour
PURPOSE: We review the use of oral antiplatelet (OAP) therapies in acute coronary syndrome (ACS) management for nurse practitioners (NPs), focusing on current guideline recommendations. DATA SOURCES: Treatment guidelines and clinical articles from PubMed. CONCLUSIONS: Guidelines recommend that dual antiplatelet therapy with a P2Y12 inhibitor and aspirin be initiated for ACS management. The P2Y12 inhibitor clopidogrel has established efficacy, but is associated with suboptimal and delayed platelet inhibition and variability in response...
January 31, 2017: Journal of the American Association of Nurse Practitioners
https://www.readbyqxmd.com/read/28135763/the-cyp2c19-2-and-cyp2c19-17-polymorphisms-play-a-vital-role-in-clopidogrel-responsiveness-after-percutaneous-coronary-intervention-a-pharmacogenomics-study
#18
Faruk Saydam, İrfan Değirmenci, Alparslan Birdane, Mahmut Özdemir, Taner Ulus, Cansu Özbayer, Ertuğrul Çolak, Necmi Ata, Hasan Veysi Güneş
Clopidogrel inhibits platelet activation and aggregation by blocking the P2Y12 receptor. Dual antiplatelet therapy with clopidogrel and aspirin is recommended treatment by current guidelines for patients undergoing percutaneous interventions. Recurrent ischaemic cardiac events after this treatment showed lack of clopidogrel responsiveness. We aimed to investigate the most noticeable variants in the genes involved in clopidogrel pharmacokinetics and pharmacodynamics. 347 Turkish patients who underwent percutaneous coronary interventions with stent implantation were included in our study...
January 30, 2017: Basic & Clinical Pharmacology & Toxicology
https://www.readbyqxmd.com/read/28131536/dual-antiplatelet-therapy-improves-outcome-in-diabetic-patients-undergoing-endovascular-femoropopliteal-stenting-for-critical-limb-ischaemia
#19
O Thott, F Granath, J Malmstedt, C-M Wahlgren
OBJECTIVE: The purpose of this study was to analyse the effect of dual antiplatelet therapy (DAPT) compared to aspirin on outcome after endovascular interventions in patients with CLI. METHODS: This was a population based retrospective nationwide cohort analysis. Several linked national databases in Sweden: Swedish National Vascular Registry, Prescribed Drug Registry and National Discharge Registry. A total of 1941 patients (median age 79; range 43-103 years; women 58%) were identified with CLI who had undergone primary femoropopliteal endovascular intervention between 2006 and 2012...
January 25, 2017: European Journal of Vascular and Endovascular Surgery
https://www.readbyqxmd.com/read/28131222/clopidogrel-and-ischemic-stroke-outcomes-by-smoking-status-smoker-s-paradox
#20
Qian Zhang, Yuan Wang, Haiqing Song, Chengbei Hou, Qingyu Cao, Kai Dong, Xiaoqin Huang, Wuwei Feng, Bruce Ovbiagele, Moli Wang, Xunming Ji
BACKGROUND AND PURPOSE: Active smokers with myocardial infarction were shown to have enhanced benefit with clopidogrel compared with aspirin. Whether this "paradox" exists in ischemic stroke patients is unknown. We aimed to investigate whether smoking status has a differential impact on the efficacy of clopidogrel vs. aspirin in patients with non-cardioembolic strokes. METHODS: This single-center study retrospectively assessed 1792 non-cardioembolic ischemic stroke patients discharged from January 2013 to October 2014, and followed for 12months...
February 15, 2017: Journal of the Neurological Sciences
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