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Oral antiplatelet

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https://www.readbyqxmd.com/read/28645935/liver-cirrhosis-in-patients-with-atrial-fibrillation-would-oral-anticoagulation-have-a-net-clinical-benefit-for-stroke-prevention
#1
Ling Kuo, Tze-Fan Chao, Chia-Jen Liu, Yenn-Jiang Lin, Shih-Lin Chang, Li-Wei Lo, Yu-Feng Hu, Ta-Chuan Tuan, Jo-Nan Liao, Fa-Po Chung, Tzeng-Ji Chen, Gregory Y H Lip, Shih-Ann Chen
BACKGROUND: Patients with liver cirrhosis have been excluded from randomized clinical trials of oral anticoagulation therapy for stroke prevention in atrial fibrillation. We hypothesized that patients with liver cirrhosis would have a positive net clinical benefit for oral anticoagulation when used for stroke prevention in atrial fibrillation. METHODS AND RESULTS: This study used the National Health Insurance Research Database in Taiwan. Among 289 559 atrial fibrillation patients aged ≥20 years, there were 10 336 with liver cirrhosis, and 9056 of them having a CHA2DS2-VASc score ≥2 were divided into 3 groups, that is, no treatment, antiplatelet therapy, and warfarin...
June 23, 2017: Journal of the American Heart Association
https://www.readbyqxmd.com/read/28642210/rationale-and-design-for-a-randomized-comparison-of-efficacy-and-safety-between-aspirin-and-clopidogrel-in-atrial-fibrillation-patients-with-low-stroke-risk-cesac-af-trial
#2
Sang Min Park, Haemin Jeong, Mi-Hyang Jung, Kyung Soon Hong, Myeong-Ki Hong, Chang Seok Bang, Christopher Y Kim
BACKGROUND: Atrial fibrillation (AF) increases the risk of thromboembolic stroke. An oral anticoagulant should be administrated to prevent stroke in patients with moderate stroke risk (ie, CHA2DS2-VASc score>2). If the stroke risk is low (i.e. the score=1), however, antiplatelet agent such as aspirin is widely used. Aspirin can cause peptic ulcer disease (PUD) while its alternative, clopidogrel, theoretically does not. OBJECTIVE: To elucidate the efficacy and safety between aspirin and clopidogrel, a multicenter randomized controlled trial was designed in AF patients with low stroke risk...
June 19, 2017: Contemporary Clinical Trials
https://www.readbyqxmd.com/read/28637375/anticoagulant-therapy-for-recurrent-in-stent-thrombosis-following-carotid-artery-stenting-a-case-report
#3
Akinori Miyakoshi, Hiroki Toda, Makoto Hayase, Takeshi Kawauchi, Yuki Oichi, Etsuko Hattori
We report a case in which strict anticoagulant therapy management was useful for a recurrent in-stent thrombosis after carotid artery stenting (CAS). An 84-year-old man presented with cognitive decline that progressed rapidly over two months. Head magnetic resonance imaging showed an acute-stage infarct occurring frequently in the right cerebral hemisphere, and he underwent hospitalization and treatment. On neck magnetic resonance angiography (MRA), severe stenosis was found at the origin of the right internal carotid artery...
January 1, 2017: Interventional Neuroradiology
https://www.readbyqxmd.com/read/28625383/the-assessment-of-the-watchman-device-in-patients-unsuitable-for-oral-anticoagulation-asap-too-trial
#4
David R Holmes, Vivek Y Reddy, Maurice Buchbinder, Kenneth Stein, Myriah Elletson, Martin W Bergmann, Boris Schmidt, Jacqueline Saw
BACKGROUND: Oral anticoagulants (OACs) reduce stroke risks with nonvalvular atrial fibrillation (AF); however, they are underused because of absolute or relative contraindications due to real or perceived risk of bleeding. Although left atrial appendage closure is increasingly performed in OAC-ineligible patients, this has not been studied in a randomized controlled trial. STUDY OBJECTIVES: The ASAP-TOO study is designed to establish the safety and effectiveness of the Watchman left atrial appendage closure device in patients with nonvalvular AF who are deemed ineligible for OAC...
July 2017: American Heart Journal
https://www.readbyqxmd.com/read/28622606/dementia-correlates-with-anticoagulation-underuse-in-older-patients-with-atrial-fibrillation
#5
Giovanni Viscogliosi, Evaristo Ettorre, Iulia Maria Chiriac
OBJECTIVES: Stroke prevention in older atrial fibrillation (AF) patients remains a challenge. This study aimed to investigate whether a dementia diagnosis is an independent correlate of lower prescription rate of oral anticoagulant treatment (OAT) in a sample of older AF patients. METHODS: Cross-sectional retrospective study. Consecutive older community-dwelling AF patients referred for a comprehensive geriatric assessment, were considered. Evaluation of physical, social and mental health, and administration of the Cumulative Illness Rating Scale (CIRS) and Barthel Index were performed...
June 8, 2017: Archives of Gerontology and Geriatrics
https://www.readbyqxmd.com/read/28612911/short-term-efficacy-and-safety-of-three-different-antiplatelet-regimens-in-diabetic-patients-treated-with-primary-percutaneous-coronary-intervention-a-randomized-study
#6
Yang Liu, Hengliang Liu, Yibin Hao, Zhenxuan Hao, Guoying Geng, Wenjie Han, Qi Chen, Danli Wang, Lingzhi Liu, Kailong Jia, Yuxin Zhou
BACKGROUND: This study aimed to investigate the efficacy and safety of dual and triple antiplatelet therapy (DAPT and TAPT) in patients with diabetes and acute ST segment elevation myocardial infarction (D-STEMI), who had undergone primary percutaneous coronary intervention (PCI). METHODS: We designed a phase IV, single-center, randomized, double-blind, placebo-controlled study. The D-STEMI patients (N=258) were randomly divided into three groups. Control group A (85 patients), was treated with aspirin and clopidogrel; group B (87 patients) received aspirin, clopidogrel, and tirofiban; and group C (86 patients) was treated with aspirin, ticagrelor, and tirofiban...
June 14, 2017: Kardiologia Polska
https://www.readbyqxmd.com/read/28606886/early-anticoagulation-drug-regimens-after-watchman-left-atrial-appendage-closure-safety-and-efficacy
#7
Martin W Bergmann, Timothy R Betts, Horst Sievert, Boris Schmidt, Evgeny Pokushalov, Stephan Kische, Thomas Schmitz, Felix Meincke, Kenneth M Stein, Lucas V Boersma, Hüseyin Ince
AIMS: While LAA closure has recently been incorporated in both European and US guidelines for stroke prevention, uncertainties regarding post-procedural drug therapy so far limit its adoption. METHODS AND RESULTS: 1005 patients were implanted with a WATCHMAN device in the prospective EWOLUTION study at 47 centers. 73.5% of the patients were deemed contraindicated for long-term OAC therapy. Here we report on 3-months data including the first follow-up TOE exam for 94% of the study population...
June 13, 2017: EuroIntervention
https://www.readbyqxmd.com/read/28596467/-embolic-stroke-of-undetermined-source
#8
Teruyuki Hirano
A new clinical construct, embolic stroke of undetermined source (ESUS) was established as a therapeutically relevant entity, which are defined as a non-lacunar infarction without proximal arterial stenosis or cardioembolic sources, with a clear indication for anticoagulation, especially with direct oral anticoagulant (DOAC). The possible embolic sources include covert atrial fibrillation, arterial stenosis with <50%, low-risk emboligenic cardiac sources, aortic plaque, cancer-associated, and paradoxical embolism...
June 2017: Brain and Nerve, Shinkei Kenkyū No Shinpo
https://www.readbyqxmd.com/read/28596454/association-between-previous-use-of-antiplatelet-therapy-and-intracerebral-hemorrhage-outcomes
#9
Nadeem I Khan, Fazeel M Siddiqui, Joshua N Goldstein, Margueritte Cox, Ying Xian, Roland A Matsouaka, Paul A Heidenreich, Eric D Peterson, Deepak L Bhatt, Gregg C Fonarow, Lee H Schwamm, Eric E Smith
BACKGROUND AND PURPOSE: Although the use of antiplatelet therapy (APT) is associated with the risk of intracerebral hemorrhage (ICH), there are limited data on prestroke APT and outcomes, particularly among patients on combination APT (CAPT). We hypothesized that the previous use of antiplatelet agents is associated with increased mortality in ICH METHODS: We analyzed data of 82 576 patients with ICH who were not on oral anticoagulant therapy from 1574 Get with the Guidelines-Stroke hospitals between October 2012 and March 2016...
June 8, 2017: Stroke; a Journal of Cerebral Circulation
https://www.readbyqxmd.com/read/28595745/antithrombotic-regimens-in-patients-with-atrial-fibrillation-and-coronary-artery-disease-after-percutaneous-coronary-intervention-a-focused-review
#10
Kay-Won Chang, Boris Arbit, Jonathan C Hsu
Atrial fibrillation and coronary artery disease are common comorbidities with increasing incidences worldwide. About 5-15% of atrial fibrillation patients will require coronary stenting at some point in their lives, which necessitates dual antiplatelet therapy with aspirin and a P2Y12 antagonist. Triple therapy refers to the clinical scenario in which a patient is prescribed aspirin, P2Y12 antagonist, and oral anticoagulant, usually in the setting of atrial fibrillation. Current guidelines on atrial fibrillation do not offer strong recommendations on triple therapy management...
June 2, 2017: International Journal of Cardiology
https://www.readbyqxmd.com/read/28590907/real-practice-thromboprophylaxis-in-atrial-fibrillation
#11
Paola Deambrosis, Alessandra Bettiol, Jenny Bolcato, Roberta Pirolo, Giulia Franchin, Sakis Themistoclakis, Michele Pellizzari, Alessandro Chinellato, Pietro Giusti
This retrospective observational study was based on databases of the Local Health Authority of Treviso, Italy. It evaluated the prevalence and the effectiveness of oral anticoagulation treatment (OAT) for the management of nonvalvular atrial fibrillation (NVAF) in everyday clinical practice. Out of 6,138 NVAF patients, only 3,024 received vitamin K antagonist (VKA). Potential barriers decreasing the probability of being treated with VKA were female sex, older age, antiplatelet treatment and history of bleeding...
June 27, 2017: Acta Pharmaceutica
https://www.readbyqxmd.com/read/28590305/management-of-diabetic-patients-hospitalized-for-acute-coronary-syndromes-a-prospective-multicenter-registry
#12
Marco Ferlini, Giuseppe Musumeci, Andrea Demarchi, Niccolò Grieco, Antonio Mafrici, Stefano De Servi, Roberta Rossini, Carlo Sponzilli, Paola Bognetti, Antonino Cardile, Silvia Frattini, Alfonso Ielasi, Alessandra Russo, Claudia Vecchiato, Corrado Lettieri, Luigi O Visconti
BACKGROUND: Patients with diabetes mellitus and acute coronary syndrome (ACS) present an increased risk of adverse cardiovascular events. An Italian Consensus Document indicated 'three specific must' to obtain in this subgroup of patients: optimal oral antiplatelet therapy, early invasive approach and a tailored strategy of revascularization for unstable angina/non-ST-elevation-myocardial infarction (UA/NSTEMI); furthermore, glycemia at admission should be managed with dedicated protocols...
June 5, 2017: Journal of Cardiovascular Medicine
https://www.readbyqxmd.com/read/28587584/strategies-to-optimize-dual-antiplatelet-therapy-after-coronary-artery-stenting-in-acute-coronary-syndrome
#13
Bridget Paravattil, Hazem Elewa
The use of aspirin and a P2Y12 receptor antagonist as dual antiplatelet therapy (DAPT) has become the treatment of choice in patients with acute coronary syndrome (ACS) and percutaneous coronary intervention to prevent recurrent thrombotic events. Although DAPT is beneficial for most patients, few patients still experience recurrent thrombotic events and increased bleeding episodes. This article reviews current literature to identify various approaches that may enhance the DAPT benefit-risk ratio in patients with ACS...
July 2017: Journal of Cardiovascular Pharmacology and Therapeutics
https://www.readbyqxmd.com/read/28584429/thromboelastography-for-evaluation-of-coagulopathy-in-nonbleeding-patients-with-sepsis-at-intensive-care-unit-admission
#14
Syed Nabeel Muzaffar, Arvind Kumar Baronia, Afzal Azim, Anupam Verma, Mohan Gurjar, Banani Poddar, Ratender Kumar Singh
BACKGROUND: Thromboelastography (TEG) is a global test of coagulation which analyzes the whole coagulation process. TEG is popular in trauma, liver transplant, and cardiac surgeries, but studies in sepsis are limited. We have assessed the utility of TEG for evaluating coagulopathy in nonbleeding patients with sepsis. MATERIALS AND METHODS: A prospective, observational study was done in 12-bedded Intensive Care Unit (ICU) of a tertiary care hospital in North India, during May 2014-November 2014...
May 2017: Indian Journal of Critical Care Medicine
https://www.readbyqxmd.com/read/28579296/the-challenge-of-coprescription-of-antiplatelet-therapy-and-oral-anticoagulants
#15
Oscar M P Jolobe
No abstract text is available yet for this article.
May 22, 2017: American Journal of Emergency Medicine
https://www.readbyqxmd.com/read/28579168/drug-coated-versus-bare-metal-stents-for-elderly-patients-a-predefined-sub-study-of-the-leaders-free-trial
#16
Marie-Claude Morice, Suneel Talwar, Oliver Gaemperli, Gert Richardt, Franz Eberli, Ian Meredith, Azfar Zaman, Jean Fajadet, Samuel Copt, Samantha Greene, Philip Urban
BACKGROUND: The randomized, LEADERS FREE trial showed superior safety and efficacy of a polymer-free DCS vs. a bare metal stent in high-bleeding risk patients with only one month dual antiplatelet treatment. We report characteristics and outcomes of the pre-specified group of elderly patients (aged ≥75). METHODS: Age >75 was one of the trial's inclusion criteria. The main additional criteria were: need for oral anticoagulants, recent bleeding, anemia, chronic renal failure and cancer...
April 25, 2017: International Journal of Cardiology
https://www.readbyqxmd.com/read/28578845/how-do-preoperative-medications-influence-outcomes-after-total-joint-arthroplasty
#17
Bradley J Zarling, Jakub Sikora-Klak, Chris Bergum, David C Markel
BACKGROUND: Recent health care policy changes require hospitals and physicians to demonstrate improved quality. In 2012, a prospective database was formed with the Blue Cross and Blue Shield of Michigan to improve quality of care. The purpose of this study was to analyze patient preoperative medication as predictors of outcomes after total joint arthroplasty. METHODS: Data were collected on patient's preoperative medications from 2012 to 2015 using a total joint arthroplasty database...
April 27, 2017: Journal of Arthroplasty
https://www.readbyqxmd.com/read/28577840/efficacy-and-safety-of-left-atrial-appendage-closure-with-watchman-in-patients-with-or-without-contraindication-to-oral-anticoagulation-1-year-follow-up-outcome-data-of-the-ewolution-trial
#18
Lucas V Boersma, Hueseyin Ince, Stephan Kische, Evgeny Pokushalov, Thomas Schmitz, Boris Schmidt, Tommaso Gori, Felix Meincke, Alexey Vladimir Protopopov, Timothy Betts, David Foley, Horst Sievert, Patrizio Mazzone, Tom De Potter, Elisa Vireca, Kenneth Stein, Martin W Bergmann
BACKGROUND: Left atrial appendage (LAA) occlusion with WATCHMAN has emerged as viable alternative to vitamin K antagonists in randomized controlled trials. OBJECTIVE: EWOLUTION was designed to provide data in routine practice from a prospective multicenter registry. METHODS: A total of 1025 patients scheduled for a WATCHMAN implant were prospectively and sequentially enrolled at 47 centers. Indication for LAA closure was based on European Society of Cardiology guidelines...
May 31, 2017: Heart Rhythm: the Official Journal of the Heart Rhythm Society
https://www.readbyqxmd.com/read/28571507/the-genetic-basis-of-antiplatelet-and-anticoagulant-therapy-a-pharmacogenetic-review-of-newer-antiplatelets-clopidogrel-prasugrel-and-ticagrelor-and-anticoagulants-dabigatran-rivaroxaban-apixaban-and-edoxaban
#19
Cormac T O'connor, Thomas J Kiernan, Bryan P Yan
The study of pharmacogenomics presents the possibility of individualised optimisation of drug therapy tailored to each patients' unique physiological traits. Both antiplatelet and anticoagulant drugs play a key role in the management of cardiovascular disease. Despite their importance, there is a substantial volume of literature to suggest marked person-to-person variability in their effect. Areas covered: This article reviews the data available for the genetic cause for this inter-patient variability of antiplatelet and anticoagulant drugs...
June 13, 2017: Expert Opinion on Drug Metabolism & Toxicology
https://www.readbyqxmd.com/read/28562105/prasugrel-hydrochloride-for-the-treatment-of-sickle-cell-disease
#20
Nicola Conran, David C Rees
Therapeutic options for sickle cell disease (SCD) are limited and, currently, only one drug (hydroxyurea) has FDA approval for the treatment of adult SCD. While this genetic disease is caused by hemoglobin polymerization, subsequent downstream events trigger platelet activation, vaso-occlusion and the disease's complex pathophysiology. Areas covered: The oral thienopyridine, prasugrel hydrochloride, irreversibly inhibits the P2Y12 receptors, inhibiting ADP-dependent platelet activation. We discuss recent clinical trials evaluating the pharmokinetics of prasugrel and its potential for use in SCD...
June 12, 2017: Expert Opinion on Investigational Drugs
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