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https://www.readbyqxmd.com/read/29782272/-duration-and-timing-of-initiation-of-therapy-with-platelet-p2y12-inhibitors-in-the-treatment-of-patients-with-acute-coronary-syndrome
#1
S V SHalaev, Z M Safiullina
In recent years, the issues of choice of an agent for dual antiplatelet therapy (DAPT) as well as timing of initiation and duration of DAPT in patients with acute coronary syndrome (ACS) have been actively discussed. In this article we present data of major randomized trials of clopidogrel and novel P2Y12 inhibitors - prasugrel, ticagrelor, cangrelor - assessing strategy of administration of antiaggregants in patients with ACS before coronary angiography / percutaneous coronary intervention. The article also contains analysis of differences between recommendations of the European Society of Cardiology and American College of Cardiology/American Heart Association on therapy with oral P2Y12 inhibitors in the management of patients with ACS...
March 2018: Kardiologiia
https://www.readbyqxmd.com/read/29781069/dual-and-triple-antithrombotic-therapies-current-patterns-of-practice-and-controversies
#2
Mark Crowther, John Eikelboom
Dual antiplatelet therapy (DAPT) has been the cornerstone of antithrombotic management for patients undergoing percutaneous coronary intervention (PCI). Despite low-quality evidence, triple antithrombotic therapy involving acetylsalicylic acid, clopidogrel and warfarin or non-vitamin K antagonist oral anticoagulant (NOAC) has been recommended in patients with concomitant atrial fibrillation undergoing PCI, who require long-term oral anticoagulation, although such strategy is associated with a substantially increased risk of bleeding compared with DAPT...
May 21, 2018: Kardiologia Polska
https://www.readbyqxmd.com/read/29776575/optimal-long-term-antithrombotic-treatment-of-patients-with-stable-coronary-artery-disease-and-atrial-fibrillation-oltat-registry
#3
Q Fischer, J L Georges, C Le Feuvre, A Sharma, N Hammoudi, E Berman, S Cohen, I Jolivet, J Silvain, G Helft
BACKGROUND: The optimal long-term antithrombotic treatment of patients with stable coronary artery disease (CAD) and atrial fibrillation (AF) is a challenge in daily practice. We sought to determine the prevalence of hemorrhagic complications and ischaemic events depending on antithrombotic strategy in patients with stable CAD and AF. METHODS: The primary outcome was major adverse cardiac and cerebrovascular events (MACCE) defined as a composite of cardiovascular mortality, myocardial infarction and ischaemic stroke...
August 1, 2018: International Journal of Cardiology
https://www.readbyqxmd.com/read/29770334/optimum-antithrombotic-therapy-in-patients-requiring-long-term-anticoagulation-and-undergoing-percutaneous-coronary-intervention
#4
REVIEW
Nayan Agarwal, Dhruv Mahtta, Cecil A Rambarat, Islam Elgendy, Ahmed N Mahmoud
Management of patients on long-term anticoagulation requiring percutaneous coronary intervention is challenging. Triple therapy with oral anticoagulant and dual antiplatelet therapy is the standard of care. However, there is no strong evidence to support this strategy. There is emerging data regarding the safety and efficacy of dual therapy with oral anticoagulant and single antiplatelet therapy in these patients. In this comprehensive review we highlight available evidence regarding various antithrombotic regimens' efficacy and safety in patient with coronary artery disease undergoing percutaneous coronary intervention with long-term anticoagulation therapy requirements...
2018: BioMed Research International
https://www.readbyqxmd.com/read/29768313/the-incidence-of-myocardial-injury-after-loading-doses-of-clopidogrel-versus-prasugrel-in-the-candidates-for-percutaneous-coronary-intervention-a-randomized-controlled-trial
#5
Reza Rahmani, Laya Jiriaee, Zahra Jiriaee, Akbar Shafiee, Amir Farhang Zand Parsa
INTRODUCTION: Prevention of myocardial injury is an essential issue in percutaneous coronary intervention (PCI). We compared the incidence of myocardial injury after loading doses of clopidogrel versus prasugrel in the candidates for PCI. METHODS: In this randomized-controlled clinical trial, we enrolled 88 stable angina patients, candidate for PCI. Patients received either prasugrel (60 mg orally) (n = 42) or clopidogrel (600 mg orally) (n = 46). Serum levels of creatine phosphokinase muscle-brain type, cardiac troponin I, and high sensitive C-reactive protein were measured at baseline and 6 and 12 hours postprocedural...
June 2018: Critical Pathways in Cardiology
https://www.readbyqxmd.com/read/29766335/ticagrelor-versus-clopidogrel-as-part-of-dual-or-triple-antithrombotic-therapy-a-systematic-review-and-meta-analysis
#6
Ioannis Andreou, Alexandros Briasoulis, Christos Pappas, Ignatios Ikonomidis, Dimitrios Alexopoulos
PURPOSE: Clopidogrel is the standard P2Y12 receptor inhibitor used in patients requiring both antiplatelet therapy and oral anticoagulation (OAC). We investigated the safety and efficacy of ticagrelor as an alternative to clopidogrel in patients on OAC. METHODS: A systematic electronic literature search was performed in MEDLINE, EMBASE, and the Cochrane Library for randomised controlled studies that examined the relative safety and efficacy of clopidogrel versus ticagrelor among patients requiring therapy with antiplatelet agents plus OAC...
May 15, 2018: Cardiovascular Drugs and Therapy
https://www.readbyqxmd.com/read/29766263/-oral-anticoagulation-current-overview-and-perioperative-management-in-ophthalmic-surgery
#7
REVIEW
C Sucker, A Hager, J Koscielny, N Feltgen
Antithrombotic treatment with oral anticoagulants and antiplatelet agents can increase the risk for perioperative bleeding. In contrast to other surgical fields, the optimal perioperative management in ophthalmic surgery has not yet been exactly defined and, thus, is not standardized. In this contribution, we provide an overview of currently available oral anticoagulants and discuss potential strategies for the management of these agents in different ophthalmic surgical procedures.
May 15, 2018: Der Ophthalmologe: Zeitschrift der Deutschen Ophthalmologischen Gesellschaft
https://www.readbyqxmd.com/read/29764885/compliance-with-current-vte-prophylaxis-guidelines-and-risk-factors-linked-to-complications-of-vte-prophylaxis-in-medical-inpatients-a-prospective-cohort-study-in-a-spanish-internal-medicine-department
#8
Ignacio Novo-Veleiro, Lucía Alvela-Suárez, Alba Costa-Grille, Javier Suárez-Dono, Fernando Ferrón-Vidan, Antonio Pose-Reino
OBJECTIVES: To evaluate the degree of compliance with the current guidelines regarding venous thromboembolism (VTE) prophylaxis in medical patients during admission and to identify risk factors linked to complications of VTE prophylaxis. DESIGN: Prospective cohort study. SETTING: The Internal Medicine Department of the University Hospital of Santiago de Compostela (tertiary referral hospital). PARTICIPANTS: A total of 396 hospitalised, elderly patients who did not undergo surgery and had no active or previous oral anticoagulation or low molecular weight heparin (LMWH) treatment (during the previous year) and who received VTE prophylaxis during admission...
May 14, 2018: BMJ Open
https://www.readbyqxmd.com/read/29764706/atrial-fibrillation-and-ischemic-events-with-rivaroxaban-in-patients-with-stable-coronary-artery-disease-afire-protocol-for-a-multicenter-prospective-randomized-open-label-parallel-group-study
#9
Satoshi Yasuda, Koichi Kaikita, Hisao Ogawa, Masaharu Akao, Junya Ako, Tetsuya Matoba, Masato Nakamura, Katsumi Miyauchi, Nobuhisa Hagiwara, Kazuo Kimura, Atsushi Hirayama, Kunihiko Matsui
BACKGROUND: In atrial fibrillation (AF) patients with coronary artery disease (CAD), anticoagulants are commonly used in combination with antiplatelet drugs. However, dual therapy can increase the risk of bleeding, and the potential therapeutic benefits must be weighed against this. Therefore, it is recommended that dual therapy is only used for a limited time, and that monotherapy with anticoagulants should start from 1 year after percutaneous coronary intervention (PCI). However, there is a lack of evidence on the use of monotherapy, in particular with direct oral anticoagulants, in this group of patients...
May 2, 2018: International Journal of Cardiology
https://www.readbyqxmd.com/read/29754652/risk-of-cardiovascular-events-and-incident-atrial-fibrillation-in-patients-without-prior-atrial-fibrillation-implications-for-expanding-the-indications-for-anticoagulation
#10
Xiaoxi Yao, Bernard J Gersh, Lindsey R Sangaralingham, Nilay D Shah, Peter A Noseworthy
BACKGROUND: There is growing interest in the role for non-vitamin K antagonist oral anticoagulants (NOACs) in patients without atrial fibrillation (AF). We aimed to provide a comprehensive assessment of the risks of ischemic stroke, myocardial infarction (MI), AF, and major bleeding in patients without previously diagnosed AF. METHODS: Using a large US administrative database, we identified 6,495,875 patients ≥50 years between January 1, 2011, and September 30, 2016, who were not diagnosed with AF and were not treated with oral anticoagulants or nonaspirin antiplatelet agents...
May 2018: American Heart Journal
https://www.readbyqxmd.com/read/29748219/frequency-reasons-and-impact-of-premature-ticagrelor-discontinuation-in-patients-undergoing-coronary-revascularization-in-routine-clinical-practice-results-from-the-bern-percutaneous-coronary-intervention-registry
#11
Thomas Zanchin, Fabrice Temperli, Alexios Karagiannis, Christian Zanchin, Markus Räsänen, Konstantinos C Koskinas, Stefan Stortecky, Lukas Hunziker, Fabien Praz, Stefan Blöchlinger, Christina Moro, Aris Moschovitis, Christian Seiler, Michael Billinger, Dik Heg, Thomas Pilgrim, Marco Valgimigli, Stephan Windecker, Lorenz Räber
BACKGROUND: Although ticagrelor has improved clinical outcomes among patients with acute coronary syndrome compared with clopidogrel, adherence to this new antiplatelet agent in real-world practice has not been fully investigated. METHODS AND RESULTS: Between November 2011 and June 2014, 1278 of 4831 consecutive patients (26.5%) undergoing percutaneous coronary intervention at a tertiary care center were treated with ticagrelor. Premature ticagrelor cessation was categorized into (1) change, when ticagrelor was replaced by prasugrel; (2) de-escalation, when ticagrelor was replaced by clopidogrel; and (3) premature discontinuation, when ticagrelor was discontinued without P2Y12 inhibitor replacement...
May 2018: Circulation. Cardiovascular Interventions
https://www.readbyqxmd.com/read/29740755/optimal-antithrombotic-treatment-of-patients-with-atrial-fibrillation-undergoing-percutaneous-coronary-intervention-triple-therapy-is-too-much
#12
REVIEW
M S Jacobs, R G Tieleman
Patients with atrial fibrillation who undergo a coronary intervention are eligible for both anticoagulation and (dual) antiplatelet therapy ((D)APT). An optimal balance has to be found to reduce the thromboembolic risk (i.e. stroke, systemic embolism and myocardial infarction) and to minimise the increased risk of bleeding with concomitant use of an anticoagulant and (D)APT. Owing to a lack of evidence, the guideline recommendations are predominantly based on expert opinion. Current evidence indicates that the combination of a non-vitamin K oral anticoagulant (NOAC) and clopidogrel is safer than vitamin-K oral antagonists plus DAPT, which increases the risk of bleeding, without clear advantages in regard to efficacy...
May 8, 2018: Netherlands Heart Journal
https://www.readbyqxmd.com/read/29740754/a-practical-guide-on-how-to-handle-patients-with-bleeding-events-while-on-oral-antithrombotic-treatment
#13
REVIEW
M E Gimbel, S C S Minderhoud, J M Ten Berg
Bleeding is a feared complication in patients who are treated with antithrombotic therapy (oral anticoagulation or antiplatelet therapy). Management of antithrombotic therapy after bleeding poses a dilemma where restarting the crucial medication could lead to recurrent bleeding, while interrupting or even discontinuing treatment could increase the thrombotic risk. In this review, we provide recommendations regarding the treatment of patients with a bleeding event while on oral antithrombotic therapy, based on the literature and expert opinion...
May 8, 2018: Netherlands Heart Journal
https://www.readbyqxmd.com/read/29737498/management-of-embolic-stroke-of-undetermined-source-esus
#14
REVIEW
Tobias Geisler, Annerose Mengel, Ulf Ziemann, Sven Poli
According to the Trial of ORG 10172 in Acute Stroke Treatment (TOAST) classification, embolic stroke of undetermined source (ESUS) has refined the old definition of cryptogenic stroke. More sophisticated criteria and a well-defined diagnostic workup point out the embolic nature of this disease. Because ESUS is associated with a high stroke recurrence, a clear risk prediction and management is of utmost importance to improve prognosis. To date, standard pharmacotherapy consists of antiplatelet drugs and statins...
May 8, 2018: Drugs
https://www.readbyqxmd.com/read/29724818/hypoxia-and-ischemia-promote-a-maladaptive-platelet-phenotype
#15
Scott J Cameron, Doran S Mix, Sara K Ture, Rachel A Schmidt, Amy Mohan, Daphne Pariser, Michael C Stoner, Punit Shah, Lijun Chen, Hui Zhang, David J Field, Kristina L Modjeski, Sandra Toth, Craig N Morrell
OBJECTIVE: Reduced blood flow and tissue oxygen tension conditions result from thrombotic and vascular diseases such as myocardial infarction, stroke, and peripheral vascular disease. It is largely assumed that while platelet activation is increased by an acute vascular event, chronic vascular inflammation, and ischemia, the platelet activation pathways and responses are not themselves changed by the disease process. We, therefore, sought to determine whether the platelet phenotype is altered by hypoxic and ischemic conditions...
May 3, 2018: Arteriosclerosis, Thrombosis, and Vascular Biology
https://www.readbyqxmd.com/read/29718528/established-and-potential-echocardiographic-markers-of-embolism-and-their-therapeutic-implications-in-patients-with-ischemic-stroke
#16
Paulina E Gąsiorek, Maciej Banach, Marek Maciejewski, Andrzej Głąbiński, Aleksandra Paduszyńska, Jacek Rysz, Agata Bielecka-Dąbrowa
Cardiogenic strokes comprised 11% of all strokes and 25% of ischemic strokes. An accurate identification of the cause of stroke is necessary in order to prepare an adequate preventive strategy. In this review the confirmed and potential causes of embolic strokes are presented, which can be detected in echocardiography in the context of present treatment guidelines and gaps in evidence. There remains a need for further studies assessing the meaning of potential cardiac sources of embolism and establishment of rules for optimal medical prevention (antiplatelet therapy [APT] vs...
May 2, 2018: Cardiology Journal
https://www.readbyqxmd.com/read/29704214/expert-opinion-paper-on-atrial-fibrillation-detection-after-ischemic-stroke
#17
REVIEW
Karl Georg Haeusler, Klaus Gröschel, Martin Köhrmann, Stefan D Anker, Johannes Brachmann, Michael Böhm, Hans-Christoph Diener, Wolfram Doehner, Matthias Endres, Christian Gerloff, Hagen B Huttner, Manfred Kaps, Paulus Kirchhof, Darius Günther Nabavi, Christian H Nolte, Waltraud Pfeilschifter, Burkert Pieske, Sven Poli, Wolf Rüdiger Schäbitz, Götz Thomalla, Roland Veltkamp, Thorsten Steiner, Ulrich Laufs, Joachim Röther, Rolf Wachter, Renate Schnabel
This expert opinion paper on atrial fibrillation detection after ischemic stroke includes a statement of the "Heart and Brain" consortium of the German Cardiac Society and the German Stroke Society. This paper was endorsed by the Stroke Unit-Commission of the German Stroke Society and the German Atrial Fibrillation NETwork. In patients with ischemic stroke, detection of atrial fibrillation should usually lead to a change in secondary stroke prevention, since oral anticoagulation is superior to antiplatelet drugs...
April 27, 2018: Clinical Research in Cardiology: Official Journal of the German Cardiac Society
https://www.readbyqxmd.com/read/29699748/a-randomized-double-blind-placebo-controlled-study-comparing-intracoronary-versus-intravenous-abciximab-in-patients-with-st-elevation-myocardial-infarction-undergoing-transradial-rescue-percutaneous-coronary-intervention-after-failed-thrombolysis
#18
Olivier F Bertrand, Éric Larose, Rodrigo Bagur, Frédéric Maes, Valérie Gaudreault, Bernard Noël, Gérald Barbeau, Jean-Pierre Déry, Charles Pirlet, Olivier Costerousse
The risk and benefit ratio of glycoprotein IIb/IIIa inhibitors with dual oral antiplatelet therapy after failed thrombolysis and rescue percutaneous coronary intervention (PCI) is unclear. Using a randomized placebo-controlled, double-blind design, we compared intravenous (IV) and intracoronary (IC) abciximab delivery in 74 patients referred for rescue transradial PCI. The primary angiographic end points were the final thrombolysis in myocardial infarction flow and myocardial blush grades. Secondary end points included acute and 6-month outcomes using angiographic parameters, platelet aggregation parameters, cardiac biomarkers, cardiac magnetic resonance measurements (CMR) and clinical end points...
March 28, 2018: American Journal of Cardiology
https://www.readbyqxmd.com/read/29698794/prognostic-and-therapeutic-implications-of-vascular-disease-in-patients-with-atrial-fibrillation
#19
REVIEW
Farhan Shahid, Daniele Pastori, Francesco Violi, Gregory Y H Lip
Atrial fibrillation (AF) is associated with a 5-fold increase in the risk of ischemic stroke, and AF-related stroke patients have a higher mortality and greater morbidity than patients with non-AF related stroke. AF and vascular disease share a close relationship, with the concomitant presence of both disease states leading to a dramatic rise in future cardiovascular events. Indeed, the presence of peripheral artery disease independently predicts stroke in patients with AF. Myocardial infarction (MI) is another well-established risk factor for the development of AF; however, the role of pre-existing AF in MI is less well evidenced, with recent studies showing that this population more frequently develops coronary ischaemic events and has a higher risk of mortality than sinus rhythm patients...
April 23, 2018: Pharmacological Research: the Official Journal of the Italian Pharmacological Society
https://www.readbyqxmd.com/read/29691276/asia-pacific-working-group-consensus-on-non-variceal-upper-gastrointestinal-bleeding-an-update-2018
#20
Joseph Jy Sung, Philip Cy Chiu, Francis K L Chan, James Yw Lau, Khean-Lee Goh, Lawrence Hy Ho, Hwoon-Young Jung, Jose D Sollano, Takuji Gotoda, Nageshwar Reddy, Rajvinder Singh, Kentaro Sugano, Kai-Chun Wu, Chun-Yin Wu, David J Bjorkman, Dennis M Jensen, Ernst J Kuipers, Angel Lanas
Non-variceal upper gastrointestinal bleeding remains an important emergency condition, leading to significant morbidity and mortality. As endoscopic therapy is the 'gold standard' of management, treatment of these patients can be considered in three stages: pre-endoscopic treatment, endoscopic haemostasis and post-endoscopic management. Since publication of the Asia-Pacific consensus on non-variceal upper gastrointestinal bleeding (NVUGIB) 7 years ago, there have been significant advancements in the clinical management of patients in all three stages...
April 24, 2018: Gut
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