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Clopidogrel AND Aspirin

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https://www.readbyqxmd.com/read/29766750/clopidogrel-and-aspirin-in-acute-ischemic-stroke-and-high-risk-tia
#1
S Claiborne Johnston, J Donald Easton, Mary Farrant, William Barsan, Robin A Conwit, Jordan J Elm, Anthony S Kim, Anne S Lindblad, Yuko Y Palesch
Background Combination antiplatelet therapy with clopidogrel and aspirin may reduce the rate of recurrent stroke during the first 3 months after a minor ischemic stroke or transient ischemic attack (TIA). A trial of combination antiplatelet therapy in a Chinese population has shown a reduction in the risk of recurrent stroke. We tested this combination in an international population. Methods In a randomized trial, we assigned patients with minor ischemic stroke or high-risk TIA to receive either clopidogrel at a loading dose of 600 mg on day 1, followed by 75 mg per day, plus aspirin (at a dose of 50 to 325 mg per day) or the same range of doses of aspirin alone...
May 16, 2018: New England Journal of Medicine
https://www.readbyqxmd.com/read/29765396/acute-in-stent-thrombosis-after-carotid-angioplasty-and-stenting-a-case-report-and-literature-review
#2
Wei Hu, Li Wang, GuoPing Wang
Background: Based on the results of a recent randomized controlled trial, carotid artery stenting (CAS) was regarded as a relatively safe, less invasive treatment of internal carotid artery stenosis. However, cerebral thromboembolic events are the most common complications of CAS. Especially acute stent thrombosis following CAS will be fatal without prompt diagnosis and revascularization. Case Report: We report a case of acute stent thrombosis in whom carotid revascularization was performed successfully via arterial thrombolysis and balloon postdilation...
April 2018: Interventional Neurology
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
#3
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/29747016/carotid-endarterectomy-and-concurrent-clopidogrel-use-us-national-practice-patterns
#4
Eva A Mistry, Jane C Khoury, Dawn Kleindorfer
BACKGROUND: Patients diagnosed with high-grade carotid stenosis often receive a carotid endarterectomy (CEA) during their hospital stay and most receive antiplatelet medication. There is inter-surgeon variability in performing CEA in patients receiving clopidogrel given the potent antiplatelet effect. METHODS: Utilizing the PREMIER database, adults with principal discharge diagnosis of stroke, transient ischemic attack (TIA) or carotid artery stenosis or occlusion without stroke/TIA(CAS), who had a CEA during the same hospital stay, in 2014 were analyzed...
May 7, 2018: World Neurosurgery
https://www.readbyqxmd.com/read/29743380/tailored-adjunctive-cilostazol-therapy-based-on-cyp2c19-genotyping-in-patients-with-acute-myocardial-infarction-the-caldera-gene-study
#5
Koichi Kaikita, Hiromi Yoshimura, Masanobu Ishii, Takashi Kudoh, Yoshihiro Yamada, Eiichiro Yamamoto, Yasuhiro Izumiya, Sunao Kojima, Hideki Shimomura, Ryusuke Tsunoda, Kunihiko Matsui, Hisao Ogawa, Kenichi Tsujita
BACKGROUND: Patients with reduced-function CYP2C19 genotypes on dual antiplatelet therapy (DAPT) with aspirin and clopidogrel show higher clinical risk for acute myocardial infarction (AMI). We investigated the effect of CYP2C19 genotype-tailored adjunctive cilostazol therapy on treatment of AMI.Methods and Results:The study group of 138 patients with suspected AMI were screened for CYP2C19 genotype immediately after percutaneous coronary intervention (PCI) using a SPARTAN RX point-of-care device...
May 8, 2018: Circulation Journal: Official Journal of the Japanese Circulation Society
https://www.readbyqxmd.com/read/29742684/myocardial-injury-after-noncardiac-surgery-incidence-and-predictors-from-a-prospective-observational-cohort-study-at-an-indian-tertiary-care-centre
#6
Rubin George, Vidya P Menon, Fabia Edathadathil, Sabarish Balachandran, Merlin Moni, Dipu Sathyapalan, Preetha Prasanna, Gokuldas S, Jerry Paul, Chandrababu K K, Lakshmi Kumar, Ashok Pillai
Asymptomatic myocardial injury following noncardiac surgery (MINS) is an independent predictor of 30-day mortality and may go unrecognized based on standard diagnostic definition for myocardial infarction (MI). Given lack of published research on MINS in India, our study aims to determine incidence of MINS in patients undergoing noncardiac surgery at our tertiary care hospital, and evaluate the clinical characteristics including 30-day outcome.The prospective observational study included patients >65 years or >45 years with either hypertension (HTN), diabetes mellitus (DM), coronary artery disease (CAD), cerebrovascular accident (CVA), or peripheral arterial disease undergoing noncardiac surgery...
May 2018: Medicine (Baltimore)
https://www.readbyqxmd.com/read/29740755/optimal-antithrombotic-treatment-of-patients-with-atrial-fibrillation-undergoing-percutaneous-coronary-intervention-triple-therapy-is-too-much
#7
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/29731992/response-to-clopidogrel-is-associated-with-early-neurological-deterioration-after-acute-ischemic-stroke
#8
Xingyang Yi, Jing Lin, Yanfen Wang, Ju Zhou, Qiang Zhou, Chun Wang
Purpose: The relationship between response to clopidogrel and early neurological deterioration (END) after acute ischemic stroke (IS) is not well defined. The aim of present study was to evaluate the associations of clopidogrel resistance (CR) with END, and stratified analyze the effectiveness of clopidogrel alone and clopidogrel plus aspirin for the prevention of END. Results: A total of 375 patients, 144 patients were received clopidogrel alone, 231 patients took clopidogrel plus aspirin...
April 13, 2018: Oncotarget
https://www.readbyqxmd.com/read/29731189/potent-effect-of-prasugrel-on-acute-phase-resolution-of-intra-stent-athero-thrombotic-burden-after-percutaneous-intervention-to-acute-coronary-syndrome
#9
Yoshiro Tsukiyama, Amane Kozuki, Toshiro Shinke, Hiromasa Otake, Yoichi Kijima, Tomoya Masano, Ryoji Nagoshi, Hiroyuki Shibata, Ryo Takeshige, Ken-Ichi Yanaka, Junya Shite, Ken-Ichi Hirata
BACKGROUND: Recent studies suggested protruding thrombus and atheroma after stent placement could be a substrate for subsequent adverse ischemic events. Although protruded atherothrombotic burden can be assessed as intra-stent tissue (IST) by optical coherence tomography (OCT), the effects of potent antiplatelet therapy on the acute phase resolution of IST in patients with acute coronary syndrome (ACS) was unknown. METHODS: Ninety-six consecutive ACS patients with multi-vessel disease were enrolled in this prospective registry...
May 3, 2018: Journal of Cardiology
https://www.readbyqxmd.com/read/29730968/is-ticagrelor-worth-its-high-cost-and-side-effects
#10
Raphaëlle-Ashley Guerbaai, Indrajeet Mahata, Sylvestre Maréchaux, Thierry H Le Jemtel, Pierre-Vladimir Ennezat
Ticagrelor is a reversible P2Y12 receptor antagonist that is more potent than clopidogrel. When used in combination with aspirin, it reduces cardiovascular events in patients with acute coronary syndrome. However, unbiased review of 5 randomised controlled trials indicates that although statistically significant, the clinical superiority of ticagrelor over clopidogrel is modest. Thus, identification of patients who benefit the most from ticagrelor is a priority. Besides bleeding issues, ticagrelor can frequently cause bouts of dyspnoea, which requires ticagrelor replacement by another P2Y12 receptor antagonist, with a loading dose...
May 7, 2018: Acta Cardiologica
https://www.readbyqxmd.com/read/29723426/cyp2c19-or-cyp3a5-genotyping-does-not-predict-clinical-response-to-clopidogrel
#11
Fayna Rodríguez-González, Efren Martínez-Quintana, Pedro Saavedra, José M Medina-Gil, Marta Riaño, Paloma Garay-Sánchez, Antonio Tugores
Along with aspirin, clopidogrel has been a widely used antiplatelet therapeutic regimen. Although generally well tolerated, its efficacy varies among individuals, with the main hypothesis that its bioavailability relies on its bioconversion to the active compound, which, in turn, depends on the genetic background and/or interactions with other drugs. To determine which factors influenced response in our patients, 368 patients receiving combined antiaggregation therapy with aspirin and clopidogrel were followed for 1 year to record 30 novel cardiovascular acute events...
May 3, 2018: Journal of Clinical Pharmacology
https://www.readbyqxmd.com/read/29717155/survey-of-antithrombotic-treatment-in-rural-patients-60-years-with-atrial-fibrillation-in-east-china
#12
Yong Wei, Juan Xu, Haiqing Wu, Genqing Zhou, Songwen Chen, Caihong Wang, Yahong Shen, Shunhong Yang, Bin Wang, Zheng He, Jianping Sun, Weidong Sun, Ping Ouyang, Shaowen Liu
The prevalence and antithrombotic treatment of atrial fibrillation (AF) in Chinese rural population is not well known. The aim of this study was to investigate the extent to which antithrombotic treatment was prescribed for rural AF patients >60 years. We identified 828 AF patients from 36734 rural residents >60 years in Shanghai China. Our data indicated the overall prevalence rate of AF was 2.3% in rural population >60 years in East China and 38.9% of AF patients underwent antithrombotic therapy, including warfarin (5...
May 1, 2018: Scientific Reports
https://www.readbyqxmd.com/read/29707148/dual-antiplatelet-therapy-with-clopidogrel-and-aspirin-increases-mortality-in-4t1-metastatic-breast-cancer-bearing-mice-by-inducing-vascular-mimicry-in-primary-tumour
#13
Marta Smeda, Anna Kieronska, Bartosz Proniewski, Agnieszka Jasztal, Anna Selmi, Krystyna Wandzel, Agnieszka Zakrzewska, Tomasz Wojcik, Kamil Przyborowski, Katarzyna Derszniak, Marta Stojak, Dawid Kaczor, Elzbieta Buczek, Cezary Watala, Joanna Wietrzyk, Stefan Chlopicki
Platelet inhibition has been considered an effective strategy for combating cancer metastasis and compromising disease malignancy although recent clinical data provided evidence that long-term platelet inhibition might increase incidence of cancer deaths in initially cancer-free patients. In the present study we demonstrated that dual anti-platelet therapy based on aspirin and clopidogrel (ASA+Cl), a routine regiment in cardiovascular patients, when given to cancer-bearing mice injected orthotopically with 4T1 breast cancer cells, promoted progression of the disease and reduced mice survival in association with induction of vascular mimicry (VM) in primary tumour...
April 3, 2018: Oncotarget
https://www.readbyqxmd.com/read/29707143/the-secondary-prevention-of-stroke-according-to-cytochrome-p450-2c19-genotype-in-patients-with-acute-large-artery-atherosclerosis-stroke
#14
Xingyang Yi, Jing Lin, Ju Zhou, Yanfeng Wang, Ruyue Huang, Chun Wang
Purpose: To investigated the effectiveness of antiplatelet agents for the secondary prevention of stroke according to CYP2C19 genotype in patients with ischemic stroke (IS). Methods: Between August 2009 and December 2011, 570 acute IS patients with acute large-artery atherosclerosis were randomly assigned to receive either combined clopidogrel and aspirin for the first 30 day, and clopidogrel thereafter (clopidogrel group, n=284) or aspirin monotherapy (aspirin group, n=286)...
April 3, 2018: Oncotarget
https://www.readbyqxmd.com/read/29701913/the-influence-of-abcb1-and-p2y12-genetic-variants-on-clinical-outcomes-in-chinese-intracranial-artery-stenosis-patients
#15
Xingang Li, Liqun Jiang, Shusen Sun, Wei Li, Xiaoqing Li, Zhongrong Miao, Zhigang Zhao, Ning Ma
For intracranial artery stenosis patients, high inter-individual variability in response to antiplatelet drug therapy results in recurrent ischemic events. We aimed to evaluate the association of drug-related genetic polymorphisms with adverse clinical outcomes. We consecutively enrolled 157 patients receiving dual-antiplatelet therapy (aspirin plus clopidogrel), and adverse clinical events occurred in 10 patients during the one year follow-up. The P2Y12 polymorphisms (rs9859538 and rs10935842) were associated with increased likelihood of relapse events (OR=2...
April 27, 2018: Clinical and Experimental Pharmacology & Physiology
https://www.readbyqxmd.com/read/29692936/safety-and-efficacy-of-triple-therapeutic-targets-with-rivaroxaban-after-acute-myocardial-infarction-complicated-by-left-ventricular-thrombi-in-a-case-of-nonvalvular-atrial-fibrillation
#16
Francesco Summaria, Gregory A Sgueglia, Fabrizio D'Errico, Antonella De Santis, Fabiana Piccioni, Gaetano Gioffrè, Achille Gaspardone
We present the complex case of a high-risk patient with nonvalvular atrial fibrillation, who experienced a non-ST elevation myocardial infarction complicated by left ventricular (LV) thrombi and underwent percutaneous coronary intervention with drug-eluting stent implantation. The patient was initially treated with short-term triple therapy including aspirin, clopidogrel, and rivaroxaban 15 mg/die. Following aspirin dropping one month after discharge, the patient continued on dual therapy with clopidogrel and rivaroxaban, and a clinical and imaging follow-up at 6 and 12 months confirmed the LV thrombi resolution, with no thromboembolic episodes and a good safety profile...
2018: Case Reports in Cardiology
https://www.readbyqxmd.com/read/29692371/obstructive-sleep-apnea-affecting-platelet-reactivity-in-patients-undergoing-percutaneous-coronary-intervention
#17
Xiao-Min Jiang, Xue-Song Qian, Xiao-Fei Gao, Zhen Ge, Nai-Liang Tian, Jing Kan, Jun-Jie Zhang
Background: The relationship between obstructive sleep apnea (OSA) and platelet reactivity in patients undergoing percutaneous coronary intervention (PCI) has not been defined. The present prospective, single-center study explored the relationship between platelet reactivity and OSA in patients with PCI. Methods: A total of 242 patients were finally included in the study. OSA was screened overnight by polysomnography. Platelet reactivity was assessed with a sequential platelet counting method, and the platelet maximum aggregation ratio (MAR) and average aggregation ratio were calculated...
May 5, 2018: Chinese Medical Journal
https://www.readbyqxmd.com/read/29691157/transcatheter-aortic-valve-replacement-and-atrial-fibrillation-impact-of-antithrombotic-strategy-on-clinical-outcomes
#18
Samuel Hui, Robert Gooley, Hashrul N Rashid, Sarah Zaman
BACKGROUND: Antithrombotic recommendations following transcatheter aortic valve replacement (TAVR) are largely based on previous trial protocols. The efficacy and risk of anticoagulation has not been systematically assessed. The aim of this study was to determine the efficacy and safety of oral anticoagulation in patients with atrial fibrillation (AF) following TAVR with the Lotus Valve System (Boston Scientific, Malborough, MA, USA). METHODS: Consecutive patients with severe aortic stenosis who underwent Lotus valve implantation were prospectively recruited (n=164)...
April 4, 2018: Heart, Lung & Circulation
https://www.readbyqxmd.com/read/29687412/optimal-pharmacological-therapy-in-st-elevation-myocardial-infarction-a-review-a-review-of-antithrombotic-therapies-in-stemi
#19
REVIEW
R S Hermanides, S Kilic, A W J van 't Hof
Antithrombotic therapy is an essential component in the optimisation of clinical outcomes in patients with ST-elevation myocardial infarction (STEMI) undergoing primary percutaneous coronary intervention. There are currently several intravenous anticoagulant drugs available for primary percutaneous coronary intervention. Dual antiplatelet therapy comprising aspirin and P2Y12 inhibitor represents the cornerstone treatment for STEMI. However, these effective treatment strategies may be associated with bleeding complications...
April 23, 2018: Netherlands Heart Journal
https://www.readbyqxmd.com/read/29685512/causes-and-outcomes-of-finger-ischemia-in-hospitalized-patients-in-the-intensive-care-unit
#20
Gregory J Landry, Courtney J Mostul, Daniel S Ahn, Bryant J McLafferty, Timothy K Liem, Erica L Mitchell, Enjae Jung, Cherrie Z Abraham, Amir F Azarbal, Robert B McLafferty, Gregory L Moneta
OBJECTIVE: Vascular surgeons may be consulted to evaluate hospitalized patients with finger ischemia. We sought to characterize causes and outcomes of finger ischemia in intensive care unit (ICU) patients. METHODS: All ICU patients who underwent evaluation for finger ischemia from 2008 to 2015 were reviewed. All were evaluated with finger photoplethysmography. The patients' demographics, comorbidities, ICU care (ventilator status, arterial lines, use of vasoactive medications), finger amputations, and survival were also recorded...
April 20, 2018: Journal of Vascular Surgery
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