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Jacques Sedat, Yves Chau, Jean Gaudart, Marina Sachet, Stephanie Beuil, Michel Lonjon
BACKGROUND: Thromboembolic complications are the main problem in stent-assisted coil embolization of unruptured intracranial aneurysms. The combination of aspirin and clopidogrel is generally used to decrease these complications, but some patients do not respond to clopidogrel and have a higher risk of stent thrombosis. In cardiology, clinical trials have shown that prasugrel reduced the incidence of ischaemic events in patients with acute coronary syndrome compared with clopidogrel but, according to several authors, prasugrel would produce an increased risk of cerebral haemorrhagic complications...
October 19, 2016: Interventional Neuroradiology
Richard R Heuser
Over 90% of patients achieve adequate levels of platelet inhibition with both Prasugrel and Ticagrelor. The introduction of Prasugrel was met with some hesitation from physicians because of the significant increase in cost. This pharmaceutically sponsored and authored retrospective study suggests that both agents are effective.
October 2016: Catheterization and Cardiovascular Interventions
Ulrike Flierl, Florian Zauner, Jan-Thorben Sieweke, Christine Berliner, L Christian Napp, Jochen Tillmanns, Johann Bauersachs, Andreas Schäfer
Prasugrel, a potent thienopyridine, achieves stronger inhibition of platelet activation than clopidogrel. However, onset of inhibition is significantly delayed in patients with acute ST-elevation myocardial infarction (STEMI), as haemodynamic instability and morphine application seem to exhibit significant influence. Since rapid onset of effect was demonstrated in non-STEMI patients when prasugrel was administered only after percutaneous coronary intervention (PCI) without increasing cardiovascular event rates we assessed the efficacy of prasugrel loading immediately after PCI for STEMI instead of pre-loading before revascularisation...
October 13, 2016: Thrombosis and Haemostasis
Shinya Ichikawa, Kengo Tsukahara, Yugo Minamimoto, Yuichiro Kimura, Yasushi Matsuzawa, Nobuhiko Maejima, Noriaki Iwahashi, Kiyoshi Hibi, Masami Kosuge, Toshiaki Ebina, Kazuo Kimura
BACKGROUND: Few studies have compared the platelet reactivity of prasugrel and clopidogrel in the acute phase of ST-segment elevation myocardial infarction (STEMI).Methods and Results:Primary percutaneous coronary intervention (PCI) was performed in 78 patients with STEMI within 12 h of onset. Patients were randomly assigned to receive a Japanese standard loading dose of prasugrel 20 mg or clopidogrel 300 mg. Platelet reactivity was serially assessed using the VerifyNow-P2Y12 assay, the results of which were expressed as P2Y12-reaction-units (PRU)...
October 6, 2016: Circulation Journal: Official Journal of the Japanese Circulation Society
Francesco Pelliccia, Fabiana Rollini, Giuseppe Marazzi, Cesare Greco, Carlo Gaudio, Dominick J Angiolillo, Giuseppe Rosano
The combination of AF and coronary artery disease not only is a common clinical setting, it is also a complex setting to deal with anticoagulation and antiplatelet therapy, and it is associated with significantly higher mortality rates. Unfortunately, there are no sufficient data available to optimally guide clinical practice in such settings. This review focuses specifically on newer oral anticoagulants (NOACs) associated with dual antiplatelet therapy (DAPT) in patients with coronary artery disease undergoing percutaneous coronary intervention (PCI)...
October 3, 2016: International Journal of Cardiology
Gian Marco Rosa, Daniele Bianco, Alberto Valbusa, Laura Massobrio, Francesco Chiarella, Claudio Brunelli
After acute coronary syndromes (ACS), the so-called dual antiplatelet therapy (DAPT), which usually consists of low-dose of aspirin in combination with a thienopyridine (clopidogrel, prasugrel) or with a cyclopentyltriazolopyrimidine (ticagrelor), reduces the risk of ischemic events. Ticagrelor, un particular, is an effective drug as it isn' a prodrug, doesn't require metabolic activation and demonstrates a rapid onset and faster offset of action. Areas covered: This article evaluates the pharmacokinetics, efficacy, safety and tolerability of ticagrelor during DAPT after ACS and its potential use beyond the canonical twelve months after PCI...
October 7, 2016: Expert Opinion on Drug Metabolism & Toxicology
Ashan Gunarathne, Shahana Hussain, Anthony H Gershlick
Dual antiplatelet therapy (DAPT) with aspirin combined with either a thienopyridine (clopidogrel or prasugrel) or acyclopentyl-triazolo-pyrimidine (ticagrelor) plays a vital role in the management of acute coronary syndrome (ACS) especially in those undergoing percutaneous coronary intervention (PCI) but even those being managed medically. Observational studies and some formal studies have shown patients on the standard dual antiplatelet regimen (clopidogrel and aspirin) continue to have further ischemic events and can suffer stent thrombosis...
October 4, 2016: Expert Review of Cardiovascular Therapy
Amit N Vora, Eric D Peterson, Lisa A McCoy, Mark B Effron, Kevin J Anstrom, Douglas E Faries, Marjorie E Zettler, Gregg C Fonarow, Brian A Baker, Gregg W Stone, Tracy Y Wang
BACKGROUND: Few studies have examined how antiplatelet therapies are selected during the routine care of acute myocardial infarction patients, particularly relative to the patient's estimated mortality and bleeding risks. METHODS AND RESULTS: We examined patients presenting with acute myocardial infarction treated with percutaneous coronary intervention at 233 US hospitals in the TRANSLATE-ACS observational study from April 2010 to October 2012. We developed a multivariable logistic regression model to identify factors associated with prasugrel selection...
2016: Journal of the American Heart Association
Steven Sra, Mary K Tan, Shamir R Mehta, Harold N Fisher, Jean-Pierre Déry, Robert C Welsh, Mark J Eisenberg, Christopher B Overgaard, Barry F Rose, Anthony J Della Siega, Asim N Cheema, Brian Y L Wong, Mark A Henderson, Sohrab Lutchmedial, Shahar Lavi, Shaun G Goodman, Andrew T Yan
BACKGROUND: Since the introduction of newer, more potent P2Y12 receptor inhibitors (P2Y12ris), practice patterns and associated clinical outcomes in patients with myocardial infarction (MI) undergoing percutaneous coronary intervention (PCI) and also requiring oral anticoagulation (OAC) have not been fully characterized. METHODS: The Canadian Observational Antiplatelet Study was a prospective, multicenter, longitudinal, observational study (26 hospitals, December 2011 to May 2013) describing P2Y12ri treatment patterns and outcomes in patients with ST-elevation and non-ST-elevation MI undergoing PCI...
October 2016: American Heart Journal
Raghav Gupta, Justin M Moore, Christoph J Griessenauer, Nimer Adeeb, Apar S Patel, Roy Youn, Karen Poliskey, Ajith J Thomas, Christopher S Ogilvy
INTRODUCTION: Flow diversion with the Pipeline Embolization Device (PED) is currently adopted for treatment of a variety of intracranial aneurysms. The elevated risk of thromboembolic complications associated with the device necessitates the need for administration of antiplatelet agents. We sought to assess current dual antiplatelet therapy practices patterns and their associated costs, following PED placement. MATERIALS AND METHODS: An online questionnaire assessing dual antiplatelet regimens following flow diversion for treatment of intracranial aneurysms was developed and disseminated to 80 neurosurgeons at major academic cerebrovascular centers...
September 15, 2016: World Neurosurgery
Eduard Shantsila, Gregory Yh Lip
BACKGROUND: Morbidity in patients with chronic heart failure is high, and this predisposes them to thrombotic complications, including stroke and thromboembolism, which in turn contribute to high mortality. Oral anticoagulants (e.g. warfarin) and antiplatelet agents (e.g. aspirin) are the principle oral antithrombotic agents. Many heart failure patients with sinus rhythm take aspirin because coronary artery disease is the leading cause of heart failure. Oral anticoagulants have become a standard in the management of heart failure with atrial fibrillation...
September 15, 2016: Cochrane Database of Systematic Reviews
Morten Würtz, Erik L Grove
Aspirin and P2Y12 receptor antagonists are widely used across the spectrum of cardiovascular diseases. Upper gastrointestinal complications, including ulcer and bleeding, are relatively common during antiplatelet treatment and, therefore, concomitant proton pump inhibitor (PPI) treatment is often prescribed.PPIs provide gastroprotection by changing the intragastric milieu, essentially by raising intragastric pH. In recent years, it has been heavily discussed whether PPIs may reduce the cardiovascular protection by aspirin and, even more so, clopidogrel...
September 15, 2016: Advances in Experimental Medicine and Biology
Ashleigh Dind, Usaid Allahwala, Kaleab N Asrress, Sanjit S Jolly, Ravinay Bhindi
Recent advances have caused a major shift in the way ST-elevation myocardial infarctions are managed. This review explores the pharmacological and interventional techniques that have evidence for improving outcomes and the landmark trials that have sparked change. The new P2Y12 inhibitors, ticagrelor and prasugrel, have been shown to be superior to clopidogrel in STEMI patients undergoing primary percutaneous coronary intervention. Concurrently, many technical aspects of percutaneous coronary intervention have been further clarified by trial data, with bare-metal stents, routine thrombus aspiration and femoral access showing evidence of inferiority...
August 22, 2016: Heart, Lung & Circulation
Dimitrios Alexopoulos, Ioanna Xanthopoulou, Athanasios Moulias, John Lekakis
Physicians considering prescription of P2Y12-receptor antagonist for long-term (>1 year) protection of patients post-myocardial infarction face the trilemma of selecting between clopidogrel, prasugrel, or ticagrelor. Differential ischemic benefits derived from relevant trials may assist in tailoring treatment, although the different bleeding definitions applied make any meaningful comparison of each agent's bleeding potential very difficult. Considering the available data and recognizing the significant limitation of observations obtained thus far from subgroup analyses, prasugrel appears to provide higher anti-ischemic protection than clopidogrel...
September 13, 2016: Journal of the American College of Cardiology
Chang Hyeun Kim, Gyojun Hwang, O-Ki Kwon, Seung Pil Ban, Nguyen Duc Chinh, Mardjono Tjahjadi, Chang Wan Oh, Jae Seung Bang, Tackeun Kim
Purpose To identify and apply an optimized P2Y12 reaction units (PRU) threshold for implementing modified antiplatelet preparation to prevent thromboembolic events in patients nonresponsive to clopidogrel (clopidogrel nonresponders) undergoing coil embolization of unruptured aneurysms and to evaluate the clinical validity. Materials and Methods The optimal PRU threshold for prediction of thromboembolic events was determined with the Youden index in post hoc analysis of a previous, prospectively enrolled cohort of 165 patients in whom the antiplatelet regimen was not modified...
September 2, 2016: Radiology
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
Jingyu Chen, Michael Zhiyan Wang
PLD-301, a phosphate prodrug of clopidogrel thiolactone discovered by Prelude Pharmaceuticals with the aim to overcome clopidogrel resistance, was evaluated for its in vivo inhibitory effect on ADP-induced platelet aggregation in rats. The potency of PLD-301 was similar to that of prasugrel, but much higher than that of clopidogrel. The results of pharmacokinetic analysis showed that the oral bioavailability of clopidogrel thiolactone converted from PLD-301 was 4- to 5-fold higher than that of the one converted from clopidogrel, suggesting that in comparison with clopidogrel, lower doses of PLD-301 could be used clinically...
March 2016: Letters in Drug Design & Discovery
Mrudula Kudaravalli, Andrew D Althouse, Oscar C Marroquin, Sameer J Khandhar, Michael S Sharbaugh, Catalin Toma, A J Conrad Smith, John T Schindler, Joon S Lee, Suresh R Mulukutla
BACKGROUND: Dual antiplatelet therapy is recommended for patients with acute coronary syndrome (ACS) that undergo percutaneous coronary intervention (PCI). However, the effect of switching P2Y12 inhibitors between the loading dose and therapy after discharge is not well described. METHODS: This post-hoc analysis of a prospectively collected registry included 3219 consecutive ACS patients who underwent PCI. Patients were categorized into four groups: clopidogrel at load and discharge (C-C), loading dose of clopidogrel and discharged on prasugrel/ticagrelor (C-PT), loading dose of prasugrel/ticagrelor and discharged on clopidogrel (PT-C), and prasugrel/ticagrelor at load and discharge (PT-PT)...
November 15, 2016: International Journal of Cardiology
Guillaume Cayla, Thomas Cuisset, Johanne Silvain, Florence Leclercq, Stephane Manzo-Silberman, Christophe Saint-Etienne, Nicolas Delarche, Anne Bellemain-Appaix, Grégoire Range, Rami El Mahmoud, Didier Carrié, Loic Belle, Geraud Souteyrand, Pierre Aubry, Pierre Sabouret, Xavier Halna du Fretay, Farzin Beygui, Jean-Louis Bonnet, Benoit Lattuca, Christophe Pouillot, Olivier Varenne, Ziad Boueri, Eric Van Belle, Patrick Henry, Pascal Motreff, Simon Elhadad, Joe-Elie Salem, Jérémie Abtan, Hélène Rousseau, Jean-Philippe Collet, Eric Vicaut, Gilles Montalescot
BACKGROUND: Elderly patients are at high risk of ischaemic and bleeding events. Platelet function monitoring offers the possibility to individualise antiplatelet therapy to improve the therapeutic risk-benefit ratio. We aimed to assess the effect of platelet function monitoring with treatment adjustment in elderly patients stented for an acute coronary syndrome. METHODS: We did this multicentre, open-label, blinded-endpoint, randomised controlled superiority study at 35 centres in France...
August 26, 2016: Lancet
Michal Droppa, Pascal Spahn, Khalid Takhgiriev, Karin A L Müller, Ahmed Alboji, Andreas Straub, Dominik Rath, Young-Hoon Jeong, Meinrad Gawaz, Tobias Geisler
BACKGROUND: Effective inhibition of platelet aggregation during PCI in high risk patients with ACS is of utmost importance. The new intravenous short acting P2Y12-receptor inhibitor cangrelor is available for use in PCI-treated patients. We aimed to study platelet inhibition during treatment with cangrelor and transition phase with oral P2Y12-receptor inhibitors in patients with acute coronary syndromes (ACS). METHODS: Cangrelor was administered during PCI to 21 P2Y12-inhibitor naïve patients with ACS...
November 15, 2016: International Journal of Cardiology
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