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Francesco Franchi, Fabiana Rollini, Jose Rivas Rios, Andrea Rivas, Malhar Agarwal, Megha Kureti, Deepa Nagaraju, Mustafa Wali, Zubair Shaikh, Maryuri Briceno, Ahmed Nawaz, Jae Youn Moon, Latonya Been, Siva Suryadevara, Daniel Soffer, Martin M Zenni, Theodore A Bass, Dominick J Angiolillo
BACKGROUND : Switching between different classes of P2Y12 inhibitors, including de-escalation from ticagrelor to clopidogrel, commonly occurs in clinical practice. However, the pharmacodynamic profiles of this strategy have been poorly explored. METHODS : This was a prospective, randomized, open-label study conducted in patients on maintenance dosing (MD) of aspirin (81 mg/d) and clopidogrel (75 mg/d). After a 7-day run-in with ticagrelor (180 mg loading dose [LD] followed by 90 mg twice daily MD), patients (n=80) were randomized into 1 of 4 groups: group A, clopidogrel 600 mg LD 24 hours after the last MD of ticagrelor (C-600 mg-24h); group B, clopidogrel 600 mg LD 12 hours after the last MD of ticagrelor (C-600 mg-12h); group C, clopidogrel 75 mg/d MD 24 hours after the last MD of ticagrelor (C-75 mg-24h); and group D, ticagrelor 90 mg twice daily MD (T-90 mg twice daily)...
March 11, 2018: Circulation
Arwa M Amin, Lim Sheau Chin, Chin-Hoe The, Hamza Mostafa, Dzul Azri Mohamed Noor, Muhamad Ali S K Abdul Kader, Yuen Kah Hay, Baharudin Ibrahim
Dual antiplatelet therapy (DAPT) of clopidogrel and aspirin is crucial for coronary artery disease (CAD) patients undergoing percutaneous coronary intervention (PCI). However, some patients may endure clopidogrel high on treatment platelets reactivity (HTPR) which may cause thromboembolic events. Clopidogrel HTPR is multifactorial with some genetic and non-genetic factors contributing to it. We aimed to use nuclear magnetic resonance (1 H NMR) pharmacometabolomics analysis of plasma to investigate this multifactorial and identify metabolic phenotypes and pathways associated with clopidogrel HTPR...
March 8, 2018: European Journal of Pharmaceutical Sciences
Min Soo Kim, Eun Suk Park, Jun Bum Park, In Uk Lyo, Hong Bo Sim, Soon Chan Kwon
OBJECTIVE: The purpose of this study was to analyze the variability of clopidogrel responses according to duration of a clopidogrel drug regimen after stent-assisted coil embolization (SAC), and to determine the correlation between the variability of clopidogrel responses and thromboembolic or hemorrhagic complications. METHODS: A total of 47 patients who underwent SAC procedures to treat unruptured intracranial aneurysms were enrolled in the study. Preoperatively, patients received more than seven days of aspirin (100 mg) and clopidogrel (75 mg), daily...
March 2018: Journal of Korean Neurosurgical Society
Patricia P Wadowski, Silvia Lee, Christoph W Kopp, Renate Koppensteiner, Simon Panzer, Thomas Gremmel
Low high-density lipoprotein cholesterol (HDL-C) levels are an independent predictor of ischemic events in patients with atherosclerotic cardiovascular disease. This may in part be due to decreased clopidogrel-mediated platelet inhibition in patients with low HDL-C. We investigated the association of HDL-C with on-treatment platelet reactivity to adenosine diphosphate (ADP) in 314 patients on dual antiplatelet therapy with clopidogrel and aspirin undergoing angioplasty and stenting. Platelet P-selectin expression was assessed by flow cytometry, and platelet aggregation was determined by the VerifyNow P2Y12 assay and the Impact-R...
January 1, 2018: Angiology
Susan C Fox, Jane A May, Natalia Dovlatova, Jackie R Glenn, Andrew Johnson, Ann E White, Ashwin Radhakrishnan, Stan Heptinstall
Measurement of P-selectin on activated platelets as a means of measuring platelet function utilizing the technology described here has the advantage of not requiring immediate access to specialist equipment and expertise. Blood samples are activated, fixed, stored, and transported to a central laboratory for flow cytometric analysis. Here we have compared P-selectin with other more traditional approaches to measuring platelet function in blood and/or platelet-rich plasma (PRP) from patients with acute coronary syndromes on treatment for at least 1 month with either aspirin and clopidogrel or aspirin with prasugrel...
February 20, 2018: Platelets
Fabio Mangiacapra, Iginio Colaiori, Elisabetta Ricottini, Antonio Creta, Giuseppe Di Gioia, Ilaria Cavallari, Edoardo Bressi, Marialessia Capuano, Emanuele Barbato, Germano Di Sciascio
We investigated the impact of suboptimal platelet reactivity on clinical outcomes after percutaneous coronary intervention (PCI). We enrolled 500 patients with stable coronary artery disease undergoing elective PCI. Platelet reactivity was measured before PCI using the VerifyNow P2Y12 assay. Primary endpoint was the incidence of ischemic or bleeding events at 1 month and 5 years. Patients with high platelet reactivity (HPR) showed significantly higher rates of ischemic events both during the 1st month after PCI (HR 2...
February 15, 2018: Journal of Thrombosis and Thrombolysis
Björn Redfors, Philippe Généreux, Bernhard Witzenbichler, Akiko Maehara, Giora Weisz, Thomas McAndrew, Roxana Mehran, Ajay J Kirtane, Gregg W Stone
BACKGROUND: There is a paucity of data from large contemporary cohorts of patients with in-stent restenosis (ISR) treated with drug-eluting stents (DESs), and no studies have examined the impact of high platelet reactivity (HPR) on the occurrence of ischemic events after ISR percutaneous coronary intervention (PCI) with DESs. We sought to report outcomes after PCI of ISR lesions and its association with HPR. METHODS: Patients in the prospective, multicenter ADAPT-DES study were stratified according to whether they had ISR versus non-ISR PCI...
March 2018: American Heart Journal
Roy Beigel, Israel Mazin, Edward Koifman, Michael Shechter, Hanna Pres, Nir Shlomo, Nurit Rosenberg, Elad Asher, Shlomi Matetzky
BACKGROUND: Recent studies have shown that the thromboxaneA 2 -dependent pathway is dependent upon the adenosine diphosphate (ADP)-P2Y 12 pathway and that strong P2Y 12 receptor blockade alone causes inhibition of platelet aggregation that is minimally enhanced by aspirin. Data from the PLATO trial suggested that among ticagrelor-treated patients, high compared with low dose (<100mg\day) aspirin is associated with increased risk for ischemic events. OBJECTIVES: In the current prospective, randomized, placebo-controlled, double-blind, cross-over study, we sought to evaluate the impact of aspirin withdrawal on platelet reactivity in acute coronary syndrome (ACS) patients treated with a potent P2Y 12 blocker...
February 14, 2018: Journal of Thrombosis and Haemostasis: JTH
Jennifer Bobbitt, Kathleen Petro, Michael Martin
This was a retrospective study to assess the effectiveness of Society of Thoracic Surgeons (STS) Guidelines in reducing resource utilization at Washington Adventist Hospital, Takoma Park, Maryland. Pre and post operative stay (days), platelets and other blood product use, along with hospital costs were compared in elective Cardiac Surgical patients receiving P2Y12 inhibitors in the year prior to and year following the implementation of the STS guidelines of preoperative monitoring of platelet inhibition with VerifyNow...
February 2018: Applied Nursing Research: ANR
Khung-Keong Yeo, Ehrin J Armstrong, Javier E López, Debbie C Chen, Gregory G Westin, Chin-Shang Li, David Anderson, Amy Hua, Anil Singapuri, Ezra A Amsterdam, Nipavan Chiamvimonvat, John R Laird
OBJECTIVES: Our aims were to examine the prevalence and genetic predictors of aspirin and clopidogrel high on-treatment platelet reactivity (HoTPR), and associated adverse cardiovascular outcomes in patients with peripheral arterial disease (PAD). BACKGROUND: The association of aspirin and clopidogrel HoTPR with outcomes in PAD remains unclear. METHODS: This is a prospective cohort study of patients with angiographically documented PAD involving carotid and lower extremity arteries...
February 7, 2018: Catheterization and Cardiovascular Interventions
Dagmar F Hernandez-Suarez, Hector Núñez-Medina, Stuart A Scott, Angel Lopez-Candales, Jose M Wiley, Mario J Garcia, Kyle Melin, Karid Nieves-Borrero, Christina Rodriguez-Ruiz, Lorraine Marshall, Jorge Duconge
BACKGROUND: Antiplatelet therapy with clopidogrel is recommended to reduce cardiovascular events in patients with peripheral artery disease (PAD); however, clopidogrel efficacy has not been adequately studied in this patient population. Therefore, we aimed to determine the effects of cilostazol therapy on platelet reactivity among PAD patients on clopidogrel. METHODS: We performed a cross-sectional pilot study of 46 Puerto Rican patients diagnosed with PAD. The cohort was divided based on use of clopidogrel and cilostazol (n=24) or clopidogrel alone (n=22)...
February 6, 2018: Drug Metabolism and Personalized Therapy
Stephane Fournier, Florine Guenat, Anne Fournier, Lorenzo Alberio, Olivier Bonny, Debora Bertaggia Calderara, Daniel Bardy, Nathalie Lauriers, Brahim Harbaoui, Pierre Monney, Patrizio Pascale, Eric Eeckhout, Olivier Muller
Aims: The circadian variation of platelet aggregation is well demonstrated. However, whether this has an impact on antiplatelet inhibition therapy is poorly documented. We aimed to observe whether ticagrelor-induced platelet inhibition follows a circadian rhythm. Methods and Results: The study included 25 healthy volunteers (11 female;14 male). Blood samples were collected every 4 hours. Ticagrelor was added in vitro at a concentration that provided 50% inhibition of the maximum response using the VerifyNow System Platelet Reactivity Test® thus avoiding any bias induced by circadian gastro-intestinal absorption...
January 23, 2018: European Heart Journal. Cardiovascular Pharmacotherapy
Angelika N Osińska, Beata Begier-Krasińska, Piotr Rzymski, Aleksandra Krasińska, Andrzej Tykarski, Zbigniew Krasiński
Introduction: Arterial hypertension (HT) is one of the most common diseases around the world and constitutes a significant medical, social, and economic problem. Lifestyle changes, including adequate fruit and vegetable consumption, play an important role in controlling blood pressure (BP) and other cardiovascular risk factors. Aim: To compare the influence of adding acetylsalicylic acid (ASA) or standardized tomato extract (STE) to standard hypotensive therapy on the values of arterial pressure and the daily blood pressure profiles of patients with hypertension and high cardiovascular risk...
December 2017: Kardiochirurgia i Torakochirurgia Polska, Polish Journal of Cardio-Thoracic Surgery
Leonardo C Clavijo, Ashwat Dhillon, Noor Al-Asady, Ray V Matthews, Jorge Caro, Han Tun, Vincent Rowe, David M Shavelle
OBJECTIVE: To investigate platelet reactivity in patients with critical limb ischemia (CLI) after switching from clopidogrel to ticagrelor. BACKGROUND: High on-treatment platelet reactivity (HPR) is highly prevalent in patients with CLI treated with clopidogrel. The effect of ticagrelor in patients with CLI is not known, however. METHODS: We performed P2Y12 platelet receptor inhibition studies (VASP and VerifyNow) in 50 patients with CLI. Tests were performed before and 6±1h after daily 75mg clopidogrel dose...
September 5, 2017: Cardiovascular Revascularization Medicine: Including Molecular Interventions
Grace Martin, Dhavan Shah, Nora Elson, Ryan Boudreau, Dennis Hanseman, Timothy A Pritts, Amy T Makley, Brandon Foreman, Michael D Goodman
BACKGROUND: Coagulopathy and platelet dysfunction commonly develop after traumatic brain injury (TBI). Thromboelastography (TEG) and platelet function assays (PFAs) are often performed at the time of admission; however, their roles in assessing post-TBI coagulopathy have not been investigated. We hypothesized that compared to blunt TBI, penetrating TBI would (1) demonstrate greater coagulopathy by TEG, (2) be associated with abnormal PFA results, and (3) require more blood product transfusions...
January 8, 2018: Neurocritical Care
Matthew B Maas, Andrew M Naidech, Minjee Kim, Ayush Batra, Edward M Manno, Farzaneh A Sorond, Shyam Prabhakaran, Eric M Liotta
OBJECTIVE: We evaluated whether reduced platelet activity detected by point-of-care (POC) testing is a better predictor of hematoma expansion and poor functional outcomes in patients with intracerebral hemorrhage (ICH) than a history of antiplatelet medication exposure. METHODS: Patients presenting with spontaneous ICH were enrolled in a prospective observational cohort study that collected demographic, clinical, laboratory, and radiographic data. We measured platelet activity using the PFA-100 (Siemens AG, Germany) and VerifyNow-ASA (Accumetrics, CA) systems on admission...
January 5, 2018: Journal of Stroke and Cerebrovascular Diseases: the Official Journal of National Stroke Association
Kate Navaratnam, Ana Alfirevic, Andrea Jorgensen, Zarko Alfirevic
OBJECTIVES: Low-dose aspirin is recommended for prevention of pre-eclampsia in high-risk pregnant women. Current doses provide a conservative risk reduction and some individuals demonstrate 'aspirin non-responsiveness', with insufficient antiplatelet effects. We aimed to determine if aspirin non-responsiveness could be identified in women at high risk of pre-eclampsia and assess for potential associations with placentally-mediated adverse outcomes. STUDY DESIGN: Prospective cohort study...
February 2018: European Journal of Obstetrics, Gynecology, and Reproductive Biology
Leonardo C Clavijo, Noor Al-Asady, Ashwat Dhillon, Ray V Matthews, Jorge Caro, Han Tun, Vincent Rowe, David M Shavelle
OBJECTIVES: The goal of this study is to establish the prevalence of high on-treatment platelet reactivity to aspirin (HPRA) and clopidogrel (HPRC) in patients with critical limb ischemia (CLI). BACKGROUND: CLI is associated with an increased risk of death and cardiovascular events. Unlike other patient populations with atherosclerotic cardiovascular disease, previous studies failed to demonstrate a benefit of antiplatelet therapy in patients with CLI. METHODS: From June 2014 to November 2016, we performed platelet reactivity studies for P2Y12 and thromboxane A2 (TXA2) inhibition in 100 CLI patients receiving daily treatment with aspirin and clopidogrel...
October 28, 2017: Cardiovascular Revascularization Medicine: Including Molecular Interventions
Patricia P Wadowski, Christoph W Kopp, Renate Koppensteiner, Irene M Lang, Joseph Pultar, Silvia Lee, Constantin Weikert, Simon Panzer, Thomas Gremmel
BACKGROUND: Anaemic patients undergoing angioplasty and stenting are at an increased risk of ischaemic events, which may be caused by an inadequate response to antiplatelet therapy with adenosine diphosphate (ADP) P2Y12 inhibitors. In the current study, we investigated the associations between anaemia and on-treatment platelet reactivity in clopidogrel-treated (group 1, n = 306) and prasugrel-/ticagrelor-treated (group 2, n = 109) patients undergoing elective and acute angioplasty with stent implantation, respectively...
January 2018: European Journal of Clinical Investigation
Andrew Yang, Quin Pon, Andrea Lavoie, Jennifer J Crawford, Sebastian Harenberg, Rodney H Zimmermann, Jeff Booker, Sheila Kelly, Shahar Lavi, Warren J Cantor, Shamir R Mehta, Akshay Bagai, Shaun G Goodman, Asim N Cheema, Payam Dehghani
The long-term pharmacodynamic effects of Ticagrelor versus Clopidogrel in patients undergoing early percutaneous coronary intervention (PCI) after fibrinolytic therapy is unknown. From May 2014 to August 2016, 212 patients undergoing PCI within 24 h of Tenecteplase (TNK), Aspirin, and Clopidogrel for ST-elevated myocardial infarction (STEMI) were randomized at four Canadian sites to receive additional Clopidogrel or Ticagrelor initiated prior to PCI. The platelet reactivity units (PRU) were measured with the VerifyNow Assay before study drug administration (baseline), at 4 and 24 h post PCI, and follow-up appointment...
February 2018: Journal of Thrombosis and Thrombolysis
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