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Clopidogrel aspirin

Aaron E Brice, Gabriel A Hernandez, Mariluz Sanchez, Marshall Haynick, Cesar E Mendoza
Dual antiplatelet therapy with aspirin and a P2Y12 receptor blocker has been proven to reduce subsequent cardiovascular events and in-stent thrombosis in patients undergoing percutaneous coronary intervention. Newer P2Y12 antagonists with faster onset and greater inhibition of platelet activity have improved cardiovascular outcomes but have created uncertainty with the appropriate dosing when switching between agents. Currently, there are no evidence-based guidelines to aid clinicians when switching between P2Y12 receptor blockers...
October 25, 2016: Platelets
Manasa Reddy, Bernard Tawfik, Chakri Gavva, Sean Yates, Nicole De Simone, Sandra L Hofmann, Siayareh Rambally, Ravi Sarode
Thrombosis is known to occur in patients with rare inherited bleeding disorders, usually in the presence of a thrombotic risk factor such as surgery and/or factor replacement therapy, but sometimes spontaneously. We present the case of a 72-year-old African American male diagnosed with congenital factor VII (FVII) deficiency after presenting with ischemic stroke, presumably embolic, in the setting of atherosclerotic carotid artery stenosis. The patient had an international normalized ratio (INR) of 2.0 at presentation, with FVII activity of 6% and normal Extem clotting time in rotational thromboelastometry...
October 17, 2016: Transfusion and Apheresis Science
Jamshed J Dalal, Aarti Digrajkar, Alap Gandhi
AIMS AND OBJECTIVES: Although clopidogrel combined with aspirin is the most commonly used dual drug combination to avert thrombotic events in patients with coronary artery disease, the poor responsiveness to clopidogrel remains a concern. The objective of the current study is to assess the extent of resistance to clopidogrel, prasugrel, and ticagrelor in a real life set of patients with coronary artery disease who underwent percutaneous coronary intervention (PCI). MATERIALS AND METHODS: A total of 539 patients, who underwent PCI and were on aspirin and on any of the three drugs, namely, clopidogrel, prasugrel and ticagrelor, were followed up regularly in the outpatient department...
September 2016: Indian Heart Journal
Andreas M Fichter, Lucas M Ritschl, Luisa K Robitzky, Stefan Wagenpfeil, David A Mitchell, Klaus-Dietrich Wolff, Thomas Mücke
The effects of antithrombotic drugs on random and free flap survival have been investigated in the past, but the experimental and clinical results are not in agreement. A perforator-based critical ischaemia model was used to evaluate the effects of different perioperatively administered pharmaceutical agents on tissue ischaemia and to assess the potential additional haemorheological or vasodilative effects of antithrombotics on flap microcirculation. Combined laser Doppler flowmetry and remission spectroscopy revealed an increase in certain microcirculation parameters in most groups in comparison with saline controls, and these changes correlated with flap survival...
October 21, 2016: Scientific Reports
Ren-Chieh Wu, Ping-Tse Chou, Li-Kuang Chen
BACKGROUND: Thrombosis and coagulopathy are the commonest hematological manifestations of envenomation of Russell's viper venom (RVV). Factor X is activated by a factor X-activating enzyme from Russell's viper venom (RVV-X) to start the coagulation cascade. We established an animal model with local ischemic effects induced by RVV. We tried to treat RVV envenomation with antiplatelets and anticoagulants without recourse to antivenom. METHODS: RVV was injected into the foot pad of mice...
2016: Thrombosis Journal
M Barburoglu, A Arat
BACKGROUND AND PURPOSE: There is very limited data concerning utilization of flow diverters in children. Our aim is to report results for the treatment of complex intracranial aneurysms and carotid cavernous fistulas by using flow diverters in children. MATERIALS AND METHODS: Retrospective review of children (17 years of age or younger) treated with flow diverters between May 2011 and July 2014 was performed. Clinical and laboratory data and angiographic findings were extracted...
October 20, 2016: AJNR. American Journal of Neuroradiology
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
Edem Efe, Ibrahim Kocayiğit, Pabuccu Mustafa Türker, Küçükukur Murat, Alpaslan Erkan, Taş Sedat, Çil Alper, Aksoy Murat Necati, Vural Mustafa Gökhan, Akdeniz Bahri
OBJECTIVES: Dual antiplatelet therapy (DAPT), consisting of clopidogrel and aspirin, is the main-stay treatment of acute coronary syndromes (ACS). However, major adverse cardiovascular events may occur even in patients undergoing DAPT, and this has been related to the variable pharmacodynamic efficacy of these drugs, especially clopidogrel. Platelet-to-lymphocyte ratio (PLR) and neutrophil-to-lymphocyte ratio (NLR) are novel inflammatory markers for cardiovascular risk stratification, which may reflect an inflammatory state and thus high on-treatment platelet reactivity (HPR)...
July 2016: Indian Journal of Pharmacology
Aung Myat, Udaya S Tantry, Jacek Kubica, Paul A Gurbel
Introduction A P2Y12 inhibitor plus aspirin is the most widely used antiplatelet strategy to prevent adverse outcomes in the setting of atherothrombotic vascular disease. Areas Covered A paucity of robust evidence for an optimal dose, gastrointestinal toxicity, ineffectiveness in high-risk patients and interactions with other antiplatelet agents, are major controversies associated with aspirin therapy. Ticagrelor is a reversibly binding oral P2Y12 receptor blocker that mediates potent inhibition of adenosine diphosphate-induced platelet function...
October 14, 2016: Expert Review of Cardiovascular Therapy
Yilun Zhou, Yuesong Pan, Yu Wu, Xingquan Zhao, Hao Li, David Wang, S Claiborne Johnston, Liping Liu, Chunxue Wang, Xia Meng, Yilong Wang, Yongjun Wang
BACKGROUND AND PURPOSE: Patients with chronic kidney disease (CKD) are at a particularly high risk for ischemic and bleeding events. Limited data exist as to the efficacy and safety of clopidogrel in stroke patients with renal dysfunction. Therefore, we sought to assess the impact of decreased kidney function on clinical outcomes for stroke patients on clopidogrel-aspirin treatment. METHODS: Patients in the CHANCE trial (Clopidogrel in High-Risk Patients With Acute Nondisabling Cerebrovascular Events) were randomized to clopidogrel-aspirin or aspirin-alone treatment...
October 13, 2016: Stroke; a Journal of Cerebral Circulation
Kimura Teruo, Adam Tucker, Toshihide Sugimura, Toshitaka Seki, Shin Fukuda, Satoru Takeuchi, Shiro Miyata, Tsutomu Fujita, Akira Hashizume, Naoto Izumi, Kazutsune Kawasaki, Makoto Katsuno, Masaaki Hashimoto, Kazuhiro Sako
BACKGROUND AND PURPOSE: The optimal use of antiplatelet therapy for intracranial branch atheromatous disease (BAD) is not known. METHODS: We conducted a prospective multicenter, single-group trial of 144 consecutive patients diagnosed with probable BAD. All patients were treated within 12 h of symptom onset to prevent clinical progression using dual antiplatelet therapy with cilostazol plus one oral antiplatelet drug (aspirin or clopidogrel). Endpoints of progressive BAD in the dual therapy group at 2 weeks were compared with a matched historical control group of 142 patients treated with single oral antiplatelet therapy using either cilostazol, aspirin, or clopidogrel...
October 12, 2016: Cerebrovascular Diseases Extra
Martin Jakl, Robert Sevcik, Ilona Fatorova, Jan M Horacek, Radek Pudil
OBJECTIVE: The aim of the present study was to assess long-term prognostic value of high on-treatment platelet reactivity (HTPR) in patients after acute myocardial infarction (MI) and its association with possible risk factors. METHODS: This prospective, case-control study was an observation of 198 patients who had acute MI. Response to aspirin and clopidogrel was assessed using impedance aggregometry. Patients were divided into groups of adequate response, dual poor responsiveness (DPR), poor responsiveness to aspirin (PRA), and poor responsiveness to clopidogrel (PRC)...
October 5, 2016: Anatolian 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
Mohamed Zaiou, Hamid El Amri
Cardiovascular disease (CVD) is the leading cause of death worldwide. The basic causes of CVD are not fully understood yet. Substantial evidence suggests that genetic predisposition plays a vital role in the physiopathology of this complex disease. Hence, identification of genetic contributors to CVD will likely add diagnostic accuracy and better prediction of an individual's risk. With high-throughput genetics and genomics technology and newer genome-wide study approaches, a number of genetic variations across the human genome were uncovered...
October 6, 2016: Clinical Genetics
Ana Lucrecia Marcano, José Luis Ferreiro
Dual therapy with a P2Y12 receptor antagonist in addition to aspirin is the antiplatelet treatment of choice in patients with acute coronary syndromes or undergoing percutaneous coronary intervention (PCI). However, available oral P2Y12 antagonists have several limitations, mostly due to their pharmacological profile, which can affect outcomes in certain clinical settings. Cangrelor is an intravenous, direct-acting, potent P2Y12 inhibitor with rapid onset and offset of action, which has been recently approved for clinical use in patients undergoing PCI...
November 2016: Current Atherosclerosis Reports
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
Benjamin Pradere, Benoit Peyronnet, Thomas Seisen, Zineddine Khene, Marina Ruggiero, Christophe Vaessen, Grégory Verhoest, Romain Mathieu, Morgan Roupret, Karim Bensalah
OBJECTIVE: To evaluate the impact of therapeutic anticoagulant or antiplatelet on the morbidity of robot assisted partial nephrectomy (RAPN). MATERIAL AND METHODS: From 2011 to 2015, we retrospectively analysed a prospectively maintained institutional review board-approved database of RAPN from two academic departments of urology. We evaluated the occurrence of overall complications and hemorrhagic complications (pseudoaneurysm, arterio- venous fistula, hematoma, transfusion)...
September 23, 2016: Urology
Alfi Yasmina, Anthonius de Boer, Vera H M Deneer, Patrick C Souverein, Olaf H Klungel
AIMS: To assess antiplatelet use patterns after a first myocardial infarction (MI) and to evaluate the determinants of antiplatelet non-persistence. METHODS: This study was conducted in 4,690 patients from the Utrecht Cardiovascular Pharmacogenetics cohort with first MI between 1986-2010, who were followed for a maximum of 10 years. Medication use and event diagnosis were obtained from the Dutch PHARMO Record Linkage System. Antiplatelet users were classified as persistent users (gap between prescriptions ≤ 90 days), non-persistent users (>90 days gap and no refills), and restarters (a new prescription after a > 90 days gap)...
September 23, 2016: British Journal of Clinical Pharmacology
S G Aoun, B G Welch, L G Pride, J White, R Novakovic, K Hoes, R Sarode
BACKGROUND: Stent-assisted coiling of intracranial aneurysms is an efficient alternative treatment to surgical clipping but requires prolonged antiplatelet therapy. Some patients are non-responsive to aspirin and/or clopidogrel. OBJECTIVE: To analyze the implications of this assessment using the 'whole blood aggregometry (WBA) by impedance' technique. MATERIALS AND METHODS: The Southwestern Tertiary Aneurysm Registry was reviewed between 2002 and 2012 for patients with unruptured aneurysms treated with stent-assisted coiling...
September 20, 2016: Journal of Neurointerventional Surgery
Jaya Chandrasekhar, Sameer Bansilal, Usman Baber, Samantha Sartori, Melissa Aquino, Serdar Farhan, Birgit Vogel, Michela Faggioni, Gennaro Giustino, Cono Ariti, Antonio Colombo, Alaide Chieffo, Annapoorna Kini, Richard Saporito, C Michael Gibson, Bernhard Witzenbichler, David Cohen, David Moliterno, Thomas Stuckey, Timothy Henry, Stuart Pocock, George Dangas, P Gabriel Steg, Roxana Mehran
BACKGROUND: Proton pump inhibitors (PPI) may decrease the availability of clopidogrel by competitive antagonism, leading to a potential increase in ischemic events. METHODS: We evaluated patients from the all-comer PARIS registry treated with dual antiplatelet therapy (DAPT) with aspirin and clopidogrel following coronary stenting for outcomes stratified by PPI use. Two-year major adverse cardiovascular events (MACE), composite of cardiac death, myocardial infarction, definite or probable stent thrombosis or target lesion revascularization (TLR), and net adverse cardiac events (NACE), composite of MACE or Bleeding Academic Research consortium (BARC) type 3 or 5 bleeding were assessed...
September 21, 2016: Catheterization and Cardiovascular Interventions
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