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dual antiplatelet

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https://www.readbyqxmd.com/read/28810280/-dual-antiplatelet-therapy-in-the-perioperative-period-to%C3%A2-continue-or-discontinue-treatment
#1
Jürgen Koscielny, Christian von Heymann, Uwe Zeymer, Jochen Cremer, Michael Spannagl, Joachim Labenz, Evangelos Giannitsis, Franz Goss
Background For secondary prevention of acute coronary syndrome, guidelines recommend dual antiplatelet therapy (DAPT) with acetylsalicylic acid and a P2Y12 receptor antagonist such as clopidogrel, prasugrel or ticagrelor for a period of 12 months. Often, uncertainty exists with respect to surgical or diagnostic procedures in these high-risk patients: can the DAPT be continued without interruption? If not, what is the recommended withdrawal strategy? What should be considered for the perioperative management? Methods An interdisciplinary group of experienced experts in the fields of cardiology, cardiac surgery, gastroenterology, anaesthesiology, intensive care and haemostaseology developed recommendations relevant to daily clinical practice based on the current scientific evidence...
August 2017: Deutsche Medizinische Wochenschrift
https://www.readbyqxmd.com/read/28807407/infrarenal-aorta-as-the-donor-site-for-bypasses-to-the-superior-mesenteric-artery-for-chronic-mesenteric-ischemia-a-prospective-clinical-series-of-24-patients
#2
Giulio Illuminati, Giulia Pizzardi, Francesco G Calio', Rocco Pasqua, Federica Masci, Francesco Vietri
BACKGROUND: Treatment of symptomatic, chronic mesenteric ischemia is indicated to relieve symptoms and prevent acute ischemia and death. Current therapeutic options include endovascular and open surgery. The purpose of this prospective study was to evaluate the results of bypasses to the superior mesenteric artery arising from the infrarenal aorta or infrarenal aortic grafts. METHODS: From January 1999 to December 2016, 24 consecutive patients with a mean age of 61 years underwent a prosthetic bypass to the superior mesenteric artery...
August 11, 2017: Surgery
https://www.readbyqxmd.com/read/28806755/acquired-von-willebrand-syndrome-in-cardiogenic-shock-patients-on-mechanical-circulatory-microaxial-pump-support
#3
Ulrike Flierl, Jörn Tongers, Dominik Berliner, Jan-Thorben Sieweke, Florian Zauner, Christoph Wingert, Christian Riehle, Johann Bauersachs, Andreas Schäfer
Early use of mechanical circulatory support, e.g. veno-arterial extracorporeal membrane oxygenation (ECMO) or left ventricular unloading by microaxial pump in refractory cardiogenic shock is recommended in current guidelines. Development of acquired von Willebrand Syndrome (AVWS) in patients with left ventricular assist devices (LVADs) and ECMO has been reported. There is an increasing number of patients treated with the Impella® CP microaxial pump for left ventricular unloading. However, the prevalence of AVWS in these high risk patients is unknown and needs to be determined...
2017: PloS One
https://www.readbyqxmd.com/read/28806270/new-clinical-paradigms-for-treating-and-preventing-antiplatelet-gastrointestinal-bleeding
#4
Neena S Abraham
PURPOSE OF REVIEW: To quantify antiplatelet-related gastrointestinal bleeding (GIB), characterize patients at greatest risk and summarize risk-management strategies emphasizing evolving knowledge in acute management of antiplatelet-related bleeding. RECENT FINDINGS: New paradigms for acute management of antiplatelet-related GIB exist in the domains of resuscitation and the transfusion of blood products, strategic use of proton pump therapy and identification and eradication of Helicobacter pylori...
August 12, 2017: Current Opinion in Gastroenterology
https://www.readbyqxmd.com/read/28806186/the-impact-of-cyp2c19-2-cyp4f2-3-and-clinical-factors-on-platelet-aggregation-cyp4f2-enzyme-activity-and-20-hydroxyeicosatetraenoic-acid-concentration-in-patients-treated-with-dual-antiplatelet-therapy
#5
Vacis Tatarunas, Nora Kupstyte, Agne Giedraitiene, Vilius Skipskis, Valdas Jakstas, Vaidotas Zvikas, Vaiva Lesauskaite
: The aim of the current study was to evaluate the impact of CYP2C192 (rs4244285), CYP4F23 (rs2108622), and nongenetic factors on platelet aggregation and to investigate the mechanism of CYP4F2's effect on platelet aggregation in the patients treated with dual antiplatelet therapy. A total of 146 patients were included in this study. Ticagrelor or clopidogrel were administered in a loading dose of 180 mg and 600 mg, respectively, in combination with aspirin (300 mg). Blood samples for analysis were taken the next morning after antiplatelet therapy induction...
August 12, 2017: Blood Coagulation & Fibrinolysis: An International Journal in Haemostasis and Thrombosis
https://www.readbyqxmd.com/read/28798016/bayesian-analysis-a-practical-approach-to-interpret-clinical-trials-and-create-clinical-practice-guidelines
#6
John A Bittl, Yulei He
Bayesian analysis is firmly grounded in the science of probability and has been increasingly supplementing or replacing traditional approaches based on P values. In this review, we present gradually more complex examples, along with programming code and data sets, to show how Bayesian analysis takes evidence from randomized clinical trials to update what is already known about specific treatments in cardiovascular medicine. In the example of revascularization choices for diabetic patients who have multivessel coronary artery disease, we combine the results of the FREEDOM trial (Future Revascularization Evaluation in Patients with Diabetes Mellitus: Optimal Management of Multivessel Disease) with prior probability distributions to show how strongly we should believe in the new Class I recommendation ("should be done") for a preference of bypass surgery over percutaneous coronary intervention...
August 2017: Circulation. Cardiovascular Quality and Outcomes
https://www.readbyqxmd.com/read/28792139/sarpogrelate-based-triple-antiplatelet-therapy-improved-left-ventricular-systolic-function-in-acute-myocardial-infarction-retrospective-study
#7
Jae Hyuk Choi, Jung Rae Cho, Sang Min Park, Kunal Bikram Shaha, Floyd Pierres, Tserendavaa Sumiya, Kwang Jin Chun, Min Kyung Kang, Seonghoon Choi, Namho Lee
PURPOSE: The purpose of this study was to assess the potential benefit of a 5-hydroxytryptamine receptor antagonist, sarpogrelate-based triple antiplatelet therapy (TAPT) in comparison with dual antiplatelet therapy (DAPT) in patients undergoing primary percutaneous coronary intervention (PCI) for ST-elevation myocardial infarction (STEMI). MATERIALS AND METHODS: 119 patients of STEMI were retrospectively assessed. All patients received aspirin and clopidogrel per standard of care...
September 2017: Yonsei Medical Journal
https://www.readbyqxmd.com/read/28783201/validation-of-the-dapt-score-in-patients-randomized-to-6-or-12-months-clopidogrel-after-predominantly-second-generation-drug-eluting-stents
#8
Yukinori Harada, Jonathan Michel, Raphaela Lohaus, Katharina Mayer, Roberto Emmer, Anna Lena Lahmann, Roisin Colleran, Daniele Giacoppo, Annabelle Wolk, Jurrien M Ten Berg, Franz-Josef Neumann, Yaling Han, Tom Adriaenssens, Ralph Tölg, Melchior Seyfarth, Michael Maeng, Bernhard Zrenner, Claudius Jacobshagen, Jochen Wöhrle, Sebastian Kufner, Tanja Morath, Tareq Ibrahim, Isabell Bernlochner, Marcus Fischer, Heribert Schunkert, Karl-Ludwig Laugwitz, Julinda Mehilli, Robert A Byrne, Adnan Kastrati, Stefanie Schulz-Schüpke
The DAPT score is a recently-proposed decision tool for guiding optimal duration of dual antiplatelet therapy (DAPT). It showed modest accuracy in prior derivation and validation cohorts of patients with ≥12 months DAPT. This study was aimed to evaluate the validity of the DAPT score in a cohort of patients with 6 or 12 months DAPT after implantation of predominantly second-generation drug-eluting stents. We analyzed data of patients enrolled in the ISAR-SAFE trial. Patients were classified into low (<2) or high (≥2) DAPT score groups...
July 27, 2017: Thrombosis and Haemostasis
https://www.readbyqxmd.com/read/28781242/outcome-of-percutaneous-coronary-intervention-with-the-absorb-bioresorbable-scaffold-data-from-the-swedish-coronary-angiography-and-angioplasty-registry-scaar
#9
Per Grimfjärd, Stefan James, Jonas Persson, Oskar Angerås, Sasha Koul, Elmir Omerovic, Christoph Varenhorst, Bo Lagerqvist, David Erlinge
AIMS: Randomised trials indicate higher rates of stent thrombosis (ST) and target lesion failure (TLF) after percutaneous coronary intervention (PCI) with the Absorb bioresorbable scaffold (BRS) compared with modern drug eluting stents (DES). We aimed to investigate the outcome of all Swedish patients treated with the Absorb BRS. METHODS AND RESULTS: Absorb BRS (n=810) was compared with commonly used modern DES (n=67,099). Main outcome measure was definite ST, mean follow-up was 2 years...
August 8, 2017: EuroIntervention
https://www.readbyqxmd.com/read/28780575/subclinical-leaflet-thrombosis-after-transcatheter-aortic-valve-implantation
#10
REVIEW
Satoshi Nakatani
Although clinically significant valve thrombosis after transcatheter aortic valve implantation (TAVI) is rare, the incidence of subclinical leaflet thrombosis has been reported to be up to about 10%-15%. It is mostly found 1-3 months after procedure in any type of transcatheter heart valve. Leaflet thrombosis is detected by high-resolution CT in the form of limited valve opening/closure and hypoattenuated leaflet thickening. Transthoracic or transesophageal echocardiography is capable of detecting limitations of valve motion, leaflet thickening, increased flow velocity across the valve...
August 5, 2017: Heart: Official Journal of the British Cardiac Society
https://www.readbyqxmd.com/read/28780077/individualized-antiplatelet-therapy-after-drug-eluting-stent-deployment-implication-of-clinical-trials-of-different-durations-of-dual-antiplatelet-therapy
#11
REVIEW
Masato Nakamura, Norihiro Kougame, Raisuke Iijima, Tsuyoshi Ono, Nobutaka Ikeda, Masahide Tokue, Fumiyuki Hayashi, Mami Watanabe, Hiroki Takenaka, Ryo Fukui, Hidehiko Hara
At present, there is consensus that prolonged dual antiplatelet therapy (DAPT) is effective to reduce cardiovascular events at the expense of bleeding complication events. A causal relationship of prolonged DAPT with an increase in mortality remains debatable, however, it appears to be obvious that bleeding complications are associated with an increase in cardiac events. Thus, individualized optimal DAPT duration balancing the risk and benefit of DAPT should be applied. In addition, strategy to minimize bleeding complications is highly recommended...
August 2, 2017: Journal of Cardiology
https://www.readbyqxmd.com/read/28780034/impact-of-aspirin-and-clopidogrel-hyporesponsiveness-in-patients-treated%C3%A2-with-drug-eluting-stents-2-year-results-of-a-prospective-multicenter-registry-study
#12
Thomas D Stuckey, Ajay J Kirtane, Bruce R Brodie, Bernhard Witzenbichler, Claire Litherland, Giora Weisz, Michael J Rinaldi, Franz-Josef Neumann, D Christopher Metzger, Timothy D Henry, David A Cox, Peter L Duffy, Ernest L Mazzaferri, Paul A Gurbel, Roxana Mehran, Philippe Généreux, Ori Ben-Yehuda, Charles A Simonton, Gregg W Stone
OBJECTIVES: In this analysis of 2-year outcomes in the ADAPT-DES (Assessment of Dual AntiPlatelet Therapy with Drug-Eluting Stents) study, the authors sought to examine the independent associations between platelet reactivity to both aspirin and clopidogrel and subsequent outcomes. BACKGROUND: The relationship between platelet reactivity and long-term adverse events following implantation of drug-eluting stents (DES) has been incompletely characterized. METHODS: The ADAPT-DES study was a multicenter registry of patients undergoing routine platelet function testing following percutaneous coronary intervention with DES...
July 27, 2017: JACC. Cardiovascular Interventions
https://www.readbyqxmd.com/read/28776542/effect-of-dialysis-on-antiplatelet-drug-efficacy-in-uremic-patients-with-coronary-heart-disease
#13
Dong-Liang Fu, Ting-Ting Zhao, Wen-Hua Peng, Peng Yang, Xiao-Fei Liu, Hu Zhang, Xian-Lun Li, Yong Wang, Jin-Gang Zheng, Yan-Xiang Gao, Hong-Kai Lu, Qi Wang
BACKGROUND: Coronary intervention therapy is the main treatment for uremic patients with coronary heart disease. The studies on whether dialysis reduces the efficacy of dual antiplatelet drugs are limited. The aim of this study was to examine the effect of dialysis on antiplatelet drugs in uremic patients with coronary heart disease. METHODS: This study included 26 uremic patients who had undergone percutaneous coronary intervention in China-Japan Friendship Hospital from November 2015 to May 2017...
August 20, 2017: Chinese Medical Journal
https://www.readbyqxmd.com/read/28776172/optimization-of-antiplatelet-therapy-in-stemi
#14
REVIEW
Abhishek Sinha, Kush Agrawal, Rahul Sakhuja
Antiplatelet therapy is an essential component of ST elevation myocardial infarction (STEMI) management. Dual antiplatelet therapy (DAPT) with aspirin and clopidogrel has previously been the standard of care for STEMI management, but the advent of newer, more potent P2Y12 inhibitors has expanded the options for the management of STEMI. As compared with clopidogrel, these newer P2Y12 agents-such as prasugrel and ticagrelor-allow for further reductions in ischemic end points, without the robust increases in bleeding seen in previous studies of antithrombotic therapies...
August 2017: Current Treatment Options in Cardiovascular Medicine
https://www.readbyqxmd.com/read/28768756/impact-of-timing-on-the-functional-recovery-achieved-with-platelet-supplementation-after-treatment-with-ticagrelor
#15
M Urooj Zafar, Donald A Smith, Usman Baber, Samantha Sartori, Kevin Chen, David W Lam, Carlos A Linares-Koloffon, Juan Rey-Mendoza, Gustavo Jimenez Britez, Gines Escolar, Valentin Fuster, Juan J Badimon
BACKGROUND: American College of Cardiology/American Heart Association guidelines advise waiting 5 to 7 days before operating on P2Y12 inhibitor-treated acute coronary syndrome patients, to allow dissipation of its antiplatelet effects. Platelet transfusion is often used to restore hemostasis during operations, but its effectiveness and optimal timing are unclear. We investigated the degree of functional gains obtained from platelet supplementation after loading and maintenance of dual antiplatelet therapy with ticagrelor and the influence of timing on this strategy...
August 2017: Circulation. Cardiovascular Interventions
https://www.readbyqxmd.com/read/28766881/angiographic-and-clinical-performance-of-polymer-free-biolimus-eluting-stent-in-patients-with-st-segment-elevation-acute-myocardial-infarction-in-a-metropolitan-public-hospital-the-besami-mucho-study
#16
Gregory A Sgueglia, Fabrizio D'Errico, Gaetano Gioffrè, Antonella De Santis, Francesco Summaria, Fabiana Piccioni, Achille Gaspardone
OBJECTIVES: This study aimed at assessing the performance of a new generation polymer-free biolimus-eluting stent (BES) in real-world patients with ST-segment elevation myocardial infarction (STEMI). BACKGROUND: Polymers components of early-generation drug-eluting stents have been implicated in the pathogenesis of delayed arterial healing, vessel remodeling, and delayed stent thrombosis. Recently, a novel polymer-free BES has shown excellent clinical performance in clinical trial setting...
August 2, 2017: Catheterization and Cardiovascular Interventions
https://www.readbyqxmd.com/read/28765738/baseline-characteristics-of-a-retrospective-patient-cohort-in-the-korean-vascular-intervention-society-endovascular-therapy-in-lower-limb-artery-diseases-k-vis-ella-registry
#17
Young-Guk Ko, Chul-Min Ahn, Pil-Ki Min, Jae-Hwan Lee, Chang-Hwan Yoon, Cheol Woong Yu, Seung Whan Lee, Sang-Rok Lee, Seung Hyuk Choi, Yoon Seok Koh, In-Ho Chae, Donghoon Choi
BACKGROUND AND OBJECTIVES: The Korean Vascular Intervention Society Endovascular Therapy in Lower Limb Artery Diseases (K-VIS ELLA) Registry is a multicenter observational study with retrospective and prospective cohorts of patients with lower extremity peripheral artery disease (PAD) undergoing endovascular treatment. In this study, we report the baseline characteristics of this retrospective cohort. SUBJECTS AND METHODS: In the present study we analyzed datasets of 3073 patients with 3972 target limbs from a retrospective cohort treated with endovascular therapy in 31 Korean hospitals...
July 2017: Korean Circulation Journal
https://www.readbyqxmd.com/read/28764572/individualizing-dual-antiplatelet-therapy-duration-after-percutaneous-coronary-intervention-from-randomized-control-trials-to-personalized-medicine
#18
Usman A Tahir, Robert W Yeh
Improved stent technologies have lead to reduced minimum durations of dual antiplatelet therapy (DAPT) to prevent stent thrombosis. However, the anti-ischemic benefits seen in extended DAPT in both stent and non-stent related lesions have called into question the optimum duration of DAPT after stent placement. Areas covered: We review the evidence for varying durations of DAPT after drug eluting stent placement including for patients on oral anticoagulation; decision tools available for clinicians to optimize patient selection for extended therapy and insight into application of these risk assessment tools in clinical practice...
August 2, 2017: Expert Review of Cardiovascular Therapy
https://www.readbyqxmd.com/read/28762022/optimal-duration-of-dual-antiplatelet-therapy-after-percutaneous-coronary-intervention-or-after-acute-coronary-syndrome-practical-lessons-from-a%C3%A2-review
#19
REVIEW
J M Ten Berg, B Zwart, A W J van 't Hof, A Liem, J Waltenberger, R J de Winter, J W Jukema
To prevent recurrent ischaemic events, dual antiplatelet therapy (DAPT) is the standard of care after percutaneous coronary intervention and in the treatment of acute coronary syndrome. Recent evidence supports an adjusted DAPT duration in selected patients.The current paper aims to encourage cardiologists to actively search for patients benefiting from either shorter or prolonged duration DAPT and proposes an algorithm to identify patients who are likely to benefit from such an alternative strategy.Individualised DAPT duration should be considered in high-risk anatomic and/or clinical subgroups or in patients at increased haemorrhagic risk with low ischaemic risk...
July 31, 2017: Netherlands Heart Journal
https://www.readbyqxmd.com/read/28761685/two-year-clinical-outcomes-of-patients-treated-with-the-dual-therapy-stent-in-a-1000-patient-all-comers-registry
#20
Deborah N Kalkman, Pier Woudstra, Ian B A Menown, Peter den Heijer, Arnoud Wj Van't Hof, Andrejs Erglis, Harry Suryapranata, Karin E Arkenbout, Andrés Iñiguez, Philippe Muller, Jan G Tijssen, Marcel A M Beijk, Robbert J de Winter
OBJECTIVE: The dual-therapy stent combines an abluminal biodegradable drug-eluting coating, with a 'pro-healing' luminal layer. This bioengineered layer attracts circulating endothelial progenitor cells that can differentiate into normal endothelium. Rapid endothelialisation of the stent might allow safe short dual antiplatelet therapy. We aim to assess clinical outcomes in patients treated with this novel device at 2-year follow-up. METHODS: A total of 1000 patients were included in the REMEDEE Registry to evaluate clinical outcomes after treatment with the dual-therapy stent...
2017: Open Heart
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