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dual antiplatelet and OAC

Erik W Holy, Julia Kebernik, Abdelhakim Allali, Mohamed El-Mawardy, Gert Richardt, Mohamed Abdel-Wahab
BACKGROUND: The choice of optimal antithrombotic regimen after transcatheter aortic valve replacement (TAVR) remains a matter of debate. The objective of this study was to compare both efficacy and safety outcomes based on the type of antithrombotic therapy prescribed after TAVR METHODS: This is a retrospective analysis of 514 consecutive patients treated with either dual antiplatelet therapy (DAPT) (n = 315; 61.3%) or oral anticoagulation (OAC) plus clopidogrel (n = 199; 38.7%) for a minimum of 3 month after TAVR followed by antiplatelet monotherapy or OAC only, respectively...
May 12, 2017: Cardiology Journal
Safi U Khan, Muhammad A Saleem, Amirahwaty Abdullah, Subash Ghimire, Manidhar Lekkala, Hammad Rahman, Ahmad N Lone, Edo Kaluski
BACKGROUND: Previous reports have been inconsistent in generating a consensus for optimal treatment strategy for patients with percutaneous coronary intervention (PCI) who also require oral anticoagulation (OAC). We conducted a traditional and network meta-analysis to evaluate the safety and efficacy of anti-thrombotic regimens in this subset of patients. METHODS: 30 articles were recovered through preferred reporting items for systematic reviews and meta-analyses (PRISMA) using MEDLINE, EMBASE and Cochrane Central Register of Controlled Clinical Trials (CENTRAL) from inception to December 2016...
April 22, 2017: Cardiovascular Revascularization Medicine: Including Molecular Interventions
John Jose, Dmitriy S Sulimov, Mohamed El-Mawardy, Takao Sato, Abdelhakim Allali, Erik W Holy, Björn Becker, Martin Landt, Julia Kebernik, Bettina Schwarz, Gert Richardt, Mohamed Abdel-Wahab
OBJECTIVES: The aim of this study was to determine the incidence, characteristics, and treatment outcomes of patients diagnosed with clinical transcatheter heart valve thrombosis. BACKGROUND: Limited data exists on clinical or manifest transcatheter heart valve thrombosis. Prior studies have focused on subclinical thrombosis. METHODS: A retrospective analysis was conducted of prospectively collected data from a single-center registry that included 642 consecutive patients who underwent transcatheter aortic valve replacement between 2007 and 2015 (305 patients had self-expanding valves; balloon-expandable, n = 281; mechanically expanding, n = 56)...
April 10, 2017: JACC. Cardiovascular Interventions
Andrea Rubboli, Francesco Saia, Alessandro Sciahbasi, Antonio M Leone, Cataldo Palmieri, Maria Letizia Bacchi-Reggiani, Paolo Calabrò, Barbara Bordoni, Giacomo Piccalò, Nicoletta Franco, Annamaria Nicolino, Paolo Magnavacchi, Luigi Vignali, Stefano Mameli, Michele Dallago, Stefano Maggiolini, Luigi Steffanon, Giancarlo Piovaccari, Giuseppe Di Pasquale
PURPOSE: To evaluate the outcome of patients with an established indication for oral anticoagulation (OAC) undergoing coronary stent implantation (PCI-S) and stratified by the baseline risk of bleeding. MATERIAL AND METHODS: The database of the prospective, multicentre, observational WAR-STENT registry ( identifier NCT00722319) was analyzed and patients with atrial fibrillation and CHA2DS2-VASc score ≥2, mechanical heart valve, prior cardiac embolism, intra-cardiac thrombus and recent venous thromboembolism who were treated with either triple (warfarin, aspirin and clopidogrel) or dual (warfarin and clopidogrel) or dual antiplatelet (aspirin and clopidogrel) therapy, identified...
March 19, 2017: Cardiovascular Revascularization Medicine: Including Molecular Interventions
Mikhail S Dzeshka, Richard A Brown, Davide Capodanno, Gregory Y H Lip
Stroke prevention is the main priority in the management cascade of atrial fibrillation. Most patients require long-term oral anticoagulation (OAC) and may require percutaneous coronary intervention. Prevention of recurrent cardiac ischemia and stent thrombosis necessitate dual antiplatelet therapy (DAPT) for up to 12 months. Triple antithrombotic therapy with OAC plus DAPT of shortest feasible duration is warranted, followed by dual antithrombotic therapy of OAC and antiplatelet agent, and OAC alone after 12 months...
January 2017: Interventional cardiology clinics
Lucia Barbieri, Monica Verdoia, Alon Schaffer, Harry Suryapranata, Giuseppe De Luca
BACKGROUND: Patients with coronary artery disease who undergo stent implantation and have concomitant indication for long-term oral anticoagulation represent a considerable proportion of the overall population. To date there is still no consensus about the optimal antithrombotic strategy to choose in this kind of patients, due to the difficult balance between an increased risk of bleeding and thromboembolic complications. Therefore, the aim of this study was to perform a meta-analysis to evaluate the risk and benefits of triple antithrombotic therapy versus dual antithrombotic therapy in patients undergoing coronary stent implantation, requiring long-term oral anticoagulation...
December 2016: Cardiovascular Drugs and Therapy
Charlotte H So, Mark H Eckman
The combined use of aspirin and oral anticoagulant therapy in patients with atrial fibrillation (AF) and stable coronary artery disease (CAD) has been questioned due to an increased risk of major bleeding with little to no benefit in preventing ischemic events. (1) To better understand patterns and indications for combined antiplatelet and anticoagulant therapy and identify patients who might reasonably be treated with oral anticoagulant (OAC) therapy alone. (2) To perform an updated literature review regarding the use of combined antiplatelet and OAC therapy in patients with AF and stable CAD...
January 2017: Journal of Thrombosis and Thrombolysis
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
Yong Cao, Xiao-Yan Tian, Ran Zhang, Jia-Qi Zhao, Meng Zhang, Yun-Tao Cheng, Chuan-Fang Li, Gen-Li Liu, Yi An
BACKGROUND: The optimal antithrombotic regimen after coronary stenting in patients taking oral anticoagulants (OACs) is still unclear. Therefore, this meta-analysis focused on the short- and long-term efficacy and safety of triple therapy (TT: OAC, aspirin, and thienopyridine) and dual therapy (DT: OAC plus single antiplatelet drug or aspirin plus thienopyridine). METHODS: We searched PubMed, Embase, the Cochrane Library, Wangfang database, and Google Scholar up to December 1, 2015 (January 1, 2000 - December 2015), from randomized and nonrandomized studies comparing TT and DT in patients with OACs undergoing drug-eluting stent (DES) implantation...
December 2016: International Journal of Clinical Pharmacology and Therapeutics
Mohan Palla, Alexandros Briasoulis, Ashok Kondur
BACKGROUND: In patients on oral anticoagulation (OAC), dual antiplatelet therapy (DAPT) is often indicated after percutaneous coronary intervention (PCI). AREAS OF UNCERTAINTY: We sought to investigate the effects of triple antithrombotic therapy (TT) versus dual therapy (DT) with OAC and clopidogrel on all-cause mortality, cardiovascular death, major bleeding, myocardial infarction (MI), stroke, and stent thrombosis. DATA SOURCES: We systematically searched on MEDLINE, EMBASE, and CENTRAL for randomized controlled or cohort studies, which investigated the comparative effects of TT versus DT...
June 23, 2016: American Journal of Therapeutics
Nikolaos A Magkoutis, Sabi Fradi, Alexandre Azmoun, Ramsi Ramadan, Sami Ben Ouanes, Manolis Vavuranakis, Dimitrios A Vrachatis, Theodore G Papaioannou, Dimitrios Tousoulis, Saïd Ghostine
Transcatheter aortic valve implantation (TAVI) is all the more used therapeutic option for patients suffering from symptomatic severe aortic valvular stenosis declined by surgeons because of high surgical risk. Given the high bleeding and ischemic risk of this vulnerable population, their antithrombotic treatment becomes a crucial issue. There is no consensus on antithrombotic treatment after TAVI and dual antiplatelet therapy (DAPT) with aspirin (indefinitely) and clopidogrel (1-6 months) is, in general, recommended...
2016: Current Pharmaceutical Design
Renato D Lopes, Meena Rao, DaJuanicia N Simon, Laine Thomas, Jack Ansell, Gregg C Fonarow, Bernard J Gersh, Alan S Go, Elaine M Hylek, Peter Kowey, Jonathan P Piccini, Daniel E Singer, Paul Chang, Eric D Peterson, Kenneth W Mahaffey
BACKGROUND: The role of triple antithrombotic therapy vs dual antithrombotic therapy in patients with both atrial fibrillation and coronary artery disease remains unclear. This study explores the differences in treatment practices and outcomes between triple antithrombotic therapy and dual antithrombotic therapy in patients with atrial fibrillation and coronary artery disease. METHODS: Using the Outcomes Registry for Better Informed Treatment of Atrial Fibrillation (n = 10,135), we analyzed outcomes in patients with coronary artery disease (n = 1827) according to treatment with triple antithrombotic therapy (defined as concurrent therapy with an oral anticoagulant, a thienopyridine, and aspirin) or dual antithrombotic therapy (comprising either an oral anticoagulant and one antiplatelet agent [OAC plus AA] or 2 antiplatelet drugs and no anticoagulant [DAP])...
June 2016: American Journal of Medicine
Shinya Suzuki, Takayuki Otsuka, Koichi Sagara, Hiroaki Semba, Hiroto Kano, Shunsuke Matsuno, Hideaki Takai, Yuko Kato, Tokuhisa Uejima, Yuji Oikawa, Kazuyuki Nagashima, Hajime Kirigaya, Takashi Kunihara, Junji Yajima, Hitoshi Sawada, Tadanori Aizawa, Takeshi Yamashita
BACKGROUND: Trends of oral anticoagulant (OAC) prescription and incidence of thromboembolism (TE) and/or major bleeding (MB) in patients with non-valvular atrial fibrillation (NVAF) in Japan are still unclear. METHODS AND RESULTS: We used data from Shinken Database 2004-2012, which included all new patients attending the Cardiovascular Institute between June 2004 and March 2013. Of them, 2,434 patients were diagnosed with NVAF. Patients were divided into 3 time periods according to the year of initial visit: 2004-2006 (n=681), 2007-2009 (n=833), and 2010-2012 (n=920)...
2016: Circulation Journal: Official Journal of the Japanese Circulation Society
Giuseppe Cocco, Philpp Amiet, Paul Jerie
Oral anticoagulation (OAC) is highly effective for stroke prevention in high-risk-patients with atrial fibrillation (AF). AF is also a risk for dementia, and effective OAC reduces the risk of dementia. Up to 30% of patients with AF have a coronary artery disease and antiplatelets are used to avoid thrombotic complications. Patients with AF often have an acute coronary syndrome (ACS) and undergo a percutaneous intervention with stent-implantation. These patients require a triple therapy, i.e. the combination of OAC with dual-antiplatelet therapy...
2016: Cardiology Journal
Renato De Vecchis, Claudio Cantatrione, Damiana Mazzei
BACKGROUND: Chronic atrial fibrillation (AF), coexisting with a history of recent coronary angioplasty with stent (PCI-S), represents an encoded indication for oral anticoagulation (OAC) with warfarin plus dual antiplatelet therapy (DAPT). METHODS: Using a retrospective cohort study, we determined the respective impacts on cardiovascular outcomes of three different pharmacologic regimens, i.e., triple therapy (TT) with warfarin + clopidogrel and aspirin, dual therapy (DT) with warfarin + clopidogrel or aspirin, and DAPT with clopidogrel + aspirin...
February 2016: Journal of Clinical Medicine Research
Alexandros Briasoulis, Nikolaos Papageorgiou, Efimia Zacharia, Mohan Palla, Mohamad Darwich El Abdallah, Emmanuel Androulakis, Dimitris Tousoulis
BACKGROUND: The combined use of dual antiplatelet therapy with oral anticoagulation (OAC) is required after coronary artery stenting or acute coronary syndromes (ACS). METHODS AND RESULTS: We performed a meta-analysis (Embase and MEDLINE search) of the comparative effects of triple antithrombotic therapy (TT) versus OAC with single antiplatelet therapy (dual therapy [DT]) on all-cause mortality, stroke, cardiovascular death, myocardial infarction (MI), target vessel revascularization, and major bleeding...
April 2016: American Journal of Cardiovascular Drugs: Drugs, Devices, and Other Interventions
Naoual Bennaghmouch, Willem J M Dewilde, Jurrien M ten Berg
PURPOSE OF REVIEW: Patients with atrial fibrillation undergoing percutaneous coronary intervention (PCI) require treatment with oral anticoagulation (OAC) and additional dual antiplatelet therapy with aspirin and clopidogrel (DAPT), i.e. triple therapy. However, triple therapy produces a high annual bleeding risk outweighing the benefits. To improve safety of antithrombotic treatment in these patients, the risks and benefits of all possible treatment options should be evaluated. This review provides an overview of current guidelines and new evidence for optimizing treatment of atrial fibrillation patients with an indication for combined treatment with OAC and DAPT...
November 2015: Current Opinion in Cardiology
Giuseppe Gargiulo, Jean-Philippe Collet, Marco Valgimigli
The clinical and demographic characteristics of patients undergoing TAVI pose unique challenges for developing and implementing optimal antithrombotic therapy. Ischaemic and bleeding events in the periprocedural period and months after TAVI still remain a relevant concern to be faced with optimised antithrombotic therapy. Moreover, the antiplatelet and anticoagulant pharmacopeia has evolved significantly in recent years with new drugs and multiple possible combinations. Dual antiplatelet therapy (DAPT) is currently recommended after TAVI with oral anticoagulation (OAC) restricted for specific indications...
September 2015: EuroIntervention
Chao-Feng Chen, Bin Chen, Jue Zhu, Yi-Zhou Xu
AIM: The aim of this meta-analysis was to evaluate the benefits and risks of triple therapy (TT) compared with dual therapy (DT) for patients with an indication for anticoagulation who had undergone percutaneous coronary intervention. BACKGROUND: An increasing number of patients undergoing percutaneous coronary intervention have atrial fibrillation or other indications for oral anticoagulants. For these patients, TT (oral anticoagulants plus aspirin and clopidogrel) is indicated, but this type of treatment increases the risk of bleeding...
December 2015: Herz
Andrea Rubboli, Stefan Agewall, Kurt Huber, Gregory Y H Lip
The antithrombotic management of patients on oral anticoagulation (OAC), with either warfarin or non-vitamin K-antagonist oral anticoagulants (NOACs), undergoing percutaneous coronary intervention with stent (PCI-S) has been recently addressed in a joint European consensus document. In accordance, triple therapy (TT) of OAC, aspirin and clopidogrel should generally be given as the initial therapy. More uncertainty exists over whether warfarin or a NOAC should be added in patients already on dual antiplatelet therapy of aspirin and clopidogrel (DAPT) after recent PCI-S...
October 1, 2015: International Journal of Cardiology
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