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https://www.readbyqxmd.com/read/27922911/meta-analysis-of-comparison-of-the-newer-p2y12-inhibitors-oral-preparation-or-intravenous-to-clopidogrel-in-patients-with-acute-coronary-syndrome
#1
Lu Zhang, Jun Lu, Weihua Dong, Huiping Tian, Weiyi Feng, Haisheng You, Hairong He, Jing Ma, Yalin Dong
AIMS: New P2Y12 adenosine diphosphate receptor antagonist that has been used in the treatment of acute coronary syndrome (ACS) with mixed results. This systematic review analyzed and compared the evidence from large, clinical trials regarding the efficacy of clopidogrel relative to that of cangrelor, prasugrel, and ticagrelor in reducing the incidence of cardiovascular events in patients with ACS. METHODS AND RESULTS: This analysis of the findings for comparing newer P2Y12 inhibitors with clopidogrel of 13 clinical trials involving a total of 87,985 patients with ACS ...
November 29, 2016: Journal of Cardiovascular Pharmacology
https://www.readbyqxmd.com/read/27920074/a-critical-appraisal-of-aspirin-in-secondary-prevention-is-less-more
#2
Giuseppe Gargiulo, Stephan Windecker, Pascal Vranckx, Charles Michael Gibson, Roxana Mehran, Marco Valgimigli
Aspirin represents the sine qua non for antiplatelet pharmacotherapy in patients with cardiovascular diseases because of its well-established role in secondary prevention and its widespread availability and affordability. Historical studies, conducted in an era that bears little resemblance to contemporary clinical practice, demonstrated large reductions in thrombotic risk when aspirin was compared with placebo, thus forming the evidence base promulgated in practice guidelines and recommendations. P2Y12 inhibitors have mostly been studied in addition to aspirin; dual-antiplatelet therapy proved superiority compared with aspirin monotherapy for the prevention of ischemic events, despite increased bleeding risks...
December 6, 2016: Circulation
https://www.readbyqxmd.com/read/27914836/perioperative-retinal-artery-occlusion-risk-factors-in-cardiac-surgery-from-the-united-states-national-inpatient-sample-1998-2013
#3
Tyler Calway, Daniel S Rubin, Heather E Moss, Charlotte E Joslin, Katharina Beckmann, Steven Roth
PURPOSE: To study the incidence and risk factors for retinal artery occlusion (RAO) in cardiac surgery. DESIGN: Retrospective study using the National Inpatient Sample (NIS). METHODS: The NIS was searched for cardiac surgery. Retinal artery occlusion was identified by International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM) codes. Postulated risk factors based on literature review were included in multivariate logistic models...
November 30, 2016: Ophthalmology
https://www.readbyqxmd.com/read/27914488/safety-of-6-month-duration-of-dual-antiplatelet-therapy-after-percutaneous-coronary-intervention-in-patients-with-acute-coronary-syndromes-rationale-and-design-of-the-smart-angioplasty-research-team-safety-of-6-month-duration-of-dual-antiplatelet-therapy-after
#4
Joo Myung Lee, Deok-Kyu Cho, Joo-Yong Hahn, Young Bin Song, Taek Kyu Park, Ju-Hyeon Oh, Jin Bae Lee, Joon-Hyung Doh, Sang-Hyun Kim, Jeong Hoon Yang, Jin-Ho Choi, Seung-Hyuck Choi, Sang Hoon Lee, Hyeon-Cheol Gwon
BACKGROUND AND RATIONALE: Dual antiplatelet therapy (DAPT) is a fundamental treatment that optimizes clinical outcomes after percutaneous coronary intervention, especially in patients with acute coronary syndrome (ACS). Although current international guidelines recommend DAPT for at least 12 months after implantation of a drug-eluting stent in patients with ACS, these recommendations are not based on randomized controlled trials dedicated to ACS population. STUDY DESIGN: The SMART-DATE trial is a prospective, multicenter, randomized, and open-label study to demonstrate the noninferiority of 6-month DAPT compared with 12 months or longer DAPT in patients with ACS undergoing percutaneous coronary intervention...
December 2016: American Heart Journal
https://www.readbyqxmd.com/read/27904903/prediction-of-severe-bleeding-after-coronary-surgery-the-will-bleed-risk-score
#5
Fausto Biancari, Debora Brascia, Francesco Onorati, Daniel Reichart, Andrea Perrotti, Vito G Ruggieri, Giuseppe Santarpino, Daniele Maselli, Giovanni Mariscalco, Riccardo Gherli, Antonino S Rubino, Marisa De Feo, Giuseppe Gatti, Francesco Santini, Magnus Dalén, Matteo Saccocci, Eeva-Maija Kinnunen, Juhani K E Airaksinen, Paola D'Errigo, Stefano Rosato, Francesco Nicolini
Severe perioperative bleeding after coronary artery bypass grafting (CABG) is associated with poor outcome. An additive score for prediction of severe bleeding was derived (n=2494) and validated (n=1250) in patients from the E-CABG registry. Severe bleeding was defined as E-CABG bleeding grades 2-3 (transfusion of >4 units of red blood cells or reoperation for bleeding). The overall incidence of severe bleeding was 6.4 %. Preoperative anaemia (3 points), female gender (2 points), eGFR <45 ml/min/1.73 m(2) (3 points), potent antiplatelet drugs discontinued less than five days (2 points), critical preoperative state (5 points), acute coronary syndrome (2 points), use of low-molecular-weight heparin/fondaparinux/unfractionated heparin (1 point) were independent predictors of severe bleeding...
December 1, 2016: Thrombosis and Haemostasis
https://www.readbyqxmd.com/read/27904506/safety-and-efficacy-of-tenecteplase-versus-alteplase-in-acute-coronary-syndrome-a-systematic-review-and-meta-analysis-of-randomized-trials
#6
REVIEW
Alexandre Guillermin, David Jun Yan, Arnaud Perrier, Christophe Marti
INTRODUCTION: Alteplase and tenecteplase are two widely used thrombolytic agents and are both approved for the treatment of acute myocardial infarction. These two molecules have increased fibrin specificity compared with older thrombolytics but distinct pharmacokinetic properties and may differ in terms of risks and benefits. We decided to review the available evidence comparing the safety and efficacy of these two molecules in acute coronary syndrome (ACS) or pulmonary embolism (PE)...
December 1, 2016: Archives of Medical Science: AMS
https://www.readbyqxmd.com/read/27902833/evaluation-of-ischemic-and-bleeding-risks-associated-with-2-parenteral-antiplatelet-strategies-comparing-cangrelor-with-glycoprotein-iib-iiia-inhibitors-an-exploratory-analysis-from-the-champion-trials
#7
Muthiah Vaduganathan, Robert A Harrington, Gregg W Stone, Efthymios N Deliargyris, Ph Gabriel Steg, C Michael Gibson, Christian W Hamm, Matthew J Price, Alberto Menozzi, Jayne Prats, Steven Elkin, Kenneth W Mahaffey, Harvey D White, Deepak L Bhatt
Importance: In the context of contemporary pharmacotherapy, optimal antiplatelet management with percutaneous coronary intervention (PCI) has not been well established. Objective: To compare the ischemic and bleeding risks associated with glycoprotein IIb/IIIa inhibitors (GPIs) and a potent P2Y12 antagonist, cangrelor, in patients undergoing PCI. Design, Setting, and Participants: An exploratory analysis of pooled patient-level data from the 3 phase 3 Cangrelor vs Standard Therapy to Achieve Optimal Management of Platelet Inhibition (CHAMPION PCI, CHAMPION PLATFORM, and CHAMPION PHOENIX) trials of patients undergoing elective or nonelective PCI...
November 30, 2016: JAMA Cardiology
https://www.readbyqxmd.com/read/27899203/bioresorbable-scaffold-implantation-in-patients-with-indication-for-oral-anticoagulation-a-propensity-matched-analysis
#8
Niklas F Boeder, Victoria Johnson, Oliver Dörr, Jens Wiebe, Albrecht Elsässer, Helge Möllmann, Christian W Hamm, Holger M Nef, Timm Bauer
OBJECTIVES: To examine ischemic and bleeding outcomes in patients on triple antithrombotic therapy (TAT) compared with dual antiplatelet therapy (DAPT) after the implantation of bioresorbable scaffolds (BRS). BACKGROUND: The optimal antithrombotic regimen in patients undergoing percutaneous coronary intervention that have an indication for oral anticoagulation is unclear, in particular among those undergoing BRS implantation. METHODS: Consecutive patients of a single-center, all-comers BRS registry were included...
November 24, 2016: International Journal of Cardiology
https://www.readbyqxmd.com/read/27887802/meta-analysis-of-clopidogrel-pretreatment-in-acute-coronary-syndrome-patients-undergoing-invasive-strategy
#9
Ramez Nairooz, Marco Valgimigli, Yogita Rochlani, Naga Venkata Pothineni, Sameer Raina, Partha Sardar, Debabrata Mukherjee, Srihari S Naidu, David M Shavelle
BACKGROUND: It is unknown whether pretreatment with clopidogrel in acute coronary syndrome (ACS) managed invasively, is superior to a strategy of administering clopidogrel in the cardiac catheterization laboratory at the time of percutaneous coronary intervention (PCI). Current practice guidelines do not endorse one strategy over the other. METHODS: A comprehensive literature search was done to identify all relevant studies comparing pretreatment with clopidogrel to administration in the cardiac catheterization laboratory at the time of PCI (no pretreatment)...
November 12, 2016: International Journal of Cardiology
https://www.readbyqxmd.com/read/27885830/extended-dual-antiplatelet-therapy-after-acute-coronary-syndrome-in-spain-results-from-the-epicor-study
#10
Alfredo Bardají, Manuel Leal, Vicente Arrarte, Xavier Garcia-Moll, Leopoldo Pérez de Isla, Héctor Bueno
INTRODUCTION: Real-world, country-specific studies of dual antiplatelet therapy (DAPT) duration among survivors of acute coronary syndrome (ACS) are important for improving long-term prognosis. AIMS: To investigate DAPT duration after hospital discharge for ACS in Spain. RESULTS: Data from patients enrolled in the Spanish cohort of the EPICOR (long-tErm follow-up of antithrombotic management Patterns In acute CORonary syndrome patients) study (NCT01171404) were analyzed for changes to antithrombotic medication up to 2 years post-discharge according to index event diagnosis and patient characteristics...
November 25, 2016: Cardiovascular Therapeutics
https://www.readbyqxmd.com/read/27884352/timing-of-coronary-invasive-strategy-in%C3%A2-non-st-segment-elevation-acute-coronary-syndromes-and-clinical-outcomes-an-updated-meta-analysis
#11
Laurent Bonello, Marc Laine, Etienne Puymirat, Gilles Lemesle, Franck Thuny, Franck Paganelli, Pierre Michelet, Antoine Roch, François Kerbaul, Laurent Boyer
OBJECTIVES: The aim of this study was to compare an early versus a delayed invasive strategy in non-ST-segment elevation acute coronary syndromes by performing a meta-analysis of all available randomized controlled clinical trials. BACKGROUND: An invasive approach is recommended to prevent death and myocardial infarction in non-ST-segment elevation acute coronary syndromes. However, the timing of angiography and the subsequent intervention, when required, remains controversial...
November 28, 2016: JACC. Cardiovascular Interventions
https://www.readbyqxmd.com/read/27881255/cost-effectiveness-analysis-of-ticagrelor-and-prasugrel-for-the-treatment-of-acute-coronary-syndrome
#12
Ying Jiao Zhao, Ai Leng Khoo, Liang Lin, Monica Teng, Tuck Seng Wu, Mark Y Chan, Boon Peng Lim
BACKGROUND: In the management of Asian patients with acute coronary syndrome (ACS), the comparative cost-effectiveness of ticagrelor and prasugrel, referenced to generic clopidogrel, is unknown. OBJECTIVE: To assess the cost-effectiveness of ticagrelor and prasugrel as compared with generic clopidogrel in patients with ACS in Singapore. METHODS: A Markov model simulating a typical cohort of 62-year-old patients with ACS was constructed from a patient's perspective over a lifetime horizon...
May 2016: Value in Health Regional Issues
https://www.readbyqxmd.com/read/27869899/-patients-with-non-st-elevation-acute-coronary-syndrome-managed-without-coronary-revascularization-an-undertreated-population
#13
Alberto Menozzi, Leonardo De Luca, Zoran Olivari, Roberta Rossini, Marco Ferlini, Daniela Lina, Maurizio Giuseppe Abrignani, Piera Capranzano, Nazario Carrabba, Marcello Galvani, Alfredo Marchese, Gianfranco Mazzotta, Luciano Moretti, Nicola Signore, Massimo Uguccioni, Stefano De Servi
Non-ST-elevation acute coronary syndromes (NSTE-ACS) represent one of the most common clinical presentations of ischemic heart disease. Patients with NSTE-ACS are a heterogeneous population, with different clinical features and prognosis. A significant proportion of this population is medically managed, without any revascularization. In the Italian EYESHOT and French FAST-MI registries, patients managed with a conservative strategy were 40% and 35%, respectively. NSTE-ACS patients not undergoing coronary revascularization are at higher risk of adverse cardiovascular events and have a worse prognosis, including short- and long-term mortality, compared with those receiving revascularization...
October 2016: Giornale Italiano di Cardiologia
https://www.readbyqxmd.com/read/27869561/successful-drug-coated-balloon-angioplasty-and-single-anti-platelet-therapy-to-treat-an-ischaemic-stroke-patient-with-haemorrhage-and-acute-coronary-syndrome
#14
Hee Hwa Ho, Kwang How Mok
A 55-year-old male presented with two challenging problems, i.e. acute coronary syndrome (ACS) and a major bleeding episode. He first presented with ischaemic stroke and was treated with thrombolysis. However this was complicated by haemorrhagic transformation. He subsequently developed ACS with urgent coronary angiography demonstrating a critical stenosis in the proximal left anterior descending artery. Percutaneous coronary intervention (PCI) was deemed necessary but we were mindful of causing bleeding complications from the use of anti-thrombotic therapy...
November 21, 2016: Acute Cardiac Care
https://www.readbyqxmd.com/read/27865674/does-anemia-affect-the-predictive-ability-of-bleeding-risk-scores-in-patients-with-acute-coronary-syndromes
#15
Alberto Garay, Albert Ariza-Solé, Francesc Formiga, Victoria Lorente, José C Sánchez-Salado, Joel Salazar-Mendiguchía, Gerard Roura, Guillem Muntané, Oriol Alegre, Lara Fuentes, Joan A Gómez-Hospital, Angel Cequier
INTRODUCTION AND OBJECTIVE: Anemia is a common comorbidity in patients with acute coronary syndromes (ACS), and is associated with higher risk for both bleeding and ischemic complications. We aimed to assess the predictive ability of bleeding risk scores (Can Rapid risk stratification of Unstable angina patients Suppress ADverse outcomes with Early implementation of the ACC/AHA guidelines [CRUSADE], Mehran and Acute Coronary Treatment and Intervention Outcomes Network [ACTION]) in ACS patients with anemia...
December 2016: Portuguese Journal of Cardiology: An Official Journal of the Portuguese Society of Cardiology
https://www.readbyqxmd.com/read/27865441/long-term-versus-short-term-dual-antiplatelet-therapy-was-similarly-associated-with-a-lower-risk-of-death-stroke-or-infarction-in-patients-with-acute-coronary-syndrome-regardless-of-underlying-kidney-disease
#16
Juan-Jesus Carrero, Christoph Varenhorst, Karin Jensevik, Karolina Szummer, Bo Lagerqvist, Marie Evans, Jonas Spaak, Claes Held, Stefan James, Tomas Jernberg
Scarce and conflicting evidence exists on whether clopidogrel is effective and whether dual antiplatelet treatment (DAPT) is safe in patients with acute coronary syndrome and chronic kidney disease (CKD). To study this, we performed an observational, prospective, multicenter cohort study of 36,001 patients of the SWEDEHEART registry. The exposure was DAPT prolonged after 3 months versus DAPT stopped at 3 months in consecutive patients with acute coronary syndrome and known serum creatinine. DAPT duration with clopidogrel and aspirin was assessed by dispensed tablets...
November 16, 2016: Kidney International
https://www.readbyqxmd.com/read/27865197/efficacy-and-safety-of-ticagrelor-versus-clopidogrel-with-different-dosage-in-high-risk-patients-with-acute-coronary-syndrome
#17
Yan-Guo Xin, Hai-Shan Zhang, Yu-Ze Li, Qi-Gang Guan, Liang Guo, Yuan Gao, Hai-Jie Yu, Xin-Gang Zhang, Feng Xu, Yue-Lan Zhang, Da-Lin Jia, Ying-Xian Sun, Guo-Xian Qi, Wen Tian
BACKGROUND: Dual antiplatelet therapy is recommended as a standard antiplatelet strategy in acute coronary syndrome. For those with reduced pharmacologic response to clopidogrel, strengthening antiplatelet therapy (clopidogrel 150mg daily) may reduce adverse clinical events. Ticagrelor is a direct-acting inhibitor of the adenosine diphosphate receptor P2Y12 that has a more rapid onset and offset than clopidogrel. METHODS: In this retrospective study, we compared ticagrelor (180mg loading dose 90mg twice daily thereafter), clopidogrel (300mg loading dose, 75mg or 150mg daily thereafter) for the prevention of cardiovascular events in 273 high-risk patients admitted to coronary care unit with acute coronary syndrome...
November 9, 2016: International Journal of Cardiology
https://www.readbyqxmd.com/read/27865117/catalytic-iron-in-acute-myocardial-infarction-complicated-by-cardiogenic-shock-a-biomarker-substudy-of-the-iabp-shock-ii-trial
#18
Georg Fuernau, Florian Traeder, Suhas S Lele, Mohan M Rajapurkar, Banibrata Mukhopadhyay, Suzanne de Waha, Steffen Desch, Ingo Eitel, Gerhard Schuler, Volker Adams, Holger Thiele
BACKGROUND: Catalytic iron (CI) is unbound ferric iron with the potential to generate reactive oxygen species with further deleterious vascular effects. In acute coronary syndromes, high levels of CI are linked to all-cause mortality. The prognostic impact of CI and iron metabolism in cardiogenic shock (CS) is currently undetermined. Aims of this study were to investigate the prognostic impact of CI and to identify predictors of high CI levels in patients with CS complicating acute myocardial infarction...
November 9, 2016: International Journal of Cardiology
https://www.readbyqxmd.com/read/27860195/long-term-outcomes-in-patients-with-acute-coronary-syndromes-related-to-prolonging-dual-antiplatelet-therapy-more-than-12-months-after-coronary-stenting
#19
Neil J Wimmer, Alyssa B Dufour, Kelly Cho, David R Gagnon, Lien Quach, Samantha Ly, Jacquelyn-My Do, Simon Ostrowski, J Michael Gaziano, David P Faxon, Scott Kinlay
OBJECTIVES: To assess the impact of stent type on the risk of death or myocardial infarction (MI) related to dual antiplatelet therapy (DAPT) more than 12 months (prolonged DAPT) versus 12 or less months after PCI for an acute coronary syndrome (ACS). BACKGROUND: The recent DAPT study reported lower recurrent ischemic events from prolonged DAPT in patients treated with PCI for an ACS, but was underpowered to determine the impact of stent type. METHODS: We determined clinical outcomes after PCI for an ACS (median follow-up: DES = 26 months, BMS = 46 months) in 18,484 patients in the Veterans Affairs system treated with first generation drug-eluting stents (DES) or bare-metal stents (BMS)...
November 10, 2016: Catheterization and Cardiovascular Interventions
https://www.readbyqxmd.com/read/27857521/global-chemical-reactivity-parameters-for-several-chiral-beta-blockers-from-the-density-functional-theory-viewpoint
#20
Mona Maria Talmaciu, Ede Bodoki, Radu Oprean
BACKGROUND AND AIM: Beta-adrenergic antagonists have been established as first line treatment in the medical management of hypertension, acute coronary syndrome and other cardiovascular diseases, as well as for the prevention of initial episodes of gastrointestinal bleeding in patients with cirrhosis and esophageal varices, glaucoma, and have recently become the main form of treatment of infantile hemangiomas. The aim of the present study is to calculate for 14 beta-blockers several quantum chemical descriptors in order to interpret various molecular properties such as electronic structure, conformation, reactivity, in the interest of determining how such descriptors could have an impact on our understanding of the experimental observations and describing various aspects of chemical binding of beta-blockers in terms of these descriptors...
2016: Clujul Medical (1957)
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