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bleeding in coronary syndroms

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https://www.readbyqxmd.com/read/28524005/rivaroxaban-metabolism-pharmacologic-properties-and-drug-interactions
#1
Tomas Kvasnicka, Ivana Malikova, Zuzana Zenahlikova, Karolína Kettnerova, Radka Brzezkova, Tomas Zima, Jan Ulrych, Jan Briza, Ivan Netuka, Jan Kvasnicka
BACKGROUND: Rivaroxaban represents a selective direct inhibitor of activated coagulation factor X (FXa) having peroral bioavailability and prompt onset of action. OBJECTIVE: The absorbtion of rivaroxaban is quick, reaching maximum plasma concentration 2-4 hours following its administration. Peroral bioavailability is high (80-100 %) and pharmacokinetic variability is considered to be moderate (coefficient of variation 30-40 %). This review discusses the properties, drug interactions, pharmacokinetics and clinical indications of rivaroxaban...
May 18, 2017: Current Drug Metabolism
https://www.readbyqxmd.com/read/28516369/management-of-elderly-patients-with-a%C3%A2-non-st-segment-elevation-acute-coronary-syndrome
#2
REVIEW
M E Gimbel, J M Ten Berg
Elderly patients with an acute coronary syndrome are underrepresented in randomised controlled trials. Neither the European Society of Cardiology nor the American Heart Association/American College of Cardiology acute coronary syndrome guidelines provide specific recommendations for elderly patients. However, elderly patients are at higher thrombotic and bleeding risk compared with younger patients leading to difficulties in choosing the optimal treatment. In this review, we discuss the uncertainties we encounter in treating elderly patients with non-ST-elevation acute coronary syndrome and suggest treatment options based on the existing literature...
May 17, 2017: Netherlands Heart Journal
https://www.readbyqxmd.com/read/28515027/early-versus-delayed-invasive-strategies-in-high-risk-non-st-elevation-acute-coronary-syndrome-patients-a-systematic-literature-review-and-meta-analysis-of-randomised-controlled-trials
#3
REVIEW
Delara Javat, Clare Heal, Stefan Buchholz, Zhihua Zhang
RATIONALE: It is unclear whether it is beneficial to perform angiography and/or percutaneous coronary intervention (PCI) as an early or delayed invasive strategy amongst high-risk non-ST elevation acute coronary syndrome (NSTEACS) patients. OBJECTIVE: To determine whether an early invasive strategy could further reduce recurrent myocardial infarction (MI) and early mortality compared to a delayed invasive strategy. METHODS AND RESULTS: We searched MEDLINE, CINAHL and SCOPUS and performed a meta-analysis of nine RCTs with a total of 5274 patients...
April 11, 2017: Heart, Lung & Circulation
https://www.readbyqxmd.com/read/28510646/benefit-of-switching-dual-antiplatelet-therapy-after-acute-coronary-syndrome-the-topic-timing-of-platelet-inhibition-after-acute-coronary-syndrome-randomized-study
#4
Thomas Cuisset, Pierre Deharo, Jacques Quilici, Thomas W Johnson, Stéphanie Deffarges, Clémence Bassez, Guillaume Bonnet, Laurent Fourcade, Jean Philippe Mouret, Marc Lambert, Valentine Verdier, Pierre Emmanuel Morange, Marie Christine Alessi, Jean Louis Bonnet
Aims: Newer P2Y12 blockers (prasugrel and ticagrelor) demonstrated significant ischaemic benefit over clopidogrel after acute coronary syndrome (ACS). However, both drugs are associated with an increase in bleeding complications. The objective of the present study was to evaluate the benefit of switching dual antiplatelet therapy (DAPT) from aspirin plus a newer P2Y12 blocker to aspirin plus clopidogrel 1 month after ACS. Methods and results: We performed an open-label, monocentric, and randomized trial...
May 16, 2017: European Heart Journal
https://www.readbyqxmd.com/read/28509568/low-body-weight-and-clinical-outcomes-in-acute-coronary-syndrome-patients-results-of-the-achilles-registry
#5
José Miguel Rivera-Caravaca, Juan M Ruiz-Nodar, Antonio Tello-Montoliu, María Asunción Esteve-Pastor, Andrea Veliz-Martínez, Esteban Orenes-Piñero, Mariano Valdés, Vicente Pernias-Escrig, Miriam Sandin-Rollán, Nuria Vicente-Ibarra, Manuel J Macías-Villanego, Elena Candela-Sánchez, Teresa Lozano, Luna Carrillo-Alemán, Francisco Marín
BACKGROUND: Being overweight increases the risk of cardiovascular diseases and mortality. However, among high-body-weight patients with established acute coronary syndrome (ACS) this evidence is not clear. In this scenario, a low body weight (LBW) has been proposed to confer higher prognostic risk and higher bleeding risk with new P2Y12 inhibitors. AIMS: We aimed to examine differences in mortality, catheterizations/revascularizations, antiplatelet therapy and ischemic/bleeding adverse events between ACS patients with LBW...
May 1, 2017: European Journal of Cardiovascular Nursing
https://www.readbyqxmd.com/read/28491083/comparison-of-the-performance-of-the-crusade-acuity-horizons-and-action-bleeding-scores-in-acs-patients-undergoing-pci-insights-from-a-cohort-of-4939-patients-in-china
#6
Ran Liu, Shu-Zheng Lyu, Guan-Qi Zhao, Wen Zheng, Xiao Wang, Xue-Dong Zhao, Sheng-Hui Zhou, Lei Zhen, Shao-Ping Nie
BACKGROUND: The CRUSADE, ACTION and ACUITY-HORIZONS scores are commonly used for predicting in-hospital major bleeding events in patients with acute coronary syndrome (ACS), but the homogeneous nature of these models' population limits simple extrapolation to other local population. We aimed to compare the performance of the three risk models in Chinese patients. METHODS: We evaluated the performance of the three predicting scores for predicting in-hospital major bleeding events defined by thrombolysis in myocardial infarction (TIMI) serious (major and minor) episodes, in a cohort of Chinese ACS patients with either non-ST-elevation ACS (NSTE-ACS) or ST-elevation myocardial infarction (STEMI)...
February 2017: Journal of Geriatric Cardiology: JGC
https://www.readbyqxmd.com/read/28490313/radial-vs-femoral-approach-in-acute-coronary-syndromes-a-comprehensive-meta-analysis-of-randomized-trials
#7
Matteo Nardin, Monica Verdoia, Lucia Barbieri, Alon Schaffer, Harry Suryapranata, Giuseppe De Luca
BACKGROUND: Substantial improvements have been achieved with percutaneous coronary intervention (PCI) for the treatment of acute coronary syndromes (ACS). Nevertheless, bleeding still affects outcomes. The radial approach for PCI has shown important benefits on access site complications, but is still not achieving universal consensus as first choice in acute settings. Therefore, we performed a comprehensive meta-analysis of randomized trials comparing radial vs femoral approach in PCI for ACS...
May 4, 2017: Current Vascular Pharmacology
https://www.readbyqxmd.com/read/28487035/radial-versus-femoral-access-for-the-treatment-of-left%C3%A2-main-lesion-in-the-era-of-second-generation-drug-eluting-stents
#8
Sebastiano Gili, Fabrizio D'Ascenzo, Roberto Di Summa, Federico Conrotto, Enrico Cerrato, Alaide Chieffo, Giacomo Boccuzzi, Antonio Montefusco, Fabrizio Ugo, Pierluigi Omedé, Hiroyoshi Kawamoto, Francesco Tomassini, Marco Pavani, Ferdinando Varbella, Roberto Garbo, Maurizio D'Amico, Giuseppe Biondi Zoccai, Claudio Moretti, Javier Escaned, Antonio Colombo, Fiorenzo Gaita
Transradial access (TRA) is often avoided in favor of the transfemoral access (TFA) during percutaneous coronary interventions of the unprotected left main coronary artery (ULM), due to technical and safety concerns. The aim of this study was to compare the performance of TRA and TFA in the treatment of ULM with second-generation drug-eluting stents. Consecutive patients who underwent percutaneous coronary intervention on ULM with second-generation drug-eluting stents were retrospectively enrolled in the multicenter Failure in Left Main Study With 2nd Generation Stents (FAILS 2) registry...
April 12, 2017: American Journal of Cardiology
https://www.readbyqxmd.com/read/28482804/choosing-between-enoxaparin-and-fondaparinux-for-the-management-of-patients-with-acute-coronary-syndrome-a-systematic-review-and-meta-analysis
#9
Pravesh Kumar Bundhun, Musaben Shaik, Jun Yuan
BACKGROUND: Enoxaparin and Fondaparinux are potential anticoagulants which are used peri-operatively in the management of patients with Acute Coronary Syndrome (ACS). We aimed to compare the adverse clinical outcomes which are associated with the use of these anticoagulants in patients who were treated for ACS. METHODS: Online databases (PubMed/Medline, EMBASE, Cochrane library) were searched for studies which compared differences in clinical outcomes observed with the use of enoxaparin and fondaparinux in patients who were treated peri-operatively for ACS...
May 8, 2017: BMC Cardiovascular Disorders
https://www.readbyqxmd.com/read/28476519/the-underutilisation-of-dual-antiplatelet-therapy-in-acute-coronary-syndrome
#10
Malcolm Anastasius, Jerrett K Lau, Karice Hyun, Mario D'Souza, Anushka Patel, Jamie Rankin, Darren Walters, Craig Juergens, Bernadette Aliprandi-Costa, Andrew T Yan, Shaun G Goodman, Derek Chew, David Brieger
BACKGROUND: Despite guideline recommendation of dual antiplatelet therapy (DAPT) in treating ACS, DAPT is underutilized. Our objective was to determine independent predictors of DAPT non-prescription in ACS and describe pattern of DAPT prescription over time. METHODS: Patients presenting to 41 Australian hospitals with an ACS diagnosis between 2009 and 2016 were stratified according to discharge prescription with DAPT and single antiplatelet therapy (SAPT) or no antiplatelet therapy...
April 25, 2017: International Journal of Cardiology
https://www.readbyqxmd.com/read/28459500/gender-related-differences-in-antiplatelet-treatment-patterns-and-outcome-insights-from-the-greekantiplatelet-grape-registry
#11
I Xanthopoulou, P Davlouros, S Deftereos, M Hamilos, G Sitafidis, I Kanakakis, M Vavouranakis, J Goudevenos, J Lekakis, D Alexopoulos
AIMS: Data on the clinical impact of gender in 'real life' acute coronary syndrome (ACS) patients undergoing percutaneous coronary intervention (PCI), receiving clopidogrel, prasugrel or ticagrelor are limited. We aimed to investigate sex-based differences in clinical outcome of those patients. METHODS: In a prospective, observational, multicenter, cohort study 2047 patients were recruited into the GReekAntiPlatElet (GRAPE) Registry and were followed-up until 1 year for major adverse cardiovascular events (MACE, composite of death, non fatal myocardial infarction,urgent revascularization and stroke) and bleeding events [Bleeding Academic Research Consortium (BARC) classification]...
April 29, 2017: Cardiovascular Therapeutics
https://www.readbyqxmd.com/read/28454837/balancing-the-risk-of-spontaneous-ischemic-and-major-bleeding-events-in-acute-coronary-syndromes
#12
Gregory Ducrocq, Phillip J Schulte, Andrzej Budaj, Jan H Cornel, Claes Held, Anders Himmelmann, Steen Husted, Robert F Storey, Christopher P Cannon, Richard C Becker, Stefan K James, Hugo A Katus, Renato D Lopes, Emmanuel Sorbets, Lars Wallentin, Philippe Gabriel Steg
Evaluation of antithrombotic treatments for acute coronary syndromes (ACS) requires balancing ischemic and bleeding risks to assess net benefit. We sought to compare the relative effects of ischemic and bleeding events on mortality. METHODS: In the PLATelet inhibition and patient Outcomes (PLATO) trial, we compared spontaneous ischemic events (myocardial infarction or stroke) with spontaneous major bleeding events (PLATO major, Thrombolysis In Myocardial Infarction [TIMI] major, Global Utilization of Streptokinase and Tissue Plasminogen Activator for Occluded Coronary Arteries [GUSTO] severe) with respect to risk of mortality using time-dependent Cox proportional hazards models...
April 2017: American Heart Journal
https://www.readbyqxmd.com/read/28454802/association-of-measured-platelet-reactivity-with-changes-in-p2y12-receptor-inhibitor-therapy-and-outcomes-after-myocardial-infarction-insights-into-routine-clinical-practice-from-the-treatment-with-adp-receptor-inhibitors-longitudinal-assessment-of-treatment
#13
Akshay Bagai, Eric D Peterson, Lisa A McCoy, Mark B Effron, Marjorie E Zettler, Gregg W Stone, Timothy D Henry, David J Cohen, Phillip J Schulte, Kevin J Anstrom, Tracy Y Wang
BACKGROUND: Little is known about the use of platelet function testing to guide choice of P2Y12 receptor inhibitor therapy in routine clinical practice. METHODS: We studied 671 myocardial infarction (MI) patients treated with percutaneous coronary intervention in the TRANSLATE-ACS Registry who had VerifyNow platelet function testing performed while on clopidogrel treatment during their index hospitalization (April 2010-October 2012). RESULTS: High platelet reactivity (>208 platelet reactivity units [PRU]) was present in 261 (38...
May 2017: American Heart Journal
https://www.readbyqxmd.com/read/28439617/-stroke-prophylaxis-in-atrial-fibrillation-when-how-and-for-whom
#14
T Maurer, C Sohns
In patients suffering from atrial fibrillation (AF), modern antithrombotic therapy and anticoagulation strategies should be individualized based on shared decision making including patient preferences and the absolute and relative risks of stroke and bleeding. Estimation of the individual risk for stroke is still based on the CHA2DS2-VASc score. Based on the most recent guidelines for the management of AF, oral anticoagulation therapy should be considered for men with a CHA2DS2-VASc score ≥1 and women with a score ≥2, balancing the expected stroke reduction, risk of bleeding and patient preference...
April 24, 2017: Herz
https://www.readbyqxmd.com/read/28438739/reporting-clinical-end-points-and-safety-events-in-an-acute-coronary-syndrome-trial-results-with-integrated-collection
#15
Patrícia O Guimarães, Renato D Lopes, Susanna R Stevens, André Zimerman, Lisa Wruck, Stefan K James, Ghazala Haque, Roberto Rocha C V Giraldez, John H Alexander, Karen P Alexander
BACKGROUND: End points and adverse events (AEs) are collected separately in clinical trials, yet regulatory requirements for serious AE reporting vary across regions, so classifying end points according to seriousness criteria can be useful in global trials. METHODS AND RESULTS: In the Apixaban for Prevention of Acute Ischemic Events 2 (APPRAISE-2) trial, patients with a recent acute coronary syndrome were randomized to apixaban or placebo for the prevention of recurrent ischemic events...
April 24, 2017: Journal of the American Heart Association
https://www.readbyqxmd.com/read/28424434/high-dose-bolus-tirofiban-versus-low-dose-bolus-in-patients-with-acute-coronary-syndrome-undergoing-percutaneous-coronary-intervention
#16
Taner Ulus, Utku Şenol, Senan Tahmazov, Kemal Iskenderov, Fezan Mutlu, Yüksel Çavuşoğlu
OBJECTIVE: Aim of the present study was to determine effects of high-dose versus low-dose intravenous (IV) bolus tirofiban on angiographic measures, ST resolution, enzymatic infarct size, and clinical outcomes in patients with acute coronary syndrome (ACS) who were undergoing percutaneous coronary intervention (PCI) and received current pharmacoinvasive therapy. METHODS: Acute coronary syndrome patients (n=271, 85.6% male; mean age: 57.9±12.6 years) from between 2009 and 2015 who received IV tirofiban therapy following PCI were retrospectively analyzed...
March 2017: Türk Kardiyoloji Derneği Arşivi: Türk Kardiyoloji Derneğinin Yayın Organıdır
https://www.readbyqxmd.com/read/28420862/clinical-characteristics-treatment-and-prognosis-of-patients-with-acute-severe-heart-failure-of-ischemic-and-non-ischemic-etiology-analysis-from-the-commit-ahf-registry
#17
Mateusz Ostręga, Marek J Gierlotka, Grzegorz Słonka, Paweł Nadziakiewicz, Mariusz Gąsior
INTRODUCTION    There are limited data on the impact of ischemic etiology on clinical status and long-term prognosis among patients with acute severe heart failure (ASHF) not associated with acute coronary syndrome (ACS).  OBJECTIVES    To assess clinical characteristics, treatment and the 12-month mortality of patients with no-ACS ASHF according to etiology.  PATIENTS AND METHODS    The data from 112 patients with ASHF that was not associated with ACS were analyzed: 61 with ischemic (IASHF) and 51 with non-ischemic (NIASHF) etiology...
April 18, 2017: Polish Archives of Internal Medicine
https://www.readbyqxmd.com/read/28420804/contemporary-trends-and-outcomes-associated-with-the-preprocedural-use-of-oral-p2y12-inhibitors-in-patients-undergoing-percutaneous-coronary-intervention-insights-from-the-blue-cross-blue-shield-of-michigan-cardiovascular-consortium-bmc2
#18
Devraj Sukul, Milan Seth, Simon R Dixon, Akshay Khandelwal, Thomas A LaLonde, Hitinder S Gurm
OBJECTIVES: We sought to describe trends in the use of preprocedural P2Y12 inhibitors and their clinical impact in patients undergoing percutaneous coronary intervention (PCI). BACKGROUND: Oral P2Y12 inhibitors are ubiquitously used medications; however, the specific timing of initial P2Y12 inhibitor administration remains intensely debated. METHODS: Our study population comprised 74,053 consecutive patients undergoing PCI at 47 hospitals in Michigan from January 2013 through June 2015...
April 15, 2017: Journal of Invasive Cardiology
https://www.readbyqxmd.com/read/28416248/contemporary-practice-and-outcomes-of-an-elderly-cohort-of-japanese-patients-with-non-st-elevation-acute-coronary-syndrome-in-the-era-of-routine-early-invasive-strategy
#19
Takuya Nagata, Yohei Hyakuna, Kenji Miyata, Masahiro Mohri
BACKGROUND: An early invasive strategy for patients with non-ST-segment elevation acute coronary syndrome (NSTE-ACS) has been recommended. However, patients at greater risk including the elderly are more often managed conservatively. We aimed to elucidate contemporary practice and outcomes of patients with NSTE-ACS who were referred to our hospital located in Kitakyushu City, one of the most aging metropolises in Japan. METHODS: A total of 270 consecutive NSTE-ACS patients hospitalized between January 2012 and December 2014 were retrospectively studied...
March 30, 2017: International Journal of Cardiology
https://www.readbyqxmd.com/read/28411246/growth-differentiation-factor-15-at-1%C3%A2-month-after-an-acute-coronary-syndrome-is-associated-with-increased-risk-of-major-bleeding
#20
Daniel Lindholm, Emil Hagström, Stefan K James, Richard C Becker, Christopher P Cannon, Anders Himmelmann, Hugo A Katus, Gerald Maurer, José Luis López-Sendón, Philippe Gabriel Steg, Robert F Storey, Agneta Siegbahn, Lars Wallentin
BACKGROUND: Growth differentiation factor-15 (GDF-15) is related to major bleeding when measured at initial presentation in patients with acute coronary syndromes (ACSs) treated with dual antiplatelet therapy. It is unknown whether follow-up measurements provide additional information. The objective of this study was to investigate whether GDF-15 measured 1 month after an ACS provides additional information beyond the baseline levels with regard to the risk of major bleeding. METHODS AND RESULTS: GDF-15 was measured at baseline and at 1 month after an ACS in 4049 patients included in the PLATelet inhibition and patient Outcomes (PLATO) trial...
April 14, 2017: Journal of the American Heart Association
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