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bleeding in coronary syndroms

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https://www.readbyqxmd.com/read/28725995/intra-aortic-balloon-pumping-and-thrombocytopenia-in-patients-with-acute-coronary-syndrome-incidence-risk-factors-and-prognosis
#1
Z Sheng, H Zhao, H Yan, S Jiang, Y Guan, Y Zhang, L Song, C Liu, P Zhou, K Liu, J Liu, Y Tan
BACKGROUND: Thrombocytopenia is a frequently encountered phenomenon during intra-aortic balloon pumping (IABP), which may limit its prolonged utilization. The aim of the study was to explore the risk factors and clinical implications of IABP-associated thrombocytopenia in patients with acute coronary syndrome (ACS). METHODS: We retrospectively analyzed the data of 222 patients with ACS undergoing invasive treatment strategy supported by IABP. The incidence and risk factors of IABP-associated thrombocytopenia, and the association between thrombocytopenia and relevant clinical endpoints (in-hospital death, bleeding according to the TIMI scale, and thromboembolic events), were analyzed...
July 19, 2017: Herz
https://www.readbyqxmd.com/read/28725326/comparison-of-clopidogrel-with-prasugrel-and-ticagrelor-in-patients-with-acute-coronary-syndrome-clinical-outcomes-from-the-national-cardiovascular-database-action-registry
#2
Mohamed Khayata, Joseph N Gabra, M Farhan Nasser, George I Litman, Shyam Bhakta, Rupesh Raina
BACKGROUND: We aimed to compare the clinical outcomes of clopidogrel, prasugrel, and ticagrelor in clinical practice using the National Cardiovascular Database ACTION Registry(®). Treatment guidelines for patients with acute coronary syndrome (ACS) undergoing percutaneous coronary intervention recommend dual antiplatelet therapy (DAPT) for 12 months. Few clinical trials have compared the safety and efficacy of clopidogrel with that of newer antiplatelet therapies. METHODS: A retrospective study of patients hospitalized for ACS at Cleveland Clinic Akron General was conducted...
June 2017: Cardiology Research
https://www.readbyqxmd.com/read/28712144/frailty-is-an-independent-prognostic-marker-in-elderly-patients-with-myocardial-infarction
#3
Gonzalo Luis Alonso Salinas, Marcelo Sanmartin, Marina Pascual Izco, Luis Miguel Rincon, Pablo Pastor Pueyo, Alvaro Marco Del Castillo, Alberto Garcia Guerrero, Pedro Caravaca Perez, Alejandro Recio-Mayoral, Asuncion Camino, Manuel Jimenez-Mena, José Luis Zamorano
BACKGROUND: Acute coronary syndrome (ACS) patients are increasingly older. Conventional prognostic scales include chronological age but do not consider vulnerability. In elderly patients, a frail phenotype represents a better reflection of biological age. HYPOTHESIS: This study aims to determine the prevalence of frailty and its influence on patients age ≥75 years with ACS. METHODS: Patients age ≥75 years admitted due to type 1 myocardial infarction were included in 2 tertiary hospitals, and clinical data were collected prospectively...
July 16, 2017: Clinical Cardiology
https://www.readbyqxmd.com/read/28707308/baseline-anemia-in-patients-undergoing-percutaneous-coronary-intervention-after-an-acute-coronary-syndrome-a-paradox-of-high-bleeding-risk-high-ischemic-risk-and-complex-coronary-disease
#4
Khaled Yazji, Fairoz Abdul, Senthil Elangovan, Muhammad Z Ul Haq, Nick Ossei-Gerning, Keith Morris, Richard Anderson, Tim Kinnaird
OBJECTIVES: To define more clearly the associations between baseline anemia, bleeding/ischemia risk, coronary disease severity, and outcomes by revascularization completeness. BACKGROUND: Anemia is associated with adverse outcomes in patients presenting with an acute coronary syndrome (ACS). METHODS AND RESULTS: Data was sourced from hospital databases for patients admitted with an ACS to a single center between 2011 and 2014. Using WHO anemia criteria, 468 (26...
July 13, 2017: Journal of Interventional Cardiology
https://www.readbyqxmd.com/read/28703181/association-between-helicobacter-pylori-infection-and-long-term-outcome-in-patients-with-drug-eluting-stent-implantation
#5
Rui Wang, Lei-Lei Chen, De-Zhao Wang, Bu-Xing Chen
To investigate the relationship between Helicobacter pylori (Hp) infection and the long-term outcome in acute coronary syndrome (ACS) patients with drug-eluting stent (DES) implantation and so as to explore the significance of Hp eradication therapy in preventing major adverse cardiac events (MACE) and upper gastrointestinal bleeding (UGIB). 539 ACS patients with DES implantation from January 1, 2010 to December 31, 2012 were analyzed. All the patients were divided into two groups according to the result of (13)C urea breath test...
July 13, 2017: Scientific Reports
https://www.readbyqxmd.com/read/28701668/effects-of-smoking-on-ischemic-stroke-intracranial-hemorrhage-and-coronary-artery-events-in-japanese-patients-with-non-valvular-atrial-fibrillation
#6
Shinya Suzuki, Takayuki Otsuka, Koichi Sagara, Hiroaki Semba, Hiroto Kano, Shunsuke Matsuno, Hideaki Takai, Yuko Kato, Tokuhisa Uejima, Yuji Oikawa, Kazuyuki Nagashima, Hajime Kirigaya, Junji Yajima, Takashi Kunihara, Hitoshi Sawada, Tadanori Aizawa, Takeshi Yamashita
The effects of smoking on the prognosis of non-valvular atrial fibrillation (NVAF) patients are unclear.The Shinken Database 2004-11 (n = 17,517) includes all new patients visiting the Cardiovascular Institute between June 2004 and March 2012. Among these cases, 2,102 NVAF patients were identified. The effects of smoking on ischemic stroke (IS), intracranial hemorrhage (ICH), and coronary artery events including percutaneous coronary intervention (PCI) and acute coronary syndrome (ACS) were analyzed. Smokers were younger and had lower risk profiles compared with non-smokers...
July 13, 2017: International Heart Journal
https://www.readbyqxmd.com/read/28701592/risk-factors-of-postcardiotomy-ventricular-dysfunction-in-moderate-to-high-risk-patients-undergoing-open-heart-surgery
#7
Christoph Ellenberger, Tornike Sologashvili, Mustafa Cikirikcioglu, Gabriel Verdon, John Diaper, Tiziano Cassina, Marc Licker
INTRODUCTION: Ventricular dysfunction requiring inotropic support frequently occurs after cardiac surgery, and the associated low cardiac output syndrome largely contributes to postoperative death. We aimed to study the incidence and potential risk factors of postcardiotomy ventricular dysfunction (PCVD) in moderate-to-high risk patients scheduled for open-heart surgery. METHODS: Over a 5-year period, we prospectively enrolled 295 consecutive patients undergoing valve replacement for severe aortic stenosis or coronary artery bypass surgery who presented with Bernstein-Parsonnet scores >7...
July 2017: Annals of Cardiac Anaesthesia
https://www.readbyqxmd.com/read/28697492/incidence-and-causes-for-early-ticagrelor-discontinuation-a-real-world-dutch-registry-experience
#8
Thomas O Bergmeijer, Paul W A Janssen, Mathijs van Oevelen, Dymphie van Rooijen, Thea C Godschalk, Johannes C Kelder, Vera H M Deneer, Victor L Serebruany, Jurriën M Ten Berg
OBJECTIVES: The PLATO trial revealed superiority of ticagrelor over clopidogrel for the prevention of atherothrombotic events in patients with acute coronary syndrome. However, adverse events such as bleeding, dyspnea, and bradycardia were frequently reported, potentially leading to excess early ticagrelor discontinuation (ETD), later confirmed in the PEGASUS trial. We here evaluated the incidence and causes for ETD in a real-world patient cohort in a high-volume nonacademic percutaneous coronary intervention center in the Netherlands...
July 12, 2017: Cardiology
https://www.readbyqxmd.com/read/28683175/cost-effectiveness-analysis-of-30-month-vs-12-month-dual-antiplatelet-therapy-with-clopidogrel-and-aspirin-after-drug-eluting-stents-in-patients-with-acute-coronary-syndrome
#9
Minghuan Jiang, Joyce H S You
Continuation of dual antiplatelet therapy (DAPT) beyond 1 year reduces late stent thrombosis and ischemic events after drug-eluting stents (DES) but increases risk of bleeding. We hypothesized that extending DAPT from 12 months to 30 months in patients with acute coronary syndrome (ACS) after DES is cost-effective. A lifelong decision-analytic model was designed to simulate 2 antiplatelet strategies in event-free ACS patients who had completed 12-month DAPT after DES: aspirin monotherapy (75-162 mg daily) and continuation of DAPT (clopidogrel 75 mg daily plus aspirin 75-162 mg daily) for 18 months...
July 6, 2017: Clinical Cardiology
https://www.readbyqxmd.com/read/28681220/comparison-of-platelet-aggregation-response-in-switching-regimen-from-prasugrel-to-clopidogrel-between-cyp2c19-extensive-versus-non-extensive-metabolizers
#10
Soichiro Ebisawa, Yasushi Ueki, Tomoaki Mochidome, Keisuke Senda, Hitoshi Nishimura, Tatsuya Saigusa, Takashi Miura, Hirohiko Motoki, Jun Koyama, Uichi Ikeda
Little is known about the response of platelet aggregation in patients with acute coronary syndrome (ACS) when prasugrel is changed to clopidogrel. In this study, we evaluated the pharmacodynamic effects of this medication switch. Twenty-one consecutive ACS patients received prasugrel 20 mg as a loading dose before emergent percutaneous coronary intervention and 3.75 mg as a maintenance dose on days 2-7 (prasugrel phase). From day 8, prasugrel was switched to clopidogrel 75 mg/day (clopidogrel phase). P2Y12 reaction units (PRU) were measured 2-4 h after prasugrel loading, and on days 7, 11, 13, 15, and 42...
July 5, 2017: Cardiovascular Intervention and Therapeutics
https://www.readbyqxmd.com/read/28678044/randomized-clinical-trial-the-impact-of-gastrointestinal-risk-factor-screening-and-prophylactic-proton-pump-inhibitor-therapy-in-patients-receiving-dual-antiplatelet-therapy
#11
Berit E S Jensen, Jane M Hansen, Kasper S Larsen, Anders B Junker, Jens F Lassen, Svend E Jensen, Ove B Schaffalitzky de Muckadell
OBJECTIVE: Dual antiplatelet therapy reduces the risk of ischemic complications after acute coronary syndrome, but increases the risk of bleeding including upper gastrointestinal bleeding (UGIB).The aim of this study was to examine the effect of screening for risk of UGIB and prophylactic proton pump inhibitor (PPI) treatment in dual-antiplatelet-treated patients at risk of UGIB and to assess the significance of dual antiplatelet therapy compliance for cardiovascular events. PATIENTS AND METHODS: In a register-based randomized-controlled trial, 2009 patients were included at the time of first percutaneous coronary intervention and randomized to either screening or control...
July 3, 2017: European Journal of Gastroenterology & Hepatology
https://www.readbyqxmd.com/read/28669702/incidence-and-prognostic-implications-of-late-bleeding-after-myocardial-infarction-or-unstable-angina-according-to-treatment-strategy
#12
Miriam Brinkert, Danielle A Southern, Matthew T James, Merrill L Knudtson, Todd J Anderson, François Charbonneau
BACKGROUND: Bleeding complications accompanying coronary revascularization are associated with increased mortality; however, few data are available on subsequent bleeding risk. We used administrative data to assess the incidence of late bleeding events in patients with acute coronary syndrome (ACS) according to treatment allocation. METHODS: The cohort and bleeding events were identified through the Canadian Institute for Health Information discharge abstract database...
May 5, 2017: Canadian Journal of Cardiology
https://www.readbyqxmd.com/read/28661903/p2y12-receptor-inhibitor-resistance-and-coronary-artery-disease-a-bench-to-bedside-primer-for-cardiovascular-specialists
#13
Derek Y F So, Akshay Bagai, Uyen Tran, Subodh Verma, Shamir R Mehta
PURPOSE OF REVIEW: Platelet P2Y12 receptor inhibitors are routinely prescribed for patients after acute coronary syndromes and percutaneous coronary interventions. Patients may have underresponsiveness (or resistance) to these drugs and in particular to clopidogrel, the most often used type. This review aims to focus on the concept of P2Y12 receptor inhibitor resistance and discuss incidence, mechanisms, novel diagnostic techniques and past and future clinical trials on the topic. RECENT FINDINGS: Patients treated with P2Y12 receptor inhibitors may develop high on-treatment platelet reactivity (HPR), a phenomenon of impaired response toward the drug, which has been associated with ischemic complications...
June 28, 2017: Current Opinion in Cardiology
https://www.readbyqxmd.com/read/28643219/triple-antithrombotic-therapy-in-atrial-fibrillation-patients-undergoing-pci-a-fading-role
#14
Dimitrios Alexopoulos, Panagiotis Vlachakis, John Lekakis
Triple antithrombotic therapy (TAT), consisting of aspirin, a P2Y12 receptor antagonist and oral anticoagulant (OAC) medication has been considered as an 'unavoidable' strategy for a 1-12 months for atrial fibrillation (AF) patients post acute coronary syndrome or percutaneous coronary angioplasty with stenting. However, TAT has rather poorly been adopted in real life practice, mainly because of an accompanying increased bleeding potential and lack of definitive results of randomized clinical trials. Several registries, meta-analyses and small randomized trials have so far provided the base of guidelines recommendations...
June 22, 2017: Cardiovascular Drugs and Therapy
https://www.readbyqxmd.com/read/28641838/dual-antiplatelet-therapy-for-6-versus-18%C3%A2-months-after-biodegradable-polymer-drug-eluting-stent-implantation
#15
Masato Nakamura, Raisuke Iijima, Junya Ako, Toshiro Shinke, Hisayuki Okada, Yoshiaki Ito, Kenji Ando, Hitoshi Anzai, Hiroyuki Tanaka, Yasunori Ueda, Shin Takiuchi, Yasunori Nishida, Hiroshi Ohira, Katsuhiro Kawaguchi, Makoto Kadotani, Hiroyuki Niinuma, Kazuto Omiya, Takashi Morita, Kan Zen, Yoshinori Yasaka, Kenji Inoue, Sugao Ishiwata, Masahiko Ochiai, Toshimitsu Hamasaki, Hiroyoshi Yokoi
OBJECTIVES: The NIPPON (Nobori Dual Antiplatelet Therapy as Appropriate Duration) study was a multicenter randomized investigation of the noninferiority of short-term versus long-term dual antiplatelet therapy (DAPT) in patients with implantation of the Nobori drug-eluting stent (DES) (Terumo, Tokyo, Japan), which has a biodegradable abluminal coating. BACKGROUND: The optimum duration of DAPT for patients with a biodegradable polymer-coated DES is unclear. METHODS: The subjects were 3,773 patients with stable or acute coronary syndromes undergoing Nobori stent implantation...
June 26, 2017: JACC. Cardiovascular Interventions
https://www.readbyqxmd.com/read/28632784/contemporary-use-of-p2y12-inhibitors-in-patients-with-acute-coronary-syndrome-undergoing-percutaneous-coronary-intervention-in-austria-a-prospective-multi-centre-registry
#16
Maximilian Tscharre, Florian Egger, Matthias Machata, Miklos Rohla, Nadia Michael, Manuel Neumayr, Robert Zweiker, Johannes Hajos, Christopher Adlbrecht, Markus Suppan, Wolfgang Helmreich, Bernd Eber, Kurt Huber, Thomas W Weiss
BACKGROUND: To this day, there is no data concerning guideline adherence on P2Y12-inhibitors in Austria. Prasugrel and ticagrelor have been shown to be superior to clopidogrel in the treatment of acute coronary syndromes (ACS). However, recent data from European registries showed a reluctant prescription policy with rates of clopidogrel at discharge ranging from 35 to 55%. METHODS: In this prospective, multi-centre registry we assessed prescription rates of P2Y12-inhibitors in patients with ACS in four Austrian PCI centres...
2017: PloS One
https://www.readbyqxmd.com/read/28629303/dual-antiplatelet-therapy-beyond-one-year-in-patients-after-stent-placement-a-review
#17
Jacob D Sumner, Brianna Zinser, Andrew Smith
PURPOSE: To review the evidence on the safety and efficacy of the continued use of dual antiplatelet therapy (DAPT) beyond 12 months after stent placement in patients following an acute coronary syndrome (ACS) event. SUMMARY: Recently, the American College of Cardiology (ACC) and the American Heart Association (AHA) released a focused update on the duration of DAPT in patients with coronary artery disease (CAD). The update makes new recommendations about the duration of DAPT in light of recently performed studies investigating this topic...
January 1, 2017: Journal of Pharmacy Practice
https://www.readbyqxmd.com/read/28628345/personalizing-antiplatelet-therapies-what-have-we-learned-from-recent-trials
#18
Sébastien Landry, Jean-François Tanguay, Marie Lordkipanidzé
Dual antiplatelet therapy with aspirin and a P2Y12 receptor antagonist is currently the standard of care for the prevention of ischemic events in patients with acute coronary syndrome or undergoing percutaneous coronary intervention. Several studies have shown that not all patients benefit from the treatment to the same degree and demonstrated that high on-treatment platelet reactivity may be associated with an increased risk of thrombotic events, while low on-treatment platelet reactivity may be linked to a higher risk of bleeding...
June 19, 2017: Platelets
https://www.readbyqxmd.com/read/28626044/revascularisation-compared-with-initial-medical-therapy-for-non-st-elevation-acute-coronary-syndromes-in-the-elderly-a-meta-analysis
#19
Sonali R Gnanenthiran, Leonard Kritharides, Mario D'Souza, Harry C Lowe, David B Brieger
OBJECTIVE: Whether revascularisation is superior to medical therapy in older populations presenting with non-ST-elevation acute coronary syndromes (NSTEACS) remains contentious, with inconclusive evidence from randomised trials. We aimed to compare routine invasive therapy with initial medical management in the elderly presenting with NSTEACS. METHODS: MEDLINE, EMBASE and Cochrane Controlled Trial Register were searched for studies comparing routine invasive therapy with initial medical management in patients ≥75 years old presenting with NSTEACS...
June 16, 2017: Heart: Official Journal of the British Cardiac Society
https://www.readbyqxmd.com/read/28625369/rationale-and-design-of-the-hunting-for-the-off-target-properties-of-ticagrelor-on-endothelial-function-and-other-circulating-biomarkers-in-humans-hi-tech-trial
#20
Sara Ariotti, Maarten van Leeuwen, Salvatore Brugaletta, Sergio Leonardi, Kristiaan Martijn Akkerhuis, Emrush Rexhaj, Gladys Janssens, Luis Ortega-Paz, Diego Rizzotti, Jan C van den Berge, Dierik Heg, Gloria Francolini, Stephan Windecker, Marco Valgimigli
BACKGROUND: Among the 3 approved oral P2Y12 inhibitors for the treatment for patients with acute coronary syndrome (ACS), ticagrelor, but not prasugrel or clopidogrel, has been associated with off-target properties, such as improved endothelial-dependent vasomotion and increased adenosine plasma levels. METHODS: The HI-TECH study (NCT02587260) is a multinational, randomized, open-label, crossover study with a Latin squares design, conducted at 5 European sites, in which patients free from recurrent ischemic or bleeding events ≥30 days after a qualifying ACS were allocated to sequentially receive a 30 ± 5-day treatment with prasugrel, clopidogrel, and ticagrelor in random order...
July 2017: American Heart Journal
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