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Anticoagulation in PCI

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https://www.readbyqxmd.com/read/27886817/antithrombotic-therapy-to-reduce-ischemic-events-in-acute-coronary-syndromes-patients-undergoing-percutaneous-coronary-intervention
#1
REVIEW
Freek W A Verheugt
Antithrombotic therapy is essential in the prevention of periprocedural death and myocardial infarction during and after percutaneous coronary intervention. In the pathogenesis of acute coronary syndromes (ACS), both platelets and the coagulation cascade play an important role. Therefore, periprocedural antithrombotic therapy is even more important in ACS than in elective PCI. The most used agents are aspirin, platelet P2Y12 blockers, platelet glycoprotein IIb/IIIa blockers, and parenteral anticoagulants. The P2Y12 blockers must be continued at least 12 months...
January 2017: Interventional cardiology clinics
https://www.readbyqxmd.com/read/27842901/comparison-of-heparin-bivalirudin-and-different-glycoprotein-iib-iiia-inhibitor-regimens-for-anticoagulation-during-percutaneous-coronary-intervention-a-network-meta-analysis
#2
Michael J Lipinski, Regina C Lee, Michael A Gaglia, Rebecca Torguson, Hector M Garcia-Garcia, Augusto D Pichard, Lowell F Satler, Ron Waksman
BACKGROUND/PURPOSE: Numerous GPIs are available for PCI. Although they were tested in randomized controlled trials, a comparison between the different GPI strategies is lacking. Thus, we performed a Bayesian network meta-analysis to compare different glycoprotein IIb/IIIa inhibitor (GPI) strategies with heparin and bivalirudin for percutaneous coronary intervention (PCI). METHODS: MEDLINE, Cochrane CENTRAL, and ClinicalTrials.gov were searched by two independent reviewers for randomized controlled trials comparing high-dose bolus tirofiban, abciximab, eptifibatide, heparin with provisional glycoprotein IIb/IIIa inhibitors, and bivalirudin with provisional GPI that reported clinical outcomes...
September 30, 2016: Cardiovascular Revascularization Medicine: Including Molecular Interventions
https://www.readbyqxmd.com/read/27836373/clinical-significance-of-platelet-reactivity-during-prasugrel-therapy-in-patients-with-acute-myocardial-infarction
#3
Tetsuya Sato, Yusuke Namba, Yuya Kashihara, Masamichi Tanaka, Soichiro Fuke, Akihisa Yumoto, Hironori Saito
BACKGROUND: Although some studies have examined platelet reactivity (PR) during prasugrel treatment, little is known about PR during the early treatment period and its clinical significance in Japan. METHODS: We investigated the early and medium-term efficacy and safety of prasugrel in patients with acute myocardial infarction (AMI) undergoing primary percutaneous coronary intervention (PCI). Seventy-eight patients were enrolled and PR was measured (in P2Y12 reaction units; PRU) by the VerifyNow P2Y12 assay (Accumetrics, San Diego, CA, USA)...
November 8, 2016: Journal of Cardiology
https://www.readbyqxmd.com/read/27818120/efficacy-and-safety-of-prehospital-administration-of-unfractionated-heparin-enoxaparin-or-bivalirudin-in-patients-undergoing-primary-percutaneous-coronary-intervention-for-st-segment-elevation-myocardial-infarction-insights-from-the-orbi-registry
#4
Vincent Auffret, Guillaume Leurent, Dominique Boulmier, Marc Bedossa, Amer Zabalawi, Jean-Philippe Hacot, Isabelle Coudert, Emmanuelle Filippi, Philippe Castellant, Antoine Rialan, Gilles Rouault, Philippe Druelles, Bertrand Boulanger, Josiane Treuil, Bertrand Avez, Marielle Le Guellec, Martine Gilard, Hervé Le Breton
BACKGROUND: Despite numerous studies in recent years, the best anticoagulant option for primary percutaneous coronary intervention (PCI) remains a matter of debate. AIMS: To compare in-hospital outcomes after prehospital administration of low-dose unfractionated heparin (UFH)±glycoprotein IIb/IIIa inhibitors (GPIs), enoxaparin±GPIs, or bivalirudin in patients undergoing primary PCI for ST-segment elevation myocardial infarction (STEMI). METHODS: A total of 1720 patients (median age 62...
November 3, 2016: Archives of Cardiovascular Diseases
https://www.readbyqxmd.com/read/27792650/use-of-chronic-oral-anticoagulation-and-associated-outcomes-among-patients-undergoing-percutaneous-coronary-intervention
#5
Eric A Secemsky, Neel M Butala, Uri Kartoun, Sadiqa Mahmood, Jason H Wasfy, Kevin F Kennedy, Stanley Y Shaw, Robert W Yeh
BACKGROUND: Contemporary rates of oral anticoagulant (OAC) therapy and associated outcomes among patients undergoing percutaneous coronary intervention (PCI) have been poorly described. METHODS AND RESULTS: Using data from an integrated health care system from 2009 to 2014, we identified patients on OACs within 30 days of PCI. Outcomes included in-hospital bleeding and mortality. Of 9566 PCIs, 837 patients (8.8%) were on OACs, and of these, 7.9% used non-vitamin K antagonist agents...
October 17, 2016: Journal of the American Heart Association
https://www.readbyqxmd.com/read/27789479/design-and-characterization-of-an-apc-specific-serpin-for-the-treatment-of-hemophilia
#6
Stéphanie G I Polderdijk, Ty E Adams, Lacramioara Ivanciu, Rodney M Camire, Trevor P Baglin, James A Huntington
Hemophilia is a bleeding disorder caused by deficiency in factors VIII or IX, the two components of the intrinsic Xase complex. Treatment with replacement factor can lead to the development of inhibitory antibodies, requiring the use of bypassing agents such as factor VIIa and factor concentrates. An alternative approach to bypass the Xase complex is to inhibit endogenous anticoagulant activities. Activated protein C (APC) breaks down the complex that produces thrombin by proteolytically inactivating factor Va...
October 27, 2016: Blood
https://www.readbyqxmd.com/read/27776204/mean-platelet-volume-a-potential-biomarker-of-the-risk-and-prognosis-of-heart-disease
#7
Dong-Hyun Choi, Seong-Ho Kang, Heesang Song
Platelets are essential for progression of atherosclerotic lesions, plaque destabilization, and thrombosis. They secrete and express many substances that are crucial mediators of coagulation, inflammation, and atherosclerosis. Mean platelet volume (MPV) is a precise measure of platelet size, and is routinely reported during complete blood count analysis. Emerging evidence supports the use of MPV as a biomarker predicting the risk of ischemic stroke in patients with atrial fibrillation, and as a guide for prescription of anticoagulation and rhythm-control therapy...
October 24, 2016: Korean Journal of Internal Medicine
https://www.readbyqxmd.com/read/27753600/impact-of-time-to-treatment-on-the-effects-of-bivalirudin-vs-glycoprotein-iib-iiia-inhibitors-and-heparin-in-patients-undergoing-primary-percutaneous-coronary-intervention-insights-from-the-horizons-ami-trial
#8
Mikkel M Schoos, Giuseppe De Luca, George D Dangas, Peter Clemmensen, Girma Minalu Ayele, Roxana Mehran, Gregg W Stone
AIMS: In the HORIZONS-AMI trial, bivalirudin compared to unfractionated heparin (UFH) plus a glycoprotein IIb/IIIa inhibitor (GPI) improved net clinical outcomes in patients undergoing primary percutaneous coronary intervention (PCI) at the cost of an increased rate of acute stent thrombosis. We sought to examine whether these effects are dependent on time to treatment. METHODS AND RESULTS: The interaction between anticoagulation regimen and symptom onset to first balloon inflation time (SBT) on the 30-day and three-year rates of major adverse cardiac events (MACE) was examined in 3,199 randomised patients according to SBT ≤3 hours versus >3 hours...
October 20, 2016: EuroIntervention
https://www.readbyqxmd.com/read/27734083/triple-antithrombotic-therapy-and-outcomes-in-post-pci-patients-undergoing-non-cardiac-surgery
#9
Javier A Valle, Laura Graham, Aerin DeRussy, Kamal Itani, Mary T Hawn, Thomas M Maddox
BACKGROUND: Triple therapy, or the use of anticoagulants with dual antiplatelet therapy (DAPT), is often used to protect against ischemic events in post-percutaneous coronary intervention (PCI) patients with indications for anticoagulation, but is associated with increased bleeding. As both ischemic and bleeding risks increase in the perioperative period, the impact of triple therapy may be especially pronounced in patients undergoing surgery. Outcomes in this population are currently unknown...
October 12, 2016: World Journal of Surgery
https://www.readbyqxmd.com/read/27723533/new-oral-anticoagulants-and-dual-antiplatelet-therapy-focus-on-apixaban
#10
REVIEW
Francesco Pelliccia, Fabiana Rollini, Giuseppe Marazzi, Cesare Greco, Carlo Gaudio, Dominick J Angiolillo, Giuseppe Rosano
The combination of AF and coronary artery disease not only is a common clinical setting, it is also a complex setting to deal with anticoagulation and antiplatelet therapy, and it is associated with significantly higher mortality rates. Unfortunately, there are no sufficient data available to optimally guide clinical practice in such settings. This review focuses specifically on newer oral anticoagulants (NOACs) associated with dual antiplatelet therapy (DAPT) in patients with coronary artery disease undergoing percutaneous coronary intervention (PCI)...
December 15, 2016: International Journal of Cardiology
https://www.readbyqxmd.com/read/27677505/optimizing-the-use-of-cangrelor-in-the-real-world
#11
Arman Qamar, Deepak L Bhatt
Thrombotic events such as myocardial infarction or stent thrombosis are the major cause of adverse outcomes in patients undergoing percutaneous coronary intervention (PCI). While current antiplatelet agents, anticoagulants, and PCI techniques have reduced the risk of thrombotic events in PCI-treated patients, a considerable hazard still remains. Cangrelor is an intravenous P2Y12 receptor antagonist that provides a rapid onset and maximal platelet inhibition, which is quickly reversible. In the large-scale CHAMPION PHOENIX trial, cangrelor was shown to reduce ischemic events significantly, including myocardial infarction and stent thrombosis, without increasing the risk of severe bleeding across the full spectrum of patients undergoing PCI, with substantial benefits in all patient subgroups examined...
September 27, 2016: American Journal of Cardiovascular Drugs: Drugs, Devices, and Other Interventions
https://www.readbyqxmd.com/read/27659886/ischemic-and-bleeding-events-in-patients-with-myocardial-infarction-undergoing-percutaneous-coronary-intervention-who-require-oral-anticoagulation-insights-from-the-canadian-observational-antiplatelet-study
#12
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
https://www.readbyqxmd.com/read/27642112/temporal-trends-predictors-and-outcomes-of-in-hospital-gastrointestinal-bleeding-associated-with-percutaneous-coronary-intervention
#13
Nileshkumar J Patel, Dhaval Pau, Nikhil Nalluri, Parth Bhatt, Badal Thakkar, Ritesh Kanotra, Kanishk Agnihotri, Nitesh Ainani, Nilay Patel, Nish Patel, Sapna Shah, Sabeeda Kadavath, Shilpkumar Arora, Azfar Sheikh, Apurva O Badheka, James Lafferty, Carlos Alfonso, Mauricio Cohen
Since the introduction of new antiplatelet and anticoagulant agents in the last decade, large-scale data studying gastrointestinal bleeding (GIB) in patients undergoing percutaneous coronary intervention (PCI) are lacking. Using the Nationwide Inpatient Sample, we identified all hospitalizations from 2006 to 2012 that required PCI. Temporal trends in the incidence and multivariate predictors of GIB associated with PCI were analyzed. A total of 4,376,950 patients underwent PCI in the United States during the study period...
October 15, 2016: American Journal of Cardiology
https://www.readbyqxmd.com/read/27623683/spotlight-on-unmet-needs-in-stroke-prevention-the-pioneer-af-pci-navigate-esus-and-galileo-trials
#14
Melanie Hemmrich, Eric D Peterson, Karen Thomitzek, Jeffrey I Weitz
Atrial fibrillation (AF) is a major healthcare concern, being associated with an estimated five-fold risk of ischaemic stroke. In patients with AF, anticoagulants reduce stroke risk to a greater extent than acetylsalicylic acid (ASA) or dual antiplatelet therapy (DAPT) with ASA plus clopidogrel. Non-vitamin K antagonist oral anticoagulants (NOACs) are now a widely-accepted therapeutic option for stroke prevention in non-valvular AF (NVAF). There are particular patient types with NVAF for whom treatment challenges remain, owing to sparse clinical data, their high-risk nature or a need to harmonise anticoagulant and antiplatelet regimens if co-administered...
September 28, 2016: Thrombosis and Haemostasis
https://www.readbyqxmd.com/read/27623680/exploring-unmet-needs-in-venous-and-arterial-thromboembolism-with-rivaroxaban
#15
Riccardo Cappato, Robert Welsh
The vast clinical research programme for the direct, oral factor Xa inhibitor rivaroxaban has generated a wealth of data since the first rivaroxaban approval in 2008 for the prevention of venous thromboembolism (VTE) in patients undergoing elective hip or knee replacement surgery. While rivaroxaban is widely used across a spectrum of seven indications, there is continuous commitment to investigating its wider benefits in new indications and attempts to refine current evidence. Key data from recently completed randomised controlled trials (RCTs) have shown that rivaroxaban is a feasible anticoagulation option for patients with non-valvular atrial fibrillation (NVAF) undergoing cardioversion or catheter ablation...
September 28, 2016: Thrombosis and Haemostasis
https://www.readbyqxmd.com/read/27583038/heparin-versus-bivalirudin-in-acute-myocardial-infarction-unfractionated-heparin-monotherapy-elevated-to-primary-treatment-in-contemporary-percutaneous-coronary-intervention
#16
Osmar Antonio Centurión
Bivalirudin, a direct thrombin inhibitor, was developed as an antithrombin agent for patients undergoing percutaneous coronary interventions (PCI) with the hypothesis that it would reduce bleeding complications without compromising the rate of ischemic events compared to heparin plus GP IIb/IIIa inhibitors. Although the cumulative evidence makes a strong argument for the use of bivalirudin rather than heparin plus systematic GP IIb/IIIa inhibitors for the great majority of patients with acute myocardial infarction (AMI) undergoing PCI, the benefit observed with bivalirudin was achieved because of the major bleeding complications with the use of heparin plus GP IIb/IIIa inhibitors...
2016: Open Cardiovascular Medicine Journal
https://www.readbyqxmd.com/read/27565018/design-and-rationale-of-the-re-dual-pci-trial-a-prospective-randomized-phase-3b-study-comparing-the-safety-and-efficacy-of-dual-antithrombotic-therapy-with-dabigatran-etexilate-versus-warfarin-triple-therapy-in-patients-with-nonvalvular-atrial-fibrillation
#17
Christopher P Cannon, Savion Gropper, Deepak L Bhatt, Stephen G Ellis, Takeshi Kimura, Gregory Y H Lip, Ph Gabriel Steg, Jurriën M Ten Berg, Jenny Manassie, Jörg Kreuzer, Jon Blatchford, Joseph M Massaro, Martina Brueckmann, Ernesto Ferreiros Ripoll, Jonas Oldgren, Stefan H Hohnloser
Antithrombotic management of patients with atrial fibrillation (AF) undergoing coronary stenting is complicated by the need for anticoagulant therapy for stroke prevention and dual antiplatelet therapy for prevention of stent thrombosis and coronary events. Triple antithrombotic therapy, typically comprising warfarin, aspirin, and clopidogrel, is associated with a high risk of bleeding. A modest-sized trial of oral anticoagulation with warfarin and clopidogrel without aspirin showed improvements in both bleeding and thrombotic events compared with triple therapy, but large trials are lacking...
October 2016: Clinical Cardiology
https://www.readbyqxmd.com/read/27558233/unfractionated-heparin-or-low-molecular-weight-heparin-in-the-elderly
#18
REVIEW
Maria Dorobantu, Stefan Bogdan
With the ageing of the general population, clinicians are facing with increased frequency the challenge of administering parenteral anti-coagulation therapy in the elderly, the main indications being venous thromboembolism (VTE), acute coronary syndromes (ACS), atrial fibrillation and bridging therapy. Assessing the risk/benefit ratio is always difficult in this category of patients, because of the higher risk for hemorrhagic events, although in most cases the benefit outweighs the risk, especially in the setting of VTE...
November 1, 2016: International Journal of Cardiology
https://www.readbyqxmd.com/read/27543479/simplified-swift-and-safe-vascular-closure-device-deployment-without-a-local-arteriogram-single-center-experience-in-2074-consecutive-patients
#19
Antonis S Manolis, Georgios Georgiopoulos, Dimitris Stalikas, Spyridon Koulouris
OBJECTIVE: Vascular closure devices (VCDs), such as the Angio-Seal, a three-component hemostatic plug, have greatly facilitated the routine clinical practice in the catheterization laboratory. The manufacturer recommends a local angiogram before Angio-Seal deployment. However, from the outset, we employed a simplified routine of deploying this VCD, i.e. without use of local angiography. METHODS: The Angio-Seal was employed without a preceding femoral arteriogram over 8 years in 2074 consecutive patients, 72% presenting with acute coronary syndromes and subjected to coronary angiography (n=1032) or PCI n=1042) via a transfemoral approach with use of heparin and dual antiplatelet therapy...
July 2016: Indian Heart Journal
https://www.readbyqxmd.com/read/27541652/meta-analysis-of-uninterrupted-as-compared-to-interrupted-oral-anticoagulation-with-or-without-bridging-in-patients-undergoing-coronary-angiography-with-or-without-percutaneous-coronary-intervention
#20
Mariusz Kowalewski, Piotr Suwalski, Giuseppe Maria Raffa, Artur Słomka, Magdalena Ewa Kowalkowska, Krzysztof Aleksander Szwed, Alina Borkowska, Janusz Kowalewski, Pietro Giorgio Malvindi, Anetta Undas, Jerzy Windyga, Wojciech Pawliszak, Lech Anisimowicz, Thierry Carrel, Domenico Paparella, Gregory Y H Lip
OBJECTIVES: To assess safety and effectiveness of different periprocedural antithrombotic strategies in patients receiving long-term oral anticoagulation and undergoing coronary angiography with or without percutaneous coronary intervention (PCI). METHODS: Studies comparing uninterrupted oral anticoagulation (UAC) with vit. K antagonists vs interrupted oral anticoagulation (IAC) with or without bridging anticoagulation before coronary procedures were eligible for inclusion in the current meta-analysis...
November 15, 2016: International Journal of Cardiology
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