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Antiplatelet guidelines

Joo-Yong Hahn, Young Bin Song, Ju-Hyeon Oh, Deok-Kyu Cho, Jin Bae Lee, Joon-Hyung Doh, Sang-Hyun Kim, Jin-Ok Jeong, Jang-Ho Bae, Byung-Ok Kim, Jang Hyun Cho, Il-Woo Suh, Doo-Il Kim, Hoon-Ki Park, Jong-Seon Park, Woong Gil Choi, Wang Soo Lee, Jihoon Kim, Ki Hong Choi, Taek Kyu Park, Joo Myung Lee, Jeong Hoon Yang, Jin-Ho Choi, Seung-Hyuk Choi, Hyeon-Cheol Gwon
BACKGROUND: Current guidelines recommend dual antiplatelet therapy (DAPT) of aspirin plus a P2Y12 inhibitor for at least 12 months after implantation of drug-eluting stents (DES) in patients with acute coronary syndrome. However, available data about the optimal duration of DAPT in patients with acute coronary syndrome undergoing percutaneous coronary intervention are scant. We aimed to investigate whether a 6-month duration of DAPT would be non-inferior to the conventional 12-month or longer duration of DAPT in this population...
March 9, 2018: Lancet
Cho-Kai Wu, Jyh-Ming Jimmy Juang, Jiun-Yang Chiang, Yi-Heng Li, Chia-Ti Tsai, Fu-Tien Chiang
Taiwanese heart registries for the main cardiovascular diseases have been conducted in the past 10 years, with the goal of examining the quality of cardiovascular patient care, which cannot be guaranteed by the universal Taiwan National Health Insurance. The results show suboptimal adherence to guideline recommendations. Door-to-balloon time and dual antiplatelet therapy use in acute coronary syndrome, standard medications for management of heart failure, low-density lipoprotein cholesterol levels in dyslipidemia, anticoagulant agent use in atrial fibrillation, and the understanding of sudden arrhythmia death syndrome were all found to be inadequate...
March 20, 2018: Journal of the American College of Cardiology
Fred Stephen Sarfo, Osei Sarfo-Kantanka, Sheila Adamu, Vida Obese, Jennifer Voeks, Raelle Tagge, Vipin Sethi, Bruce Ovbiagele
BACKGROUND: There is an unprecedented rise in the prevalence of stroke in sub-Saharan Africa (SSA). Secondary prevention guidelines recommend that antihypertensive, statin and antiplatelet therapy be initiated promptly after ischemic stroke and adhered to in a persistent fashion to achieve optimal vascular-risk reduction. However, these goals are seldom realized in routine clinical care settings in SSA due to logistical challenges. We seek to assess whether a polypill containing fixed doses of three antihypertensive agents, a statin and antiplatelet therapy taken once daily per os for 12 months among recent stroke survivors would result in carotid intimal thickness regression compared with usual care (UC)...
March 14, 2018: Trials
GianMarco Podda, Mariangela Scavone, Eti Alessandra Femia, Marco Cattaneo
A variety of laboratory tests have been developed, which can diagnose a number of both congenital and acquired disorders of platelet function. Many tests of platelet function measure the ability of platelets to adhere to each other, forming platelet aggregates, which represent the major constituents of hemostatic plugs and of arterial thrombi. Light transmission aggregometry (LTA) is still considered the gold standard of platelet aggregation tests, but other platelet aggregation-based tests are also available...
March 14, 2018: Platelets
Jeehoon Kang, Jung-Kyu Han, Youngkeun Ahn, Shung Chull Chae, Young Jo Kim, In-Ho Chae, Seung-Ho Hur, In-Whan Seong, Jei-Keon Chae, Myeong Chan Cho, Ki-Bae Seung, Myung Ho Jeong, Han-Mo Yang, Kyung Woo Park, Hyun-Jae Kang, Bon-Kwon Koo, Hyo-Soo Kim
Third-generation P2Y12 inhibitors (prasugrel, ticagrelor) are recommended in acute myocardial infarction (AMI). We aimed to evaluate the efficacy and safety of third-generation P2Y12 inhibitors in East Asian AMI patients. From the Korean AMI Registry, 9,355 patients who received dual antiplatelet agent (aspirin with clopidogrel [AC], 6,444 [70.5%] patients; aspirin with prasugrel [AP], 1,100 [11.8%] patients; or aspirin with ticagrelor [AT], 1,811 [19.4%] patients) were analysed. In-hospital endpoints were all-cause mortality or bleeding events during admission and 1-year endpoints were major adverse cardiac and cerebrovascular events (MACCE) and major bleeding events...
March 2018: Thrombosis and Haemostasis
(no author information available yet)
Cardiovascular prevention represents a cornerstone of modern strategies to reduce the burden of cardiovascular disease. It is of key importance to prevent cardiovascular diseases and associated events, not only to reduce morbidity and mortality, but also to increase the years of wellness in the aging population and to make the growing socio-economic burden imposed by cardiovascular events more sustainable.The current approach to prevention is based on an integrated use of effective lifestyle measures and, whenever appropriate, of antihypertensive and antidiabetic drugs, lipid-lowering agents and antiplatelet drugs...
February 2018: Giornale Italiano di Cardiologia
Gerhard Selhorst, Fabian Schmidtler, Armin Ott, Evelyn Hitzke, June Tomelden, Diethmar Antoni, Ellen Hoffmann, Johannes Rieber
Dual antiplatelet therapy (DAPT) with aspirin and a P2Y12 inhibitor is a mainstay of the prevention of stent thrombosis following percutaneous coronary intervention (PCI). In the 2015 European guidelines for the management of acute coronary syndrome (ACS), prasugrel (PRA) and ticagrelor (TICA) combined with aspirin are recommended as first-line therapy. Clopidogrel (CLO) is recommended as an alternative medication for patients with contradictions to these new drugs. This single-center study analyzed the platelet function of 809 ACS patients undergoing PCI and treatment with DAPT...
March 9, 2018: Platelets
Tom Kai Ming Wang, Kok-Lam Chow, Aaron Lin, Alexei Chataline, Harvey White, Matthew Dawes, Greg Gamble, Chris Ellis
AIMS: To review the number, characteristics and clinical management of suspected ACS patients admitted to cardiology and non-cardiology services at Auckland City Hospital, to assess differences between these services and to assess the number who would potentially be enrolled in the All New Zealand Acute Coronary Syndrome (ACS) Quality Improvement Programme (ANZACS-QI) database. METHODS: Auckland City Hospital patient data was extracted from the Australia and New Zealand ACS 'SNAPSHOT' audit, performed over 14 days in May 2012...
March 9, 2018: New Zealand Medical Journal
Bülent Özin, Kudret Aytemir, Özgür Aslan, Türkay Özcan, Mehmet Kanadaşı, Mesut Demir, Mustafa Gökçe, Mehmet Murat Sucu, Murat Özdemir, Zerrin Yiğit, Mustafa Ferzeyn Yavuzkır, Ali Oto
OBJECTIVE: The goal of this study was to define clinical practice patterns for assessing stroke and bleeding risks and thromboprophylaxis in nonvalvular atrial fibrillation (NVAF) and to evaluate treatment outcomes and patient quality of life. METHODS: A clinical surveillance study was conducted in 10 tertiary healthcare centers across Turkey. Therapeutic approaches and persistence with initial treatment were recorded at baseline, the 6th month, and the 12th month in NVAF patients...
March 2018: Türk Kardiyoloji Derneği Arşivi: Türk Kardiyoloji Derneğinin Yayın Organıdır
Erman Öztürk, Ferit Onur Mutluer
In cardiology practice, anticoagulation and antiplatelet therapies are essential for most patients. As of yet, there is no high quality evidence regarding these treatments in thrombocytopenic patients, which continues to be an issue. Thrombocytopenia is defined as a platelet count of <150x109/L and is classified as severe when the platelet count is <50x109/L. Pseudothrombocytopenia, drug-induced thrombocytopenia, immune thrombocytopenia, heparin-induced thrombocytopenia, and thrombotic thrombocytopenic purpura are some of the main causes of thrombocytopenia...
March 2018: Türk Kardiyoloji Derneği Arşivi: Türk Kardiyoloji Derneğinin Yayın Organıdır
Chenglin Tian, Xiangyu Cao, Jun Wang
Various mechanisms underlie causative large artery occlusion (LAO) in patients with acute ischaemic stroke. Cardioembolic and atherosclerotic occlusions are the two most common types. The pathophysiological changes and responses to mechanical thrombectomy (MT) and antithrombotic treatments including thrombolysis, antiplatelet and anticoagulation therapy may vary among patients with different aetiological mechanisms of occlusion. Atherosclerotic occlusion is inclined to have relatively abundant collaterals and larger area of penumbra, hence a relatively wider time window for reperfusion therapy, while poor response to medical thrombolysis and MT...
December 2017: Stroke and Vascular Neurology
Kiyoshi Azakami
Patients who undergo percutaneous endoscopic gastrostomy (PEG) placement are often on antiplatelet therapy. There is a potential risk of infarction if these medications are discontinued.The guidelines of the Japan Gastroenterological Endoscopy Society, classify PEG as an operation associated with a high risk of bleeding; however, it is known that surgery can be performed without interruption when patients are treated with low-dose aspirin alone. Nevertheless, we experienced the case of severe bleeding at the incision site, which was accompanied by massive hematemesis and hemorrhagic shock the night after PEG using the modified introducer method in an 87-year-old male patient...
2018: Nihon Ronen Igakkai Zasshi. Japanese Journal of Geriatrics
Alessandra Bura Riviere, Stéphane Bouée, Caroline Laurendeau, Elodie Torreton, Julie Gourmelen, Florence Thomas-Delecourt
BACKGROUND: Little is known about the characteristics and prognosis of patients with peripheral arterial disease (PAD) and related real-life health costs in France. METHODS: A cohort of patients diagnosed with PAD between 2007 and 2011 was extracted from the French Echantillon Généraliste des Bénéficiaires (EGB) claims database. The patients were followed up from the date of PAD diagnosis. Their characteristics, incidence of death and other events, treatments, and costs were analyzed by comparison with age- and gender-matched PAD-free controls...
March 1, 2018: Journal of Vascular Surgery
Shamir R Mehta, Kevin R Bainey, Warren J Cantor, Marie Lordkipanidzé, Guillaume Marquis-Gravel, Simon D Robinson, Matthew Sibbald, Derek Y So, Graham C Wong, Joseph G Abunassar, Margaret L Ackman, Alan D Bell, Raymond Cartier, James D Douketis, Patrick R Lawler, Michael S McMurtry, Jacob A Udell, Sean van Diepen, Subodh Verma, G B John Mancini, John A Cairns, Jean-François Tanguay
Antiplatelet therapy (APT) has become an important tool in the treatment and prevention of atherosclerotic events, particularly those associated with coronary artery disease. A large evidence base has evolved regarding the relationship between APT prescription in various clinical contexts and risk/benefit relationships. The Guidelines Committee of the Canadian Cardiovascular Society and Canadian Association of Interventional Cardiology publishes regular updates of its recommendations, taking into consideration the most recent clinical evidence...
March 2018: Canadian Journal of Cardiology
Erik N Sorensen, Hannah J Voorhees, Lynn M Dees, Si M Pham, Zachary N Kon, Bartley P Griffith, Erika D Feller
There are no evidence-based guidelines for antithrombotic therapy in left ventricular assist device patients. We evaluated the efficacy of a multi-agent, test-guided protocol, which remained consistent throughout our use of the Heartware HVAD. Thrombelastography and PFA-100 guide antiplatelet titration. Goals are normal kaolin thrombelastography maximum amplitude and prolonged PFA-100. We analyzed incidence and rates of nonprocedural bleeding, stroke, and pump thrombosis for all 81 primary Heartware left ventricular assist devices implanted since 2011...
February 15, 2018: ASAIO Journal: a Peer-reviewed Journal of the American Society for Artificial Internal Organs
Urmil Pandya, Alexander Malik, Michael Messina, Abdul-Rahman Albeiruti, Chance Spalding
Reversal of antiplatelet therapy with platelet transfusion in traumatic intracranial hemorrhage remains controversial. Several studies have examined this topic but few have investigated whether the timing of transfusion affects outcomes. Patients admitted to a level 1 trauma center from 1/1/14 to 3/31/16 with traumatic intracranial hemorrhage taking pre-injury antiplatelet therapy were retrospectively analyzed. Patients on concurrent pre-injury anticoagulant therapy were excluded. Per institutional guideline, patients on pre-injury clopidogrel received 2 doses of platelets while patients on pre-injury aspirin received 1 dose of platelets...
February 13, 2018: Journal of Clinical Neuroscience: Official Journal of the Neurosurgical Society of Australasia
James A Chenoweth, Samuel D Gaona, Mark Faul, James F Holmes, Daniel K Nishijima
Importance: Current guidelines conflict on the management of older adults who have blunt head trauma taking anticoagulant and antiplatelet medications. This is partially due to the limited data comparing patients who are taking these medications with those who are not. Objective: To investigate the incidence of delayed traumatic intracranial hemorrhage in older adults with head trauma, including those taking anticoagulant and antiplatelet medications. Design, Setting, and Participants: This prospective observational cohort study included patients 55 years and older who had blunt head trauma and were transported via emergency medical services between August 1, 2015, and September 30, 2016...
February 14, 2018: JAMA Surgery
Sooyeon Oh, Sang Gyun Kim, Jung Kim, Ji Min Choi, Joo Hyun Lim, Hyo-Joon Yang, Jae Yong Park, Seung Jun Han, Jue Lie Kim, Hyunsoo Chung, Hyun Chae Jung
Background/Aims: Current guidelines recommend withholding antiplatelets for 5-7 days before high-risk endoscopic procedures. We investigated whether this reduces post-endoscopic submucosal dissection (ESD) bleeding. Methods: Gastric ESD cases with antiplatelets were retorospectively reviewed. Withholding antiplatelets for 5-7 days before ESD was defined as cessation and 0-4 days as continuation. The rate and risk of post-ESD bleeding according to the types and cessation of antiplatelets were assessed...
February 13, 2018: Gut and Liver
Ana-Catarina Pinho-Gomes, Luis Azevedo, Jung-Min Ahn, Seung-Jung Park, Taye H Hamza, Michael E Farkouh, Patrick W Serruys, Milan Milojevic, Arie Pieter Kappetein, Gregg W Stone, Andre Lamy, Valentin Fuster, David P Taggart
BACKGROUND: Despite the well-established benefits of secondary cardiovascular prevention, the importance of concurrent medical therapy in clinical trials of coronary revascularization is often overlooked. OBJECTIVES: The goal of this study was to assess compliance with guideline-directed medical therapy (GDMT) in clinical trials and its potential impact on the comparison between percutaneous coronary intervention (PCI) and coronary artery bypass grafting (CABG)...
February 13, 2018: Journal of the American College of Cardiology
Mauro Chiarito, Davide Cao, Francesco Cannata, Cosmo Godino, Corrado Lodigiani, Giuseppe Ferrante, Renato D Lopes, John H Alexander, Bernhard Reimers, Gianluigi Condorelli, Giulio G Stefanini
Importance: Patients with acute coronary syndrome (ACS) remain at high risk for experiencing recurrent ischemic events. Direct oral anticoagulants (DOAC) have been proposed for secondary prevention after ACS. Objective: To evaluate the safety and efficacy of DOAC in addition to antiplatelet therapy (APT) after ACS, focusing on treatment effects stratified by baseline clinical presentation (non-ST-segment elevation ACS [NSTE-ACS] vs ST-segment elevation myocardial infarction [STEMI])...
February 7, 2018: JAMA Cardiology
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