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Antiplatelet guidelines

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https://www.readbyqxmd.com/read/28938240/atrial-fibrillation-bleeding-and-coronary-intervention-current-recommendations
#1
Serdar Farhan, Roxana Mehran
The patient population with the need for oral anticoagulation to reduce stroke risk associated with atrial fibrillation (AF) and dual antiplatelet therapy to prevent stent thrombosis and myocardial infarction after percutaneous coronary intervention is increasing. However, patients treated with a triple therapy consisting of oral anticoagulation, aspirin, and a P2Y12 inhibitor have been demonstrated to be at high bleeding risk. The best combination of these agents and the duration of the different therapies are still uncertain...
September 21, 2017: Coronary Artery Disease
https://www.readbyqxmd.com/read/28910463/use-of-acetylsalicylic-acid-in-the-prehospital-setting-for-suspected-acute-ischemic-stroke
#2
John M Levri, Armando Ocon, Paul Schunk, Cord W Cunningham
Acute ischemic stroke (AIS) treatment guidelines include various recommendations for treatment once the patient arrives at the hospital. Prehospital care recommendations, however, are limited to expeditious transport to a qualified hospital and supportive care. The literature has insufficiently considered prehospital antiplatelet therapy. An otherwise healthy 30-year-old black man presented with headache for about 3 hours, left-sided facial and upper extremity numbness, slurred speech, miosis, lacrimation, and general fatigue and malaise...
2017: Journal of Special Operations Medicine: a Peer Reviewed Journal for SOF Medical Professionals
https://www.readbyqxmd.com/read/28906404/ticagrelor-induced-life-threatening-bleeding-via-the-cyclosporine-mediated-drug-interaction-a-case-report
#3
Chi Zhang, Long Shen, Min Cui, Xiaoyan Liu, Zhichun Gu
RATIONALE: Ticagrelor has become one of the first-line antiplatelet agents in acute coronary syndrome (ACS) patients recommend by the guideline due to its more potent and predictable antiplatelet effect. However, bleeding is still a severe drug adverse reaction of ticagrelor therapy. We report a first case on ticagrelor-induced life-threatening bleeding via the cyclosporine-mediated drug interaction. PATIENT CONCERNS: A 58-year-old Chinese male who received cyclosporine 200 mg daily 5 years after renal transplantation...
September 2017: Medicine (Baltimore)
https://www.readbyqxmd.com/read/28874297/patients-with-non-st-segment-elevation-acute-coronary-syndromes-managed-without-coronary-revascularization-a-population-needing-treatment-improvement
#4
Alberto Menozzi, Stefano De Servi, 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, Zoran Olivari, Leonardo De Luca
NSTE-ACS patients are a heterogeneous population, with different clinical features and prognosis. A large proportion of them is medically managed, without any revascularization. In the EYSHOT and FAST-MI registries such patients were 40% and 35%, respectively. These patients are at higher risk of adverse cardiovascular events and have a worse prognosis compared with those receiving revascularization. Medically managed NSTE-ACS patients consist of different subgroups: those not undergoing coronary angiography, those without significant coronary artery disease, and those with coronary stenoses not referred to revascularization...
October 15, 2017: International Journal of Cardiology
https://www.readbyqxmd.com/read/28868073/antithrombotic-treatment-tailoring-and-risk-score-evaluation-in-elderly-patients-diagnosed-with-an-acute-coronary-syndrome
#5
REVIEW
Alexandru Nicolae Mischie, Catalina Liliana Andrei, Crina Sinescu, Gani Bajraktari, Eugen Ivan, Georgios Nikolaos Chatziathanasiou, Michele Schiariti
Age is an important prognostic factor in the outcome of acute coronary syndromes (ACS). A substantial percentage of patients who experience ACS is more than 75 years old, and they represent the fastest-growing segment of the population treated in this setting. These patients present different patterns of responses to pharmacotherapy, namely, a higher ischemic and bleeding risk than do patients under 75 years of age. Our aim was to identify whether the currently available ACS ischemic and bleeding risk scores, which has been validated for the general population, may also apply to the elderly population...
July 2017: Journal of Geriatric Cardiology: JGC
https://www.readbyqxmd.com/read/28867157/-fine-tuning-of-antithrombotic-therapy-in-patients-with-non-valvular-atrial-fibrillation-the-afinva-register
#6
Daniela Dubois Marques, Vicente Mora Llabata, Julián Pacheco Arroyo, Salvador Gasull Insertis, Manuela Vicente Cañizares, Ildefonso Roldán Torres
OBJECTIVE: To determine whether antithrombotic treatment (ATT) in patients with non-valvular atrial fibrillation in a health area complies with the recommendations of current clinical guidelines. DESIGN: Prospective observational study. LOCATION: Primary Health Care Centres and Cardiology Department of a Health Department of the Valencian Community, Spain. PARTICIPANTS: A total of 505 patients with nonvalvular atrial fibrillation were included in the study...
August 31, 2017: Atencion Primaria
https://www.readbyqxmd.com/read/28862960/selection-of-stent-type-in-patients-with-atrial-fibrillation-presenting-with-acute-myocardial-infarction-an-analysis-from-the-action-acute-coronary-treatment-and-intervention-outcomes-network-registry-get-with-the-guidelines
#7
Amit N Vora, Tracy Y Wang, Shuang Li, Karen Chiswell, Connie Hess, Renato D Lopes, Sunil V Rao, Eric D Peterson
BACKGROUND: Patients receiving oral anticoagulation in addition to dual-antiplatelet therapy are known to be at high risk for bleeding events; thus, the selection of a drug-eluting stent (DES) versus a bare metal stent (BMS) can have important implications for patients with atrial fibrillation (AF) presenting with acute myocardial infarction (MI). METHODS AND RESULTS: From the National Cardiovascular Data Registry ACTION (Acute Coronary Treatment and Intervention Outcomes Network) Registry-Get With the Guidelines, we identified 14 427 AF patients presenting with acute MI undergoing percutaneous coronary intervention from 2008 to 2014...
August 21, 2017: Journal of the American Heart Association
https://www.readbyqxmd.com/read/28861274/long-term-left-ventricular-remodelling-after-revascularisation-for-st-segment-elevation-myocardial-infarction-as-assessed-by-cardiac-magnetic-resonance-imaging
#8
Mariella Ecj Hassell, Wieneke Vlastra, Lourens Robbers, Alexander Hirsch, Robin Nijveldt, Jan Gp Tijssen, Albert C van Rossum, Felix Zijlstra, Jan J Piek, Ronak Delewi
OBJECTIVE: Left ventricular remodelling following a ST-segment elevated myocardial infarction (STEMI) is an adaptive response to maintain the cardiac output despite myocardial tissue loss. Limited studies have evaluated long term ventricular function using cardiac magnetic resonance imaging (CMR) after STEMI. METHODS: Study population consisted of 155 primary percutaneous coronary intervention treated first STEMI patients. CMR was performed at 4±2 days, 4 months and 24 months follow-up...
2017: Open Heart
https://www.readbyqxmd.com/read/28859658/the-effect-of-socioeconomic-disadvantage-on-prescription-of-guideline-recommended-medications-for-patients-with-acute-coronary-syndrome-systematic-review-and-meta-analysis
#9
REVIEW
Karice K Hyun, David Brieger, Mark Woodward, Sarah Richtering, Julie Redfern
BACKGROUND: There are varying data on whether socioeconomic status (SES) affects the treatment in patients with acute coronary syndrome (ACS). Our aim was to obtain a reliable estimate of the effect of SES on discharge prescription of medications following an ACS through systematic review and meta-analysis. METHODS: Medline, EMBASE and Global Health were searched systematically on 6th April 2016. Studies were eligible if the participants had ACS and reported the rate/odds of guideline-recommended ACS medications prescription (aspirin, antiplatelet, beta blocker, angiotensin co-enzyme inhibitors (ACEi)/angiotensin receptor blockers (ARB) and statin) at discharge stratified by SES...
August 31, 2017: International Journal for Equity in Health
https://www.readbyqxmd.com/read/28855078/guided-de-escalation-of-antiplatelet-treatment-in-patients-with-acute-coronary-syndrome-undergoing-percutaneous-coronary-intervention-tropical-acs-a-randomised-open-label-multicentre-trial
#10
Dirk Sibbing, Dániel Aradi, Claudius Jacobshagen, Lisa Gross, Dietmar Trenk, Tobias Geisler, Martin Orban, Martin Hadamitzky, Béla Merkely, Róbert Gábor Kiss, András Komócsi, Csaba A Dézsi, Lesca Holdt, Stephan B Felix, Radoslaw Parma, Mariusz Klopotowski, Robert H G Schwinger, Johannes Rieber, Kurt Huber, Franz-Josef Neumann, Lukasz Koltowski, Julinda Mehilli, Zenon Huczek, Steffen Massberg
BACKGROUND: Current guidelines recommend potent platelet inhibition with prasugrel or ticagrelor for 12 months after an acute coronary syndrome managed with percutaneous coronary intervention (PCI). However, the greatest anti-ischaemic benefit of potent antiplatelet drugs over the less potent clopidogrel occurs early, while most excess bleeding events arise during chronic treatment. Hence, a stage-adapted treatment with potent platelet inhibition in the acute phase and de-escalation to clopidogrel in the maintenance phase could be an alternative approach...
August 25, 2017: Lancet
https://www.readbyqxmd.com/read/28844991/recalibrating-reperfusion-waypoints
#11
Paul W Armstrong, Robert C Welsh
The realization that thrombus was the cause and not the consequence of acute myocardial infarction was a transformative pathophysiologic insight. An even more stunning observation was the subsequent discovery that restoration of coronary patency could salvage ischemic myocardium and improve clinical outcomes in ST-elevation acute myocardial infarction (STEMI). Assertive clinical investigations of both the content and process of STEMI care over the subsequent 4 decades has demonstrated that the ultimate success of reperfusion is modulated by the timeliness, efficiency, and efficacy with which it is applied...
August 27, 2017: Circulation
https://www.readbyqxmd.com/read/28844035/state-of-the-art-optimal-medical-therapy-competing-with-or-complementary-to-revascularisation-in-patients-with-coronary-artery-disease
#12
Javaid Iqbal, Robert Widmer, Bernard J Gersh
The role of coronary revascularisation with PCI and CABG in patients with stable and unstable coronary artery disease (CAD) is well established and there is a general consensus among guidelines as regards the indications for coronary revascularisation. Although revascularisation has undoubtedly revolutionised the treatment of CAD, it is vital to understand the recent advances and importance of the concomitant use of evidence-based optimal medical therapy (OMT). In contemporary practice, OMT should include an antiplatelet agent (or dual antiplatelet therapy when indicated) and a lipid-lowering drug for all patients, and a beta-blocker and an ACE inhibitor (or angiotensin receptor blocker) for the vast majority of patients, along with addressing cardiac risk factors and lifestyle management...
August 25, 2017: EuroIntervention
https://www.readbyqxmd.com/read/28830706/underutilization-of-antiplatelet-and-statin-therapy-after-postoperative-myocardial-infarction-following-vascular-surgery
#13
Andrea M Steely, Peter W Callas, Patrick K Hohl, David J Schneider, Randall R De Martino, Daniel J Bertges
OBJECTIVE: The objective of this study was to investigate adherence to practice guidelines for antiplatelet and statin use after postoperative myocardial infarction (POMI) and its effect on late mortality following vascular surgery in a multicenter registry. METHODS: Antiplatelet and statin use was examined in 1749 vascular surgery procedures with POMI within the Vascular Quality Initiative (VQI) from 2005 to 2015. Our primary aim was to assess cardiac medication (CM) use at discharge, defined as (1) single antiplatelet therapy (SAPT; aspirin or P2Y12 inhibitor) or dual antiplatelet therapy (DAPT; aspirin and P2Y12 inhibitor) and (2) statin therapy...
August 19, 2017: Journal of Vascular Surgery
https://www.readbyqxmd.com/read/28826823/medication-use-in-long-term-survivors-from-the-monica-kora-myocardial-infarction-registry
#14
Ute Amann, Inge Kirchberger, Margit Heier, Christian Thilo, Bernhard Kuch, Christa Meisinger
BACKGROUND: Prior studies reported high guideline adherence for secondary prevention medications (SPM) at hospital discharge in patients with acute myocardial infarction (AMI). Less is known about medication use in long-term AMI survivors. METHODS: Of the 2077 registered persons with an AMI between 2000 and 2008 who responded to a postal follow-up survey in 2011, 1311 men and 356 women, aged between 34.4 and 84.9years, reported medication intake 7days prior to the survey...
August 18, 2017: European Journal of Internal Medicine
https://www.readbyqxmd.com/read/28826683/perioperative-management-of-dual-antiplatelet-therapy-in-patients-with-new-generation-drug-eluting-metallic-stents-and-bioresorbable-vascular-scaffolds-undergoing-elective-noncardiac-surgery
#15
REVIEW
Michael Essandoh, Adam A Dalia, Mazen Albaghdadi, Barry George, Nicoleta Stoicea, Muhammad Shabsigh, Sunil V Rao
Dual-antiplatelet therapy (DAPT) is considered mandatory after new-generation drug-eluting coronary stent implantation to reduce ischemic complications such as stent thrombosis, but the need for DAPT makes the timing of elective surgery difficult. Interrupting DAPT places patients at risk for stent thrombosis, and surgery in the setting of DAPT may lead to bleeding. The 2016 American College of Cardiology/American Heart Association guideline recommends delaying elective noncardiac surgery for a minimum 6-month period to reduce ischemic risks after the implantation of a second-generation metallic drug-eluting stent (DES)...
April 26, 2017: Journal of Cardiothoracic and Vascular Anesthesia
https://www.readbyqxmd.com/read/28818058/evaluation-of-therapy-management-and-outcome-in-takotsubo-syndrome
#16
Nadine Abanador-Kamper, Lars Kamper, Judith Wolfertz, Witali Pomjanski, Anamaria Wolf-Pütz, Melchior Seyfarth
BACKGROUND: To date there is no validated evidence for standardized treatment of patients with Takotsubo syndrome (TTS). Medication therapy after final TTS diagnosis remains unclear. Previous data on patient outcome is ambivalent. Aim of this study was to evaluate medication therapy in TTS and to analyze patient outcome. METHODS: Within an observational retrospective cohort study we analyzed our medical records and included 72 patients with TTS that underwent cardiovascular magnetic resonance imaging (CMR) after a median of 2 days interquartile range (IQR 1-3...
August 17, 2017: BMC Cardiovascular Disorders
https://www.readbyqxmd.com/read/28816774/practitioner-gender-and-quality-of-care-in-ambulatory-cardiology-practices-a-report-from-the-national-cardiovascular-data-practice-innovation-and-clinical-excellence-pinnacle-registry
#17
Dipti Gupta, Fengming Tang, Frederick A Masoudi, Philip G Jones, Paul S Chan, Stacie L Daugherty
BACKGROUND: Some studies suggest that female practitioners are more likely to provide guideline-concordant care than male practitioners; however, little is known about the role of practitioner gender in cardiology. OBJECTIVE: The aim of the study was to measure the association between practitioner gender and adherence to the cardiovascular performance measures in the American College of Cardiology's ambulatory Practice Innovation and Clinical Excellence Registry...
August 15, 2017: Journal of Cardiovascular Nursing
https://www.readbyqxmd.com/read/28810280/-dual-antiplatelet-therapy-in-the-perioperative-period-to%C3%A2-continue-or-discontinue-treatment
#18
Jürgen Koscielny, Christian von Heymann, Uwe Zeymer, Jochen Cremer, Michael Spannagl, Joachim Labenz, Evangelos Giannitsis, Franz Goss
Background For secondary prevention of acute coronary syndrome, guidelines recommend dual antiplatelet therapy (DAPT) with acetylsalicylic acid and a P2Y12 receptor antagonist such as clopidogrel, prasugrel or ticagrelor for a period of 12 months. Often, uncertainty exists with respect to surgical or diagnostic procedures in these high-risk patients: can the DAPT be continued without interruption? If not, what is the recommended withdrawal strategy? What should be considered for the perioperative management? Methods An interdisciplinary group of experienced experts in the fields of cardiology, cardiac surgery, gastroenterology, anaesthesiology, intensive care and haemostaseology developed recommendations relevant to daily clinical practice based on the current scientific evidence...
August 2017: Deutsche Medizinische Wochenschrift
https://www.readbyqxmd.com/read/28806755/acquired-von-willebrand-syndrome-in-cardiogenic-shock-patients-on-mechanical-circulatory-microaxial-pump-support
#19
Ulrike Flierl, Jörn Tongers, Dominik Berliner, Jan-Thorben Sieweke, Florian Zauner, Christoph Wingert, Christian Riehle, Johann Bauersachs, Andreas Schäfer
Early use of mechanical circulatory support, e.g. veno-arterial extracorporeal membrane oxygenation (ECMO) or left ventricular unloading by microaxial pump in refractory cardiogenic shock is recommended in current guidelines. Development of acquired von Willebrand Syndrome (AVWS) in patients with left ventricular assist devices (LVADs) and ECMO has been reported. There is an increasing number of patients treated with the Impella® CP microaxial pump for left ventricular unloading. However, the prevalence of AVWS in these high risk patients is unknown and needs to be determined...
2017: PloS One
https://www.readbyqxmd.com/read/28806011/a-primer-on-bleeding-risk-and-management-strategies-of-newer-oral-anti-platelet-agents-in-cardiovascular-disease
#20
Jimmy Yee, Vishesh Kumar, Amornpol Anuwatworn, Marian Petrasko, Adam Stys
Aspirin, the first antiplatelet agent, has been around since the 19th century, and is one of the most established drugs in history. With the improvement of coronary interventions in the past few decades, there has been more reliance on oral antiplatelet agents to reduce complications of in-stent restenosis/thrombosis. Clopidogrel was initially introduced in 1997, and within the past seven years, two additional oral antiplatelet agents have been approved by the U.S. Food and Drug Administration. With more potent antiplatelet agents comes increased risks of adverse effects...
October 2016: South Dakota Medicine: the Journal of the South Dakota State Medical Association
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