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Antiplatelet therapy

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https://www.readbyqxmd.com/read/28823143/stent-thrombosis-and-optimal-duration-of-dual-antiplatelet-therapy-after-coronary-stenting-in-contemporary-practice
#1
Min Soo Cho, Duk-Woo Park
The introduction of drug-eluting stents (DES) in the practice of percutaneous coronary intervention (PCI) has substantially reduced angiographic and clinical restenosis but is associated with an increasing propensity for very late stent thrombosis (ST). Among several clinical, lesion, or procedure-related predictors of ST, early discontinuation of dual antiplatelet therapy (DAPT) is the most important factor for DES-associated late thrombosis; therefore, the optimal duration of DAPT is a major issue to be critically considered in the current DES era...
August 22, 2017: Korean Journal of Internal Medicine
https://www.readbyqxmd.com/read/28822088/very-late-scaffold-thrombosis-one-week-after-the-discontinuation-of-dual-antiplatelet-therapy
#2
Futoshi Yamanaka, Koki Shishido, Shigeru Saito
No abstract text is available yet for this article.
August 18, 2017: Cardiovascular Intervention and Therapeutics
https://www.readbyqxmd.com/read/28820484/platelet-aggregometry-testing-molecular-mechanisms-techniques-and-clinical-implications
#3
REVIEW
Katalin Koltai, Gabor Kesmarky, Gergely Feher, Antal Tibold, Kalman Toth
Platelets play a fundamental role in normal hemostasis, while their inherited or acquired dysfunctions are involved in a variety of bleeding disorders or thrombotic events. Several laboratory methodologies or point-of-care testing methods are currently available for clinical and experimental settings. These methods describe different aspects of platelet function based on platelet aggregation, platelet adhesion, the viscoelastic properties during clot formation, the evaluation of thromboxane metabolism or certain flow cytometry techniques...
August 18, 2017: International Journal of Molecular Sciences
https://www.readbyqxmd.com/read/28819709/use-of-direct-oral-anticoagulants-in-patients-on-immunomodulatory-agents
#4
L Man, A Morris, J Brown, S Palkimas, K Davidson
Immunomodulatory agents (IMiDs) are used to treat multiple hematologic malignancies. Their use is also associated with increased risk of venous thromboembolism (VTE). Direct oral anticoagulants (DOACs) have been increasingly utilized but due to their relative novelty, their role in malignancy has only been recently investigated. The objective of this study was to assess the safety and efficacy of DOACs in patients receiving IMiDs. This was a retrospective study of patients at our institution treated with an IMiD and concomitant warfarin or DOAC between January 1, 2010 and December 31, 2015...
August 17, 2017: Journal of Thrombosis and Thrombolysis
https://www.readbyqxmd.com/read/28818746/patients-with-atrial-fibrillation-and-coronary-artery-disease-double-trouble
#5
REVIEW
Ewelina Michniewicz, Elżbieta Mlodawska, Paulina Lopatowska, Anna Tomaszuk-Kazberuk, Jolanta Malyszko
Coronary artery disease (CAD) is the most common cardiovascular disease while atrial fibrillation (AF) is the most common cardiac arrhythmia. Both diseases share associated risk factors - hypertension, diabetes mellitus, sleep apnea, obesity and smoking. Moreover, inflammation plays a causative role in both diseases. The prevalence of CAD in patients with AF is from 17% to 46.5% while the prevalence of AF among patients with CAD is low and it is estimated from 0.2% to 5%. AF is a well-established factor of poor short- and long-term prognosis in patients with acute myocardial infarction (AMI) and is associated with a marked increase in overall mortality...
August 14, 2017: Advances in Medical Sciences
https://www.readbyqxmd.com/read/28818261/contemporary-medical-therapies-of-atherosclerotic-carotid-artery-disease
#6
Suk F Cheng, Martin M Brown
Contemporary medical therapy consists of identification and treatment of all patient-modifiable vascular risk factors. Specific atherosclerotic disease therapies are designed to reduce the risk of thrombosis, and the disease progression in order to reduce the risk of future cardiovascular events. Contemporary medical management emphasizes the need to support the patient in achieving lifestyle modifications and to adjust medication to achieve individualized target values for specific quantifiable risk factors...
March 2017: Seminars in Vascular Surgery
https://www.readbyqxmd.com/read/28818254/medical-treatment-strategies-to-reduce-perioperative-morbidity-and-mortality-after-carotid-surgery
#7
A Ross Naylor
There is a paucity of high-quality evidence regarding what constitutes "optimal medical therapy" for the purposes of reducing morbidity/mortality after carotid endarterectomy (CEA). All patients should be prescribed antiplatelet therapy. Low-dose aspirin (75 to 325 mg) should be continued throughout the perioperative period and there is no evidence that higher doses confer additional benefit. There is emerging evidence that early implementation of dual antiplatelet therapy in recently symptomatic patients (aspirin 75 mg plus clopidogrel 75 mg) can reduce recurrent cerebral events before CEA and that dual antiplatelet therapy will significantly reduce stroke due to early postoperative carotid thrombosis...
March 2017: Seminars in Vascular Surgery
https://www.readbyqxmd.com/read/28818164/outcome-in-chronic-subdural-hematoma-after-subdural-vs-subgaleal-drain
#8
Asim Ishfaq
OBJECTIVE: To compare the outcome after surgery for chronic subdural hematoma when the drain is placed in subdural space or subgaleal space. STUDY DESIGN: Quasi experimental study. PLACE AND DURATION OF STUDY: Combined Military Hospital, Lahore, from July 2015 to June 2016. METHODOLOGY: Patients with chronic subdural hematoma of both genders and age, ranging between 55 to 85 years, were included. Patients on antiplatelet/anticoagulant therapy and acute on chronic subdural hematoma were excluded...
July 2017: Journal of the College of Physicians and Surgeons—Pakistan: JCPSP
https://www.readbyqxmd.com/read/28818058/evaluation-of-therapy-management-and-outcome-in-takotsubo-syndrome
#9
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/28817535/can-prasugrel-decrease-the-extent-of-periprocedural-myocardial-injury-during-elective-pci
#10
Mariusz Tomaniak, Łukasz Kołtowski, Janusz Kochman, Zenon Huczek, Adam Rdzanek, Arkadiusz Pietrasik, Aleksandra Gasecka, Sylwia Gajda, Grzegorz Opolski, Krzysztof J Filipiak
INTRODUCTION    Periprocedural myocardial injury may be associated with an increased risk of cardiovascular events. The evidence on safety and efficacy of more potent P2Y12 antagonists in reduction of periprocedural myocardial injury among patients undergoing elective percutaneous coronary interventions (PCI) with inadequate response to clopidogrel is limited.  OBJECTIVES    The aim of the study was to evaluate the impact of prasugrel on the incidence of periprocedural myocardial injury among patients undergoing elective PCI with inadequate response to clopidogrel diagnosed by point-of-care genotyping and platelet function testing (PFT)...
August 17, 2017: Polish Archives of Internal Medicine
https://www.readbyqxmd.com/read/28816542/the-fate-of-asymptomatic-severe-carotid-stenosis-in-the-era-of-best-medical-therapy
#11
Rodolfo Pini, Gianluca Faggioli, Andrea Vacirca, Laura Maria Cacioppa, Enrico Gallitto, Mauro Gargiulo, Andrea Stella
BACKGROUND: Medical therapy for asymptomatic carotid artery stenosis (ACAS) may obviate the carotid revascularization, according to recent literature reports, but many studies also considered moderate carotid artery stenosis (50-69% NASCET). This study reviews the most recent series of ACAS focusing on ipsilateral transient ischemic attack (TIA) stroke and annual risk of stroke in patients with ACAS ≥70%, thereby also evaluating the adherence to best medical therapy (BMT). METHODS: A systematic review consisting of all the series of patients with ACAS being treated medically was performed, which was published after 2005...
August 17, 2017: Brain Injury: [BI]
https://www.readbyqxmd.com/read/28814587/a-case-of-cardiopulmonary-arrest-due-to-spontaneous-coronary-artery-dissection-in-a-pregnant-woman
#12
Emiko Ejima, Yoshinobu Murasato
We present the case of a young pregnant woman with cardiopulmonary arrest due to acute coronary syndrome. Emergent coronary angiography (CAG) and intravascular ultrasound (IVUS) showed extensive coronary artery dissection in the left anterior descending artery, which was treated with primary percutaneous coronary intervention. After managing the heart failure and disseminated intravascular coagulation, a dead fetus was delivered via caesarean section 4 days after admission to the hospital. Follow-up CAG and IVUS at 18 months showed persistent dissection in the non-stented site; hence, another stent was implanted...
August 16, 2017: BMJ Case Reports
https://www.readbyqxmd.com/read/28810647/limb-graft-occlusion-following-endovascular-aortic-repair-incidence-causes-treatment-and-prevention-in-a-study-cohort
#13
Guoquan Wang, Shuiting Zhai, Tianxiao Li, Xuan Li, Danghui Lu, Bo Wang, Dongbin Zhang, Shuaitao Shi, Zhidong Zhang, Kai Liang, Kewei Zhang, Xiaoyang Fu, Kun Li, Weixiao Li
The present study investigated the incidence, causes, treatment and prevention of limb graft occlusion following endovascular aortic repair (EVAR). A total of 66 cases of abdominal aortic aneurysm receiving EVAR at our department from January 2005 to December 2013 were enrolled. After EVAR, patients received routine antiplatelet therapy of 75 mg PLAVIX for 6 months and then 100 mg Aspirin for another 6 months by oral administration. According to previous clinical experiences, antiplatelet therapy is able to effectively reduce the incidence of iliac occlusion after EVAR...
August 2017: Experimental and Therapeutic Medicine
https://www.readbyqxmd.com/read/28810280/-dual-antiplatelet-therapy-in-the-perioperative-period-to%C3%A2-continue-or-discontinue-treatment
#14
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/28809046/platelet-transfusion-to-reverse-antiplatelet-therapy-before-decompressive-surgery-in-patients-with-intracranial-haemorrhage
#15
M Baschin, S Selleng, J-P Zeden, A Westphal, T Kohlmann, H W Schroeder, A Greinacher, T Thiele
BACKGROUND: Platelet concentrates (PC) are transfused to improve primary haemostasis before urgent neurosurgery in patients with intracranial haemorrhage (ICH) receiving antiplatelet therapy (APT). It is unresolved, whether PCs increase the risk for major cardio- and cerebrovascular adverse events. We evaluated a standardized transfusion regimen to reverse APT in patients with ICH who required decompressive neurosurgery. METHODS: Analysed were consecutive patients between 2012 and 2014...
August 14, 2017: Vox Sanguinis
https://www.readbyqxmd.com/read/28808507/cyp2c19-genetic-variation-and-individualized-clopidogrel-prescription-in-a-cardiology-clinic
#16
Seyed Abbas Mirabbasi, Koroush Khalighi, Yin Wu, Stanley Walker, Bahar Khalighi, Wuqiang Fan, Archana Kodali, Gang Cheng
Background: Clopidogrel (Plavix) is an antiplatelet medication that is routinely used in patients with cardiovascular disease. Cytochrome P2C19 enzymes play a major role in its metabolism, which determines its varied therapeutic level and its effectiveness. Objectives: To customize clopidogrel therapy and evaluate its efficacy by using CYP2C19 genotypic and phenotypic information to improve clinical outcomes in patients. Methods: A total of 465 patients with underlying cardiovascular disease were selected from our out-patient cardiology clinic...
July 2017: Journal of Community Hospital Internal Medicine Perspectives
https://www.readbyqxmd.com/read/28807744/primary-stenting-is-not-necessary-in-benign-central-venous-stenosis
#17
Lynsey E Rangel, Sean P Lyden, Daniel G Clair
OBJECTIVE: To evaluate central venous stenosis (CVS) etiologies and presentation within a vascular surgery practice. We evaluated endovascular treatment modalities and the patency rates of our interventions. METHODS: 5 year retrospective review of endovascular intervention for CVS. Patient demographics, medical comorbidities, and variables were collected including etiology, indwelling device, previous upper extremity (UE) deep venous thrombosis (DVT), long term UE indwelling device (defined as greater than 30 days), malignancy status, hypercoagulable disorders, history of radiation or mediastinal fibrosis or masses, and anticoagulation and/or antiplatelet therapy...
August 11, 2017: Annals of Vascular Surgery
https://www.readbyqxmd.com/read/28807382/association-between-statin-therapy-and-amputation-free-survival-in-patients-with-critical-limb-ischemia-in-the-critisch-registry
#18
Konstantinos Stavroulakis, Matthias Borowski, Giovanni Torsello, Theodosios Bisdas
OBJECTIVE: Secondary prevention in patients with critical limb ischemia (CLI) is crucial for the reduction of cardiovascular morbidity and mortality. Nonetheless, current recommendations are extrapolated from other high-risk populations because of the lack of CLI-dedicated trials. The aim of this explorative study was to evaluate the association of statin therapy with the outcomes of CLI patients. METHODS: The First-Line Treatments in Patients With Critical Limb Ischemia (CRITISCH) registry is a prospective multicenter registry analyzing the effectiveness of all available treatment strategies in 1200 CLI patients...
August 11, 2017: Journal of Vascular Surgery
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/28806270/new-clinical-paradigms-for-treating-and-preventing-antiplatelet-gastrointestinal-bleeding
#20
Neena S Abraham
PURPOSE OF REVIEW: To quantify antiplatelet-related gastrointestinal bleeding (GIB), characterize patients at greatest risk and summarize risk-management strategies emphasizing evolving knowledge in acute management of antiplatelet-related bleeding. RECENT FINDINGS: New paradigms for acute management of antiplatelet-related GIB exist in the domains of resuscitation and the transfusion of blood products, strategic use of proton pump therapy and identification and eradication of Helicobacter pylori...
August 12, 2017: Current Opinion in Gastroenterology
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