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Dapt score

Xiaodan Luo, Lihua Xu, Yangqiu Li, Huo Tan
Graft-versus-host disease (GVHD) induced by host antigen-presenting cells (APCs) and donor-derived T cells remains the major limitation of allogeneic bone marrow transplantation (allo-BMT). Notch signaling pathway is a highly conserved cell-cell communication that is important in T cell development. Recently, Notch signaling pathway is reported to be involved in regulating GVHD. To investigate the role of Notch inhibition in modulating GVHD, we established MHC-mismatched murine allo-BMT model. We found that inhibition of Notch signaling pathway by γ-secretase inhibitor in vivo could reduce aGVHD, which was shown by the onset time of aGVHD, body weight, clinical aGVHD scores, pathology aGVHD scores, and survival...
October 21, 2016: Cell Biology and Toxicology
Daisuke Ueshima, Takashi Ashikaga, Shunji Yoshikawa, Taro Sasaoka, Yu Hatano, Ken Kurihara, Yasuhiro Maejima, Mitsuaki Isobe
BACKGROUND: Long-term dual antiplatelet therapy (DAPT) for patients treated with coronary stents has been reported to be effective. However the effectiveness of long-term DAPT for everolimus-eluting stent (EES) implanted patients has been controversial. We assessed the major adverse cardiac and cerebral events (MACCE: a composite of death, myocardial infarction, or cerebral arterial disease) in patients free from MACCE during the first 2 years after EES implantation. METHODS AND RESULTS: A total of 1918 patients who underwent successful percutaneous coronary intervention (PCI) with EES at 22 centers in Japan in 2010-2011 were enrolled, and 742 patients were free from MACCE for 2 years...
September 27, 2016: Journal of Cardiology
Francesco Barillà, Francesco Pelliccia, Mauro Borzi, Paolo Camici, Livio Dei Cas, Matteo Di Biase, Ciro Indolfi, Giuseppe Mercuro, Vincenzo Montemurro, Luigi Padeletti, Pasquale Perrone Filardi, Carmine D Vizza, Francesco Romeo
Definition of the optimal duration of dual anti-platelet therapy (DAPT) is an important clinical issue, given the large number of patients having percutaneous coronary intervention (PCI), the costs and risks of pharmacologic therapy, the consequences of stent thrombosis, and the potential benefits of DAPT in preventing ischaemic outcomes beyond stent thrombosis. Nowadays, the rationale for a prolonged duration of DAPT should be not only the prevention of stent thrombosis, but also the prevention of ischaemic events unrelated to the coronary stenosis treated with index PCI...
September 15, 2016: Journal of Cardiovascular Medicine
Seung-Yul Lee, Myeong-Ki Hong, Dong-Ho Shin, Jung-Sun Kim, Byeong-Keuk Kim, Young-Guk Ko, Donghoon Choi, Yangsoo Jang, Hyo-Soo Kim, Marco Valgimigli, Tullio Palmerini, Gregg W Stone
BACKGROUND: The optimal duration of dual antiplatelet therapy (DAPT) after drug-eluting stent (DES) implantation has not been established yet. The objectives of this study were to evaluate the optimal duration of DAPT after the DES implantation. METHODS: From three randomized controlled trials investigating DAPT duration after coronary stent implantation, we evaluated the clinical outcomes of short-term (6 months or less) DAPT compared with prolonged DAPT (12 months or more) in 1661 DES-treated pairs matched by propensity scores...
September 8, 2016: Clinical Research in Cardiology: Official Journal of the German Cardiac Society
Norihiro Kobayashi, Masahiro Yamawaki, Masatsugu Nakano, Keisuke Hirano, Motoharu Araki, Hideyuki Takimura, Yasunari Sakamoto, Shinsuke Mori, Masakazu Tsutsumi, Yoshiaki Ito
BACKGROUND: No scoring system for evaluating the bleeding risk of atrial fibrillation (AF) patients after drug-eluting stent (DES) implantation with triple antithrombotic therapy (TAT) is available. We aimed to develop a new scoring system for predicting bleeding complications in AF patients after DES implantation with TAT. METHODS AND RESULTS: Between April 2007 and April 2014, 227 AF patients undergoing DES implantation with TAT were enrolled. Bleeding incidence defined as Bleeding Academic Research Consortium criteria≥2 was investigated and predictors of bleeding complications were evaluated using multivariate analysis...
November 15, 2016: International Journal of Cardiology
Fathima Aaysha Cader, M Maksumul Haq, Sahela Nasrin, Md Rezaul Karim
BACKGROUND: Striking an adequate balance between bleeding risks and prevention of stent thrombosis can be challenging in the setting of percutaneous coronary intervention (PCI) with drug eluting stents (DES) in acute myocardial infarction (MI). This is more pronounced in patients treated with both low molecular weight heparin (LMWH) and dual antiplatelet therapy (DAPT). Prasugrel, a second generation thienopyridine with more potent platelet inhibition capability, is associated with significant bleeding risks...
August 30, 2016: BMC Cardiovascular Disorders
Kohei Ishibashi, Koji Miyamoto, Tsukasa Kamakura, Mitsuru Wada, Ikutaro Nakajima, Yuko Inoue, Hideo Okamura, Takashi Noda, Takeshi Aiba, Shiro Kamakura, Wataru Shimizu, Satoshi Yasuda, Takashi Akasaka, Kengo Kusano
Previous studies showed that continuous anticoagulation or single antiplatelet therapy during implantations of cardiac implantable electronic devices (CIED) was relatively safe. However, the safety of continuous multi antithrombotic therapy (AT) in patients undergoing CIED interventions has not been clearly defined. We sought to evaluate the safety of this therapy during CIED implantations. A total of 300 consecutive patients (mean 69 years old, 171 males) with CIED implantations were enrolled in this study...
July 28, 2016: Heart and Vessels
Tim Kinnaird, Mehmood Butt, Fairoz Abdul, Khaled Yazji, Ahmed Hailan, Sean Gallagher, Nicholas Ossei-Gerning, Alexander Chase, Anirban Choudhury, David Smith, Richard Anderson
INTRODUCTION: Prolonged dual anti-platelet therapy (DAPT) may cause excess bleeding in certain patients. The biolimus-A9 drug-coated stent (BA9-DCS) has a rapid drug-elution profile allowing shortened DAPT. Data were gathered on the early experience implanting this stent in drug-eluting stent eligible patients deemed to be at high risk of bleeding. BACKGROUND AND METHODS: The demographics, procedural data and clinical outcomes were gathered prospectively for 249 patients treated with a BA9-DCS stent at 2 UK centres, and compared to a cohort of patients treated in the same period with drug-eluting stents (PCI-DES)...
2016: PloS One
Aimee L Fake, Scott A Harding, Philip P Matsis, Peter D Larsen
BACKGROUND: Dual anti-platelet therapy (DAPT) with aspirin and a P2Y12receptor antagonist is standard of care following an acute coronary syndrome (ACS), as it has been shown to reduce recurrent myocardial infarction (MI) and death. In atrial fibrillation (AF) patients, the use of oral anticoagulants (OACs) is the standard of care as these agents have been shown to reduce the risk of stroke and death. Current guidelines suggest that decisions around antithrombotic therapy should be made by assessing ischaemic and bleeding risks...
2016: New Zealand Medical Journal
C Yang, Y Q Zhang, X Tang, P Gao, C L Wei, Y H Hu
OBJECTIVE: To see the influence of different antiplatelet therapies on stroke patients' readmission by performing a deep data-mining into Beijing Healthcare Insuring Database, based on a large sample size. METHODS: Aretrospective cohort study, was adopted to extract patients primarily diagnosed as ischemic stroke from healthcare database. The first hospital records were considered as the patient's baseline in this study, who were divided into MAPT (aspirin) and DAPT (aspirin and clopidogrel) according to the patient's baseline medications...
June 18, 2016: Beijing da Xue Xue Bao. Yi Xue Ban, Journal of Peking University. Health Sciences
Mariko Takeuchi, Kotaro Miyashita, Jyoji Nakagawara, Kazunori Toyoda, Kenichi Todo, Norifumi Metoki, Rieko Suzuki, Yasuhiro Manabe, Yasuhisa Akaiwa, Yasumasa Yamamoto, Kazuyuki Nagatsuka
BACKGROUND: Patients with penetrating artery territory infarction occasionally show progressive motor deficits during the acute stage with poor prognosis. Predictive indices or medical therapies for suppressing the symptomatic progression (SP) of penetrating artery infarction have not been established. In this study, we investigated SP-related clinical factors and functional outcomes, specifically improvement 3 months post ictus in patients with penetrating artery infarction. METHODS: We retrospectively examined acute stroke patients with penetrating artery infarction admitted at 7 collaborative hospitals...
August 2016: Journal of Stroke and Cerebrovascular Diseases: the Official Journal of National Stroke Association
Ruchit R Shah, Ajay Pillai, Abdullah Omar, John Zhao, Vishal Arora, Deepak Kapoor, Paul Poommipanit
INTRODUCTION: Current guidelines recommend continuation of dual anti-platelet therapy (DAPT) for 12 months after percutaneous coronary intervention (PCI). Recent studies have shown benefit in continuing DAPT beyond 12 months but at the risk of increase bleeding. To date, there has been little data on risk stratifying patients to determine who can continue DAPT beyond 12 months at minimal bleeding risk. METHODS: All patients who underwent drug-eluting stent (DES) placement from January 1, 2013 to September 30, 2014 were reviewed...
May 17, 2016: Catheterization and Cardiovascular Interventions
Usman Baber, Roxana Mehran, Gennaro Giustino, David J Cohen, Timothy D Henry, Samantha Sartori, Cono Ariti, Claire Litherland, George Dangas, C Michael Gibson, Mitchell W Krucoff, David J Moliterno, Ajay J Kirtane, Gregg W Stone, Antonio Colombo, Alaide Chieffo, Annapoorna S Kini, Bernhard Witzenbichler, Giora Weisz, Philippe Gabriel Steg, Stuart Pocock
BACKGROUND: Dual-antiplatelet therapy with aspirin and clopidogrel after percutaneous coronary intervention reduces the risk for coronary thrombotic events (CTEs) at the expense of increasing risk for major bleeding (MB). Metrics to accurately predict the occurrence of each respective event and inform clinical decision making are lacking. OBJECTIVES: The aim of this study was to develop and validate separate models to predict risks for out-of-hospital thrombotic and bleeding events after percutaneous coronary intervention with drug-eluting stents...
May 17, 2016: Journal of the American College of Cardiology
Dean J Kereiakes, Robert W Yeh, Joseph M Massaro, Donald E Cutlip, P Gabriel Steg, Stephen D Wiviott, Laura Mauri
BACKGROUND: The DAPT (Dual Antiplatelet Therapy) study enrolled patients after coronary stenting. Patients randomized to continued thienopyridine and aspirin after 12 months had lower ischemic risk but higher bleeding risk than those treated with placebo and aspirin. OBJECTIVES: This study sought to determine whether a decision tool (DAPT score) aids prescription of dual antiplatelet therapy duration in patients with or without prior myocardial infarction (MI) treated with coronary stents...
May 31, 2016: Journal of the American College of Cardiology
Robert W Yeh, Eric A Secemsky, Dean J Kereiakes, Sharon-Lise T Normand, Anthony H Gershlick, David J Cohen, John A Spertus, Philippe Gabriel Steg, Donald E Cutlip, Michael J Rinaldi, Edoardo Camenzind, William Wijns, Patricia K Apruzzese, Yang Song, Joseph M Massaro, Laura Mauri
IMPORTANCE: Dual antiplatelet therapy after percutaneous coronary intervention (PCI) reduces ischemia but increases bleeding. OBJECTIVE: To develop a clinical decision tool to identify patients expected to derive benefit vs harm from continuing thienopyridine beyond 1 year after PCI. DESIGN, SETTING, AND PARTICIPANTS: Among 11,648 randomized DAPT Study patients from 11 countries (August 2009-May 2014), a prediction rule was derived stratifying patients into groups to distinguish ischemic and bleeding risk 12 to 30 months after PCI...
April 26, 2016: JAMA: the Journal of the American Medical Association
Giuseppe Gargiulo, Francesco Costa, Sara Ariotti, Simone Biscaglia, Gianluca Campo, Giovanni Esposito, Sergio Leonardi, Pascal Vranckx, Stephan Windecker, Marco Valgimigli
BACKGROUND: Proton pump inhibitors (PPIs) are frequently prescribed in combination with clopidogrel, but conflicting data exist as to whether PPIs diminish the efficacy of clopidogrel. We assessed the association between PPI use and clinical outcomes for patients treated with percutaneous coronary intervention (PCI) and dual-antiplatelet therapy (DAPT) with clopidogrel plus aspirin. METHODS AND RESULTS: In the PRODIGY trial, 1,970 patients were randomized to 6- or 24-month DAPT at 30 days from index procedure...
April 2016: American Heart Journal
Antonia Sambola, Maria Mutuberría, Bruno García Del Blanco, Albert Alonso, José A Barrabés, Héctor Bueno, Fernando Alfonso, Angel Cequier, Javier Zueco, Oriol Rodríguez-Leor, Pilar Tornos, David García-Dorado
BACKGROUND AND PURPOSE: Selecting an ideal antithrombotic therapy for elderly patients with atrial fibrillation (AF) undergoing percutaneous coronary intervention (PCI) can be challenging since they have a higher thromboembolic and bleeding risk than younger patients. The current study aimed to assess the efficacy and safety of triple therapy (TT: oral anticoagulation plus dual antiplatelet therapy: aspirin plus clopidogrel) in patients ≥75 years of age with atrial fibrillation (AF) undergoing percutaneous coronary intervention (PCI)...
2016: PloS One
Amit P Amin, Tracy Y Wang, Lisa McCoy, Richard G Bach, Mark B Effron, Eric D Peterson, David J Cohen
BACKGROUND: Prolonged dual antiplatelet therapy (DAPT) is recommended after an acute myocardial infarction (AMI) to reduce ischemic events but is associated with increased rates of major and minor bleeding. OBJECTIVES: This study sought to determine the incidence of post-percutaneous coronary intervention (PCI) bleeding that occurs on contemporary DAPT and its impact on quality of life (QOL). METHODS: We studied 9,290 AMI patients treated with PCI and discharged alive between April 2010 and September 2012...
January 5, 2016: Journal of the American College of Cardiology
Antonia Sambola, Maria Mutuberría, Bruno García Del Blanco, Albert Alonso, José A Barrabés, Fernando Alfonso, Héctor Bueno, Angel Cequier, Javier Zueco, Oriol Rodríguez-Leor, Eduard Bosch, Pilar Tornos, David García-Dorado
BACKGROUND: The effects of dual antiplatelet therapy (DAPT) and triple therapy (TT: DAPT plus oral anticoagulation) in patients with atrial fibrillation (AF) undergoing percutaneous coronary intervention (PCI) regarding to CHA2DS2-VASc score remain undefined.We compare the effect of TT vs. DAPT in this setting regarding the CHA2DS2-VASc score. METHODS AND RESULTS: In a prospective multicenter registry, 585 patients (75.2% male, 73.2 ± 8.2 years) with AF undergoing PCI were followed up during 1 year...
2016: Circulation Journal: Official Journal of the Japanese Circulation Society
Ikram Ullah, Farooq Ahmad, Salman Ahmad, Yasir Hayat
BACKGROUND: Stroke secondary to Atrial Fibrillation is usually due to thrombi formed in the left atrium and left atrial appendage embolizing to cause ischemic stroke. Therefore, in patients with Atrial Fibrillation, antithrombotic therapy is recommended to prevent stroke. Vitamin K antagonist therapy is most widely used antithrombotic therapy for patients with valvular and non valvular AF. Aspirin is recommended only in low risk patients. This study was conducted to determine the stroke prevention practices in local patients with atrial fibrillation who were candidates for anticoagulation therapy...
July 2015: Journal of Ayub Medical College, Abbottabad: JAMC
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