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cardiac stents and discontinuing clopidogrel

Wataru Fujimoto, Takahiro Sawada, Takayoshi Toba, Yu Takahashi, Taishi Miyata, Shogo Oishi, Tsuyoshi Osue, Tetsuari Onishi, Tomofumi Takaya, Akira Shimane, Yasuyo Taniguchi, Hiroya Kawai, Yoshinori Yasaka
BACKGROUND: The use of short-duration dual antiplatelet therapy (DAPT) remains controversial. To investigate efficacy and safety of short-duration DAPT, we performed a detailed comparison of intra-stent conditions by optical coherence tomography (OCT) after second-generation drug-eluting stent implantation with short-term and standard DAPT. METHODS AND RESULTS: Eighty-two consecutive patients with stable angina pectoris who received Resolute zotarolimus-eluting stents (R-ZESs; Medtronic Cardiovascular, Santa Rosa, CA, USA) were enrolled...
February 16, 2018: Journal of Cardiology
Janna C Beavers
PURPOSE: Ticagrelor and atorvastatin are commonly used medications in the management of acute coronary syndrome and percutaneous intervention. This is a report of a patient case of a potential drug interaction leading to the use of alternative therapy. CASE REPORT: A 58-year-old male presented for cardiac catheterization following an abnormal stress test. He underwent placement of a drug-eluting stent and was started on ticagrelor. Three months later, he was noted to have elevated creatine kinase (CK), thought to be related to a potential drug-drug interaction between ticagrelor and atorvastatin...
January 1, 2017: Journal of Pharmacy Practice
Raffaele Piccolo, Fausto Feres, Alexandre Abizaid, Martine Gilard, Marie-Claude Morice, Myeong-Ki Hong, Hyo-Soo Kim, Antonio Colombo, Deepak L Bhatt, Tullio Palmerini, Gregg W Stone, Stephan Windecker, Marco Valgimigli
OBJECTIVES: The study sought to evaluate the presence of a clinically relevant rebound phenomenon after dual antiplatelet therapy (DAPT) discontinuation in randomized trials. BACKGROUND: It is currently unknown whether clopidogrel discontinuation after short-term DAPT is associated with an early hazard of ischemic events. METHODS: The authors performed an individual participant data analysis and aggregate meta-analysis. The primary outcome was major adverse cardiac and cerebrovascular events (MACCE), defined as the composite of cardiac death, myocardial infarction (MI), or stroke...
August 28, 2017: JACC. Cardiovascular Interventions
Jaya Chandrasekhar, Sameer Bansilal, Usman Baber, Samantha Sartori, Melissa Aquino, Serdar Farhan, Birgit Vogel, Michela Faggioni, Gennaro Giustino, Cono Ariti, Antonio Colombo, Alaide Chieffo, Annapoorna Kini, Richard Saporito, C Michael Gibson, Bernhard Witzenbichler, David Cohen, David Moliterno, Thomas Stuckey, Timothy Henry, Stuart Pocock, George Dangas, P Gabriel Steg, Roxana Mehran
BACKGROUND: Proton pump inhibitors (PPI) may decrease the availability of clopidogrel by competitive antagonism, leading to a potential increase in ischemic events. METHODS: We evaluated patients from the all-comer PARIS registry treated with dual antiplatelet therapy (DAPT) with aspirin and clopidogrel following coronary stenting for outcomes stratified by PPI use. Two-year major adverse cardiovascular events (MACE), composite of cardiac death, myocardial infarction, definite or probable stent thrombosis or target lesion revascularization (TLR), and net adverse cardiac events (NACE), composite of MACE or Bleeding Academic Research consortium (BARC) type 3 or 5 bleeding were assessed...
June 1, 2017: Catheterization and Cardiovascular Interventions
Luigi Chiariello, Paolo Nardi, Antonio Pellegrino, Guglielmo Saitto, Giovanni Alfonso Chiariello, Marco Russo, Jacob Zeitani, Francesco Versaci
BACKGROUND: The aim of this study was to evaluate 10-year results of same-day hybrid revascularization of concomitant carotid artery disease by stenting (CAS) and coronary artery disease by coronary artery bypass grafting (CABG), later also applied to patients requiring CAS and other than coronary open heart cardiac surgery. METHODS: One hundred thirty-two consecutive patients (70 ± 8 years, 102 men) underwent same-day CAS and CABG (group 1, n = 97) or other cardiac surgical procedures (aortic ± mitral valve surgery ± ascending aorta replacement ± CABG; group 2, n = 35)...
April 2015: Annals of Thoracic Surgery
Shirish Hiremath, Praveen Chandra, Devang Desai, R Sivakumar, S Selvamani, Anand Srinivasan, Madhu Paulose, Sajy Jose, B C Kalmath, Vilas P Magarkar, Abhijeet Pathak, Tushar Mhetre
OBJECTIVES: This study aims to assess the safety and efficacy of a biodegradable polymer-coated Rapamycin-Eluting Stent (Excel) used in conjunction with six-month dual antiplatelet therapy in daily practice. BACKGROUND: The polymeric material of cardiac stents has been reported to adversely affect the safety profile of the drug-eluting stents and is also suspected to cause serious long-term complications. It has been proposed that the biodegradable polymer coatings may reduce such late-stage adverse effects...
November 2014: Indian Heart Journal
Peng Dong, Xin-Chun Yang, Su-Yan Bian
In-stent thrombosis after cessation of antiplatelet medications in patients with drug-eluting stents (DES) is a significant problem in medical practice, particularly in the perioperative period. We report a case of an 87-year-old man with a medical history of hypertension, coronary artery disease and chronic atrophic gastritis. Very late thrombosis of a sirolimus-eluting stent occurred 1207 days after implantation, seven months after discontinuation of clopidogrel, and the interruption of aspirin 13 days in preparation of an elective endoscopic gastrointestinal procedure presented with acute myocardial infarction...
September 2014: Journal of Geriatric Cardiology: JGC
Troels Thim, Martin Berg Johansen, Gro Egholm Chisholm, Morten Schmidt, Anne Kaltoft, Henrik Toft Sørensen, Leif Thuesen, Steen Dalby Kristensen, Hans Erik Bøtker, Lars Romer Krusell, Jens Flensted Lassen, Per Thayssen, Lisette Okkels Jensen, Hans-Henrik Tilsted, Michael Maeng
BACKGROUND: The impact of adherence to the recommended duration of dual antiplatelet therapy after first generation drug-eluting stent implantation is difficult to assess in real-world settings and limited data are available. METHODS: We followed 4,154 patients treated with coronary drug-eluting stents in Western Denmark for 1 year and obtained data on redeemed clopidogrel prescriptions and major adverse cardiovascular events (MACE, i.e., cardiac death, myocardial infarction, or stent thrombosis) from medical databases...
August 13, 2014: BMC Cardiovascular Disorders
Georges El-Hayek, Franz Messerli, Sripal Bangalore, Mun K Hong, Eyal Herzog, Alexandre Benjo, Jacqueline E Tamis-Holland
Current guidelines recommend 12 months of dual antiplatelet therapy (DAPT) after drug-eluting stent (DES) implantation in the absence of increased bleeding risk. Studies have suggested that early discontinuation of DAPT can result in an increased risk of stent thrombosis. However, given the potential for major bleeding, the optimal duration of DAPT after DES implantation remains uncertain. We searched PubMed, EMBASE, Scopus, and databases from inception until October 2013 for randomized controlled trials that compared shorter versus longer DAPT duration after DES implantation...
July 15, 2014: American Journal of Cardiology
Xiao-Dong Zhuang, Ming Long, Cui-Ling Li, Cheng-Heng Hu, Zhi-Ming Du, Xin-Xue Liao
BACKGROUND: To prevent stent thrombosis (ST) after implantation of drug-eluting stents (DESs) in patients with coronary heart disease, 12-month dual antiplatelet therapy (DAPT) is recommended. However, the optimal long-term antiplatelet regimen is not clear for the patients who have completed the 12-month DAPT. METHODS: We reviewed the data of 755 consecutive patients who had undergone percutaneous coronary intervention (PCI) three years ago and completed 12-month DAPT...
May 2014: Journal of Thoracic Disease
Matthew R Reynolds, Ammar H Hawasli, Rory K J Murphy, Wilson Z Ray, Joseph R Simpson, Robert E Drzymala, Keith M Rich
BACKGROUND: Gamma Knife radiosurgery (GKS) is a primary treatment modality for small, surgically-challenging meningiomas of the skull base in carefully selected patients. Despite the overall low incidence of complications from this procedure, rare instances of hemorrhagic events following GKS have been reported. In fact, only a single, probable case of acute hemorrhage after GKS for a meningioma exists in the literature. CASE DESCRIPTION: The authors present the case of a 59-year-old female treated with GKS to a clival meningioma who suffered an acute intra- and peritumoral hemorrhage within three hours after the procedure...
February 1, 2013: Journal of Spine & Neurosurgery
Joshua P Loh, Rebecca Torguson, Lakshmana K Pendyala, Alfazir Omar, Fang Chen, Lowell F Satler, Augusto D Pichard, Ron Waksman
Premature antiplatelet therapy discontinuation (ATD) after drug-eluting stent (DES) implantation is known to predict stent thrombosis (ST). However, recent data suggest that a shorter antiplatelet therapy duration is safe with newer generation DESs. The study aimed to compare the impact of early and late clopidogrel ATDs on ST in a real-world registry of first- and second-generation DES use. A total of 6,236 patients who underwent DES implantation were analyzed retrospectively: 4,217 received first-generation DESs (sirolimus- and paclitaxel-eluting stents) and 2,019 received second-generation DESs (everolimus-eluting stents)...
June 15, 2014: American Journal of Cardiology
K Anette Fiedler, Julinda Mehilli, Sebastian Kufner, Anna Schlichting, Tareq Ibrahim, Dirk Sibbing, Ilka Ott, Heribert Schunkert, Karl-Ludwig Laugwitz, Adnan Kastrati, Stefanie Schulz
There is little evidence on the optimal mode of clopidogrel discontinuation. Epidemiological studies observed clustering of thrombotic events after cessation of chronic clopidogrel therapy. The underlying mechanism has been ascribed to transient platelet hyper-reactivity. Gradual tapering of clopidogrel may have the potential to attenuate this phenomenon. The objective of the present study was to assess whether in patients with drug-eluting stents (DES) gradual discontinuation of clopidogrel maintenance therapy is superior to conventional, abrupt discontinuation...
June 2014: Thrombosis and Haemostasis
Joseph A Walsh, Matthew J Price
INTRODUCTION: Percutaneous coronary intervention (PCI) is a highly effective treatment for obstructive coronary artery disease. Oral platelet P2Y12 receptor antagonists reduce ischemic events in patients treated with PCI. However, there are several limitations to their use, including variable pharmacodynamics, a slow onset and offset, and in those patients who are pretreated but subsequently require cardiac surgery, increased bleeding. Cangrelor is an intravenous agent that provides rapid and intensive inhibition of the P2Y12 receptor that quickly dissipates after discontinuation...
March 2014: Expert Opinion on Pharmacotherapy
Hanna Schotola, Anselm Bräuer, Katharina Meyer, José Hinz, Friedrich Albert Schöndube, Martin Bauer, Prashant Nanasaheb Mohite, Bernd Christoph Danner, Samuel Sossalla, Aron Frederik Popov
OBJECTIVES: Ticagrelor (Brilique®) is a novel reversible platelet inhibitor at P2Y12 receptor used in patients with acute coronary syndrome and patients undergoing percutaneous coronary interventions. Unlike clopidogrel (Plavix®), ticagrelor has a quicker offset of action, and therefore, it seems that platelet function recovers faster on discontinuation of therapy. These drugs sometimes cannot be stopped before coronary artery bypass grafting due to the risk of stent thrombosis or in case of emergency operations...
August 2014: European Journal of Cardio-thoracic Surgery
Yoshinobu Onuma, Dariusz Dudek, Leif Thuesen, Mark Webster, Koen Nieman, Hector M Garcia-Garcia, John A Ormiston, Patrick W Serruys
OBJECTIVES: This study sought to demonstrate the 5-year clinical and functional multislice computed tomography angiographic results after implantation of the fully resorbable everolimus-eluting scaffold (Absorb BVS, Abbott Vascular, Santa Clara, California). BACKGROUND: Multimodality imaging of the first-in-humans trial using a ABSORB BVS scaffold demonstrated at 2 years the bioresorption of the device while preventing restenosis. However, the long-term safety and efficacy of this therapy remain to be documented...
October 2013: JACC. Cardiovascular Interventions
Marek Prech, Magdalena Janus, Konrad Lukawski, Maciej Lesiak
A 36 year-old man, who had undergone a paclitaxel-eluting stent deployment into the left main (LM) coronary artery three years before, was admitted after successful resuscitation following out-of-hospital cardiac arrest due to an acute ST-segment elevation myocardial infarction. Six weeks before the admission, he had discontinued clopidogrel. Coronary angiography showed a total occlusion of the LM artery. A complex percutaneous coronary intervention including thrombectomy and a second everolimus-eluting stent deployment in the LM artery and the left descending coronary artery was performed; this resulted in the restoration of TIMI 2/3 flow...
2013: Kardiologia Polska
Laith I Alshawabkeh, Amit Prasad, Fima Lenkovsky, Laila F Makary, Enas S Kandil, Rick A Weideman, Kevin C Kelly, Bavana V Rangan, Subhash Banerjee, Emmanouil S Brilakis
AIMS: Surgery after drug-eluting stent (DES) implantation may be associated with increased risk for perioperative stent thrombosis (ST). METHODS AND RESULTS: We evaluated the outcomes of 67 patients who underwent non-cardiac (n=51) or cardiac (n=16) surgery after DES implantation at our institution between 2008 and 2010 and who underwent preoperative "bridging" with a glycoprotein IIb/IIIa inhibitor. Surgery occurred after a mean time of 13.9 ± 1.7 and 8.7 ± 2 months post stenting for non-cardiac (NCS) and cardiac surgery, respectively...
June 22, 2013: EuroIntervention
Hamid Reza Poorhosseini, Seyed Kianoosh Hosseini, Tahereh Davarpasand, Masoumeh Lotfi Tokaldany, Mojtaba Salarifar, Seyed Ebrahim Kassaian, Mohammad Alidoosti, Younes Nozari, Ebrahim Nematipour, Ali Mohammad Haji Zeinali, Hasan Aghajani, Ali Reza Amirzadegan
BACKGROUND: Impact of 12 months' versus 24 months' use of dual antiplatelet therapy on the prevalence of stent thrombosis in patients undergoing percutaneous coronary intervention (PCI) with the drug-eluting stent (DES) is not clear. As a result, duration of dual antiplatelet therapy is still under debate among interventionists. METHODS: From March 2007 until August 2008, all consecutive patients with successful PCI who received at least one DES and were treated with dual antiplatelet therapy (Clopidogrel + Aspirin) were included...
2012: Journal of Tehran Heart Center
Omar S Darwish, Erum Iqbal
OBJECTIVE: To report a case of a spontaneous liver hematoma in a patient receiving dual antiplatelet therapy for 5 years after coronary stent implantation. CASE SUMMARY: A 76-year-old man with coronary artery disease presented to the hospital with acute right upper quadrant pain. He had been taking clopidogrel 75 mg/day, a P2Y(12) inhibitor, and aspirin 81 mg/day for 5 years after having a drug-eluting stent (DES) placed. Given a drop in hemoglobin (from 13.0 g/dL to 8...
November 2012: Annals of Pharmacotherapy
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