In SPS3 Trial dual anti-platelet therapy compared to aspirin alone exhibited no benefit and significant evidence of harm including risk of hemorrhage of 2.1% for dual anti-platelet therapy compared to 1.1% for aspirin alone and the dual anti-platelet therapy group also showed higher rates of mortality
The REPLACE-2 trial validated bivalirudin plus provisional GP IIb/IIIa blockade as an alternative anticoagulant regimen to heparin plus planned GP IIb/IIIa blockade during urgent or elective PCI. This substudy of the REPLACE-2 trial focused on the role of clopidogrel pretreatment with both these treatment strategies. Although administration of clopidogrel before PCI was associated with a trend toward lower rates of periprocedural ischemic events for patients who received either bivalirudin or heparin plus GP IIb/IIIa blockade, bivalirudin with provisional GP IIb/IIIa blockade was noninferior to heparin plus planned GP IIb/IIIa blockade in all subgroups irrespective of pretreatment or the duration of pretreatment. Moreover, there was no evidence that clopidogrel pretreatment attenuated the reduction in bleeding complications by bivalirudin. Therefore, clopidogrel pretreatment appears to improve clinical outcomes without compromising safety, but is not required for bivalirudin to achieve efficacy ...
Recently, several newer antiplatelet treatment strategies have been used in patients with coronary artery disease (CAD). Apart from the dual antiplatelet therapy (DAPT) consisting of aspirin and clopidogrel, double dose clopidogrel (DDC), triple antiplatelet therapy (TAPT) consisting of aspirin, clopidogrel and cilostazol and other newer antiplatelet agents have shown to be effective in different ways. In this analysis, we aimed to systematically compare the adverse clinical outcomes and the bleeding events which were observed when DDC was compared to the other antiplatelet regimens in patients with CAD. English publications comparing DDC with other antiplatelet regimens were searched from MEDLARS/MEDLINE, EMBASE, www.ClinicalTrials.gov and Google Scholar. Adverse cardiovascular outcomes and bleeding events were the study endpoints. Statistical analysis was carried out by the RevMan 5.3 software whereby odds ratios (OR) with 95% confidence
To the Editor:. We read with interest the work by Chen et al,1 which reported that triple antiplatelet therapy seems to be superior to dual antiplatelet therapy in patients with ST-segment elevation myocardial infarction (STEMI) undergoing primary percutaneous coronary intervention with drug-eluting stents. Chen et al1 reported the mortality benefits of triple antiplatelet therapy obtained mainly within 30 days after STEMI, reflecting the importance of the addition of cilostazol to aspirin and clopidogrel before stenting. Meanwhile, the authors pointed out the limitation of the nonrandomized trial, that several baseline differences were present between the groups. In our opinion, the advantage of the short-term outcome of triple therapy should be emphasized in higher-risk patients with STEMI undergoing primary percutaneous coronary intervention regardless of whether cilostazol or abciximab was selected.. Because glycoprotein IIb/IIIa inhibitors (abciximab) as adjunctive pharmacological therapy ...
DAPT - Dual Antiplatelet Therapy. Looking for abbreviations of DAPT? It is Dual Antiplatelet Therapy. Dual Antiplatelet Therapy listed as DAPT
Background: The potential benefits and risks of the use of dual anti-platelet therapy (DAT) beyond 12 months in patients receiving drug-eluting stents (DES) with acute myocardial infarction (AMI) have not been clearly established.. Methods: We analyzed 795 patients who had undergone DES implantation with AMI and had been free of major adverse cardiac or cerebrovascular events at least for 12 months in prospective multi-center registry (Infarct Prognosis Study). The duration of DAT was categorized in group 1 (N=185): ≤ 12 months and group 2 (N=610): , 12 months. The incidence of cardiac death or recurrent MI was compared between 2 groups.. Results: The median duration of follow up was 28.4 months. The Kaplan Meier analysis indicated a benefit of group 2 compared with less than group 1. (2.5 % vs. 8.6 %, log rank test p , 0.001). Continuation of DAT beyond 12 months showed the significant reduction of cardiac death or recurrent MI in Cox proportional hazards analysis even after controlling of ...
Dual anti-platelet therapy following percutaneous coronary intervention (PCI) for the treatment of STEMI has traditionally consisted of aspirin and clopidogrel. Despite this treatment approach, a substantial portion of patients experience recurrent adverse cardiovascular events including death, myocardial infarction, and stent thrombosis. This persistent vulnerability has been associated with inadequate platelet inhibition in response to clopidogrel administration, a phenomenon referred to as high on-treatment platelet reactivity. Although multiple variables have been implicated in altered clopidogrel response, mounting evidence has suggested a crucial role for common genetic variants including: CYP2C19*2, *17, and ABCB1 3435 C,T alleles.. Presence of the CYP2C19*2 allele has been associated with a 1.5- to 6-fold increased risk of cardiovascular death, myocardial infarction, and stent thrombosis following PCI in patients treated with clopidogrel. These findings, recently bolstered by 2 separate ...
Participating Centers : 38 french high PCI volume (,700) centers Rationale: Clopidogrel / Prasugrel (75 mg/day), in combination with aspirin (75 mg/day), is currently the antiplatelet treatment of choice for prevention of stent thrombosis, and clinical trials have shown that, in high-risk patients, prolonged dual antiplatelet treatment is more effective than aspirin alone in preventing major cardiovascular events. However, despite the use of clopidogrel, a considerable number of patients continue to have cardiovascular events. Numerous in VITRO studies have shown that individual responsiveness to clopidogrel but also to aspirin is not uniform in all patients and is subject to inter- and intraindividual variability. The recent possibility of bedside monitoring of oral antiplatelet therapy offers the unique opportunity of tailoring antiplatelet therapy. However, the relevance of such strategy has never been evaluated in a randomized prospective adequately powered study having long term follow-up ...
A one-month treatment of dual anti-platelet therapy is safe and as effective as a longer duration of therapy at preventing cardiac events in patients one year after stent placement, according to late-breaking research presented today at the American Heart Associations Scientific Sessions 2020.
TY - JOUR. T1 - Optimal duration of dual antiplatelet therapy after drug-eluting stent implantation a randomized, controlled trial. AU - Lee, Cheol Whan. AU - Ahn, Jung Min. AU - Park, Duk Woo. AU - Kang, Soo Jin. AU - Lee, Seung Whan. AU - Kim, Young Hak. AU - Park, Seong Wook. AU - Han, Seungbong. AU - Lee, Sang Gon. AU - Seong, In Whan. AU - Rha, Seung Woon. AU - Jeong, Myung Ho. AU - Lim, Do Sun. AU - Yoon, Jung Han. AU - Hur, Seung Ho. AU - Choi, Yun Seok. AU - Yang, Joo Young. AU - Lee, Nae Hee. AU - Kim, Hyun Sook. AU - Lee, Bong Ki. AU - Kim, Kee Sik. AU - Lee, Seung Uk. AU - Chae, Jei Keon. AU - Cheong, Sang Sig. AU - Suh, Il Woo. AU - Park, Hun Sik. AU - Nah, Deuk Young. AU - Jeon, Doo Soo. AU - Seung, Ki Bae. AU - Lee, Keun. AU - Jang, Jae Sik. AU - Park, Seung Jung. PY - 2014/1/21. Y1 - 2014/1/21. N2 - Background-The risks and benefits of long-term dual antiplatelet therapy remain unclear. Methods and Results-This prospective, multicenter, open-label, randomized comparison trial was ...
OBJECTIVE: To determine the effects of antiplatelet therapy among patients at high risk of occlusive vascular events. DESIGN: Collaborative meta-analyses (systematic overviews). INCLUSION CRITERIA: Randomised trials of an antiplatelet regimen versus control or of one antiplatelet regimen versus another in high risk patients (with acute or previous vascular disease or some other predisposing condition) from which results were available before September 1997. Trials had to use a method of randomisation that precluded prior knowledge of the next treatment to be allocated and comparisons had to be unconfounded-that is, have study groups that differed only in terms of antiplatelet regimen. STUDIES REVIEWED: 287 studies involving 135 000 patients in comparisons of antiplatelet therapy versus control and 77 000 in comparisons of different antiplatelet regimens. MAIN OUTCOME MEASURE: Serious vascular event: non-fatal myocardial infarction, non-fatal stroke, or vascular death. RESULTS: Overall, among these
We investigated the impact of suboptimal platelet reactivity on clinical outcomes after percutaneous coronary intervention (PCI). We enrolled 500 patients with stable coronary artery disease...
To help prevent this, physicians may prescribe antiplatelets in patients who are at high risk for developing a thrombus within their blood vessels. Antiplatelets are types of anticoagulants - medications used to help prevent the formation of blood clots when no injury has occurred. They work by reducing the platelets stickiness (viscosity). The most common antiplatelet in use today is the over-the-counter drug aspirin, which has been found to prevent platelet binding and clot formation. Today, many physicians place their heart patients on a small daily dose of aspirin (generally 81 milligrams) to prevent the formation of blood clots that may injure the heart. For patients who do not respond to aspirin as a preventive therapy, other antiplatelet medications are available. The most common are clopidogrel and ticlopidine ...
[Percutaneous coronary intervention (PCI) is meant to optimalise cardiac status, that is, short-term and long-term outcomes. It is known from large Western databases that stent implantation is performed in 77-85% of coronary interventions, which means hundreds of thousands of new patients with stent every year. The great majority of these patients has to take platelet aggregation inhibitors, namely acetylsalicylic acid and thienopyridin, most often clopidrogel. It presents a major therapeutic dilemma when these patients require noncardiac surgery. First, surgery should be performed with the least possible blood loss, which would be optimal if the platelet aggregation inhibitor therapy - that is indispensable for a certain period because of the stent - was suspended. Second, stent thrombosis has to be avoided, which can only be achieved if platelet aggregation inhibitor therapy is continued. The aim of our paper is to summarise the current guidelines and the risk estimation on the basis of our current
We read with interest the CILON-T (Influence of Cilostazol-based Triple Antiplatelet Therapy on Ischemic Complication After Drug-Eluting Stent Implantation) trial on the efficacy of cilostazol on ischemic complications after drug-eluting stent (DES) implantation (1), which suggested the potential link between platelet reactivity and ischemic events in Asians.. Asians exhibit poor response to clopidogrel, maybe due to the high prevalence of CYP2C19*2/*3 allele carriage (∼55% to 70%) (1). In the CILON-T study, ,50% of the patients receiving dual antiplatelet therapy had high platelet reactivity based on Western population (P2Y12 reaction units [PRU] ,235). However, similar to other Asian studies, the CILON-T study showed a low ischemic events rate (∼2% during 6 months). In the CILON-T study, patients under the certain PRU (,210) were absent from ischemic events (1). Meanwhile, the GRAVITAS trial demonstrated a different threshold (∼175 PRU), showing the complete immunity against 6-month ...
Prolonging dual antiplatelet therapy with aspirin plus clopidogrel (Plavix) for more than one year after the placement of a drug-eluting stent confers no clinical benefit.
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. Validation was internal via bootstrap resampling and external among 8136 patients from 36 countries randomized in the PROTECT trial (June 2007-July 2014).. EXPOSURES: Twelve months of open-label thienopyridine plus aspirin, then randomized to 18 months of continued thienopyridine plus aspirin vs placebo plus aspirin.. MAIN OUTCOMES AND MEASURES: Ischemia (myocardial infarction or stent thrombosis) and bleeding (moderate or severe) 12 to 30 months after ...
To the Editor:. We read with great interest the recent article published by Fiorella et al who report a multicenter experience with the use of the Wingspan stent system (Boston Scientific) for the treatment of intracranial atherosclerosis.1 This collaborative effort should be applauded, but we would advocate for closer scrutiny to future registry designs in order to enhance our understanding of treatment modalities being used.. A total of 78 patients with 82 lesions were treated with a high technical success rate and a periprocedural complication rate (stroke or death) of 6.1%.1 We would like to bring attention to 3 issues that may help with further study in this area. The first is the patient selection for the registry. Nineteen of the 78 (24%) patients were not on antiplatelet therapy at the time of their stroke or transient ischemic attack. The natural history of patients who were not on antiplatelet therapy is not clear to date; thus, selection of such patients for angioplasty and stenting ...
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Arguably, antiplatelet agents are the most important therapy we administer to stented patients. Antiplatelet agents are given to prevent the most dreaded event that often has catastrophic consequences, coronary thrombosis. It is well established that platelet reactivity to adenosine diphosphate (ADP) mediated by the P2Y12 receptor plays a central role in the development of post-percutaneous coronary intervention (PCI) ischemic events, including stent thrombosis. The active metabolite of clopidogrel blocks this pivotal receptor (1,2). Platelet reactivity to ADP during clopidogrel therapy has been determined by turbidimetric aggregometry, VerifyNow (Accumetrics, San Diego, California) assay, Thrombelastography (TEG, Hemonetics, Braintree, Massachusetts), Multiplate Analyzer (Dynabyte Informationssysteme GmbH, Munich, Germany), and flow cytometry to measure phosphorylated vasodilator stimulated phosphoprotein (VASP Assay, Biocytex, Marseille, France). All of these methods have demonstrated ...
Dual antiplatelet therapy (DAPT) with acetylsalicylic acid and an inhibitor of the adenosine diphosphate platelet receptor P2Y12 has been shown to reduce the risk of stent thrombosis (ST), myocardial infarction and cardiac death after percutaneous coronary intervention (PCI) with bare-metal stents (BMS) and drug-eluting stents (DES). However, while there is consensus on 1-month DAPT after BMS, the optimal duration and the risk-benefit ratio of DAPT duration after DES implantation remains controversial. Controversy surrounding this issue is demonstrated by differences in guideline recommendations for DAPT duration after PCI with DES. For example, while the ACC/AHA recommends a minimum of 12 months, ESC guidelines recommend at least 6 months of DAPT. Recent reports suggest that 6 months of DAPT after second-generation DES implantation might be safe compared with longer durations. Large randomized controlled trials powered to examine ST and bleeding events are currently ongoing and will shed novel ...
CO Clopidogrel: Clopidogrel belongs to the class of medications called platelet aggregation inhibitors or antiplatelets. Clopidogrel is used to help prevent heart attacks, strokes, and other circulation problems in people who have atherosclerosis (narrowed blood vessels caused by hardening of the arteries) and have already experienced at least one atherothrombotic event such as heart attack, stroke, or diagnosed peripheral arterial disease (problems with blood flow in the arteries). It is also used with ASA (acetylsalicylic acid) by people with acute coronary syndrome or atrial fibrillation (a fast, irregular heartbeat).
In patients with ACS (NSTE-ACS or STEMI) treated with coronary stent implantation who have tolerated DAPT without a bleeding complication and who are not at high bleeding risk (e.g., prior bleeding on DAPT, coagulopathy, oral anticoagulant use), continuation of DAPT (clopidogrel, prasugrel, or ticagrelor) for longer than 12 months may be reasonable (Class IIb). A new risk score (the DAPT score), derived from the Dual Antiplatelet Therapy study, may be useful for decisions about whether to continue (prolong or extend) DAPT in patients treated with coronary stent implantation ...
Part I Concepts in Platelet Physiology, Function and Measurement. 1 Platelet physiology and the role of the platelet in ischemic heart disease.. Robert F. Storey .. 2 Laboratory assessment of platelet function and the effects of antiplatelet agents.. Alan D. Michelson, A.L. Frelinger .. Part II Pharmacology of Oral Antiplatelet Agents.. 3 Cyclooxygenase inhibitors.. Nina Chetty Raju, John W. Eikelboom .. 4 Aspirin response variability and resistance.. Wai-Hong Chen, Daniel I. Simon .. 5 P2Y12 inhibitors: Thienopyridines and direct oral inhibitors.. Jean-Philippe Collet, Boris Aleil, Christian Gachet, Gilles Montalescot .. 6 Thienopyridine response variability and resistance.. Udaya S. Tantry, Thomas A. Suarez, Paul A. Gurbel .. Part III Pharmacology of Intravenous Antiplatelet Agents.. 7 Pharmacology of intravenous glycoprotein IIb/IIIa antagonists.. James C. Blankenship, Peter B. Berger .. 8 Intravenous P2Y12 inhibitors.. Steven P. Dunn, Steven R. Steinhubl .. 9 Antiplatelet effects of thrombin ...
There are limited real-world data on prevalence and predictors of dual antiplatelet therapy (DAPT) prolongation beyond one year after acute coronary syndrome (ACS). We have explored such issue in the START ANTIPLATELET Registry, which is a prospective, observational, multicenter, Italian registry performed in seven Italian cardiology institutions including patients admitted for ACS and followed up to one year. Out of a total population of 840 ACS patients, 596 patients had completed 12-month follow-up being on DAPT. Decision to prolong DAPT beyond one year was taken in 79 patients (13%), whereas in 517 patients DAPT was stopped. The strongest predictors of DAPT continuation were a new cardiovascular events after the index admission event (OR 3.3, 95% CI 1.4-7.7), no bleeding complications (OR 3.2, 95% CI 1.2-8.3) and no anemia during one-year follow-up (OR 2.6, 95% CI 1.1-5.9); other independent predictors were renal failure (OR 2.5, 95% CI 1.3-5.0) and peripheral artery disease (OR 1.8, 95% CI ...
Journal cover image about duration of dual anti platelet therapy following angioplasty. Antiplatelet medicines work to keep platelets from sticking together and forming blood clots. There have been many recent studies debating whether shorter or longer courses of dual antiplatelet therapy are better for patients undergoing percutaneous coronary intervention.
Title:Antiplatelet Therapy in Children: Why So Different from Adults?. VOLUME: 18 ISSUE: 21. Author(s):Pier Paolo Bassareo, Vassilios Fanos, Nicoletta Iacovidou and Giuseppe Mercuro. Affiliation:Department of Cardiovascular and Neurological Sciences, University of Cagliari, Policlinico Universitario, S.S. 554, bivio di Sestu -09042 Monserrato (Cagliari).. Keywords:Platelet, antiplatelet agents, aspirin, haemostasis, paediatric, coronary heart disease, ischemic stroke, peripheral arterial disease, arrhythmias, thromboembolic complications. Abstract:Antiplatelet agents are administered in the treatment of a large number of adult diseases: coronary heart disease, ischemic stroke, peripheral arterial disease, arrhythmias with their thromboembolic complications, primary and secondary prevention. In childhood however, the situation is substantially different. The lack of large interventional trials on the use of antiplatelet drugs in children, has led to greater uncertainty, and a less extensive use ...
People with peripheral vascular disease are at high risk of vascular events and major adverse limb events. Use of antiplatelet therapy is effective at reducing this risk. Other antithrombotic strategies that have been tested, such as use of anticoagulation, dual antiplatelet therapy or novel antiplatelet agents, have not been found to be superior to single antiplatelet therapy. The new oral factor Xa inhibitors such as rivaroxaban have been shown to be at least as effective as vitamin K antagonists in preventing thromboembolic events in atrial fibrillation,1 and offer a potential alternative strategy, either in addition to, or instead of, a single antiplatelet agent. ...
Clopidogrel has anti-platelet activity by irreversible inhibition of the P2Y12 platelet receptor. Clopidogrel must be converted into an active metabolite in order to show anti-platelet activity. Hepatic CYP2C19 enzyme is one of the key hepatic enzymes which convert clopidogrel into active metabolite and its genetic polymorphism is related to clopidogrel resistance. CYP2C19 poor or intermediate metabolizer groups show reduced anti-platelet activity of clopidogrel compared to extensive metabolizer group ...
Health, ...The findings were presented by Dr Jolanta Siller-Matula from Medical U...Standard antiplatelet treatment in patients undergoing percutaneous co...But measurements of platelet aggregation in clopidogrel treated patien...Personalized antiplatelet treatment involves choosing a therapy base...,Personalized,antiplatelet,treatment,improves,outcome,after,PCI,medicine,medical news today,latest medical news,medical newsletters,current medical news,latest medicine news
Objective We retrospectively assessed the incidence of hemorrhagic complications associated with pacemaker implantation in patients receiving one or more antiplatelet agents.
Three year follow-up of patients who received dual antiplatelet therapy (DAPT) after placement of a drug-eluting stent (DES) shows that a short course of the therapy continues to be as beneficial as a longer course.
Clopidogrel belongs to the class of medications called platelet aggregation inhibitors or antiplatelets. Clopidogrel is used to help prevent heart attacks, strokes, and other circulation problems in people who have atherosclerosis (narrowed blood vessels caused by
Novel oral anti-coagulants (NOACs) are increasingly being used in clinical practice and are set to almost entirely replace the vitamin K antagonists, such as warfarin, in the near future. Similarly, new antiplatelet agents are now regularly used in place of older agents, such as aspirin and clopidogrel. In an ageing population, with an increasing burden of complex comorbidities, urologists will frequently encounter patients who will be using such agents. Some background knowledge, and an understanding, of these drugs and the issues that surround their usage, is essential. The present article will provide readers with an understanding of these new drugs, including their mechanisms of action, the up-to-date evidence justifying their recent introduction into clinical practice and the appropriate interval for stopping them before surgery. It will also consider the risks of perioperative bleeding for patients taking these drugs and the risks of venous thromboembolism in those in whom they are ...
Antiplatelet agentsThese agents inhibit the cyclo-oxygenase system, decreasing the level of thromboxane A2, which is a potent platelet activator.Aspirin (Bayer Buffered Aspirin, Bayer Aspirin, Anacin)... more
Platelet adhesion, activation and aggregation to the injured vessel wall are crucially involved in the pathogenesis of thrombus formation. Agents in theory thwarting thes..
After coronary artery stenting, patients are maintained on dual antiplatelet therapy (DAPT). When presenting for elective surgery, these medications are often held to minimize bleeding risk intraoperatively. The ideal timeframe to wait after stenting before proceeding with elective surgery is guideline based, and therefore does change periodically. [More… ...
Dr. Routh responded: Different Actions. Anticoagulants are medicines which keep the blood from clotting by action on factors in the blood which are needed to stop bleeding. Oral examples would include |a href=/topics/warfarin track_data={
Riva-Clopidogrel: Clopidogrel belongs to the class of medications called platelet aggregation inhibitors or antiplatelets. Clopidogrel is used to help prevent heart attacks, strokes, and other circulation problems in people who have atherosclerosis (narrowed blood vessels caused by hardening of the arteries) and have already experienced at least one atherothrombotic event such as heart attack, stroke, or have been diagnosed peripheral arterial disease (problems with blood flow in the arteries). It is also used with ASA (acetylsalicylic acid) by people with acute coronary syndrome or atrial fibrillation (a fast, irregular heartbeat) to reduce the risk of heart attack or stroke.
Looking for online definition of Platelet aggregation inhibitor in the Medical Dictionary? Platelet aggregation inhibitor explanation free. What is Platelet aggregation inhibitor? Meaning of Platelet aggregation inhibitor medical term. What does Platelet aggregation inhibitor mean?
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Comparison of two platelet glycoprotein IIb/IIIa inhibitors, tirofiban and abciximab, for the prevention of ischemic events with percutaneous coronary revascularization
TY - JOUR. T1 - Safety issues surrounding use of platelet GP IIb/IIIa antagonists. T2 - Reversibility and readministration. AU - Kleiman, Neal. AU - Tcheng, J. E.. PY - 1999/1/1. Y1 - 1999/1/1. N2 - The platelet glycoprotein IIb/IIIa (GPIIb/IIIa) receptor antagonists abciximab, eptifibatide, and tirofiban have been shown to be safe and effective in patients with acute coronary syndromes and in those undergoing percutaneous coronary intervention. Consequently, the use of these drugs is becoming increasingly common. However, issues regarding the ability to reverse their effects remain, particularly in the setting of emergency surgery. The short-acting agents eptifibatide and tirofiban are characterized by less avid binding, significant plasma reservoirs of unbound drug, rapid decay of receptor occupancy and relatively rapid clearance in the presence of intact renal/hepatic mechnisms. The avid-binding abciximab is characterized by a shorter plasma half-life, relative absence of unbound drug, a long ...
TY - JOUR. T1 - Relationship between high platelet turnover and platelet function in high-risk patients with coronary artery disease on dual antiplatelet therapy. AU - Cesari, Francesca. AU - Marcucci, Rossella. AU - Caporale, Roberto. AU - Paniccia, Rita. AU - Romano, Eloisa. AU - Gensini, Gian Franco. AU - Abbate, Rosanna. AU - Gori, Anna Maria. PY - 2008/5. Y1 - 2008/5. N2 - A high platelet turnover rate produce a population of immature reticulated platelets (RP) that could confer, despite of antiplatelet drugs, a residual platelet reactivity (RPR) in coronary artery disease (CAD) patients. To assess the influence of RP on platelet reactivity in CAD patients on dual antiplatelet therapy we measured RP in 372 patients by using the Sysmex XE-2100 haematology analyzer and platelet function by optical platelet aggregometry (PA) on platelet-rich-plasma induced by 1 mmol arachidonic acid (AA-PA) and 10 μM ADP (ADP-PA). RPR was defined as either AA-PA ,20% or ADP-PA ,70%. RP were expressed as a ...
Inflammation plays an important role in plaque development and left ventricular remodeling during acute myocardial infarction (AMI). Clopidogrel may exhibit some anti-inflammatory properties and high loading dose of clopidogrel results in improved clinical outcomes in patients with AMI. 357 patients who received successful primary percutaneous coronary intervention from January 2008 to March 2011 in Peking University Third Hospital were included in this study. Different loading dose of clopidogrel (300 mg, 450 mg, or 600 mg) was given at the discretion of the clinician. Neutrophils reached their peak values on the first day after AMI. Higher levels of peak neutrophil and lower left ventricular ejection fraction (LVEF) were found in patients of low clopidogrel loading dose group (300 mg or 450 mg). After adjusting for the related confounders, a logistic regression model showed that low clopidogrel loading dose remained an independent predictor of low LVEF (LVEF ≤
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PPIs are widely prescribed in conjunction with antiplatelet therapy. Current American Heart Association guidelines recommend that all patients on dual antiplatelet therapy be prescribed a PPI regardless of Helicobacter pylori status or gastrointestinal bleeding risk.20 PPIs are inhibitors of CYP2C19 in vitro, with omeprazole showing more potent inhibition than newer-generation PPIs such as pantoprazole.21 Based on this evidence, several studies have assessed RPA in patients coprescribed clopidogrel and a PPI. For omeprazole, there is a significant increase in RPA in patients prescribed both clopidogrel and a PPI compared with clopidogrel alone.22 The results for other PPIs, particularly pantoprazole, are less clear. One study showed that RPA in ACS patients on clopidogrel and pantoprazole was similar to that of patients on clopidogrel alone,23 suggesting a compound-specific effect.. Despite the evidence that at least some PPIs affect residual platelet function in patients taking clopidogrel, the ...
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Aims: Antiplatelet therapy with aspirin and clopidogrel are recommended for 1 year after drug-eluting stent (DES) implantation or myocardial infarction. However, the discontinuation of antiplatelet therapy has become an important issue as recent studies have suggested a clustering of ischaemic events within 90 days of clopidogrel withdrawal. The objective of this investigation was to explore the hypothesis that there is a transient rebound increase in platelet reactivity within three months of clopidogrel discontinuation. Methods and Results: In this prospective study, platelet function was assessed in patients taking aspirin and clopidogrel for at least 1 year following DES implantation. Platelet aggregation was measured using a modification of light transmission aggregometry in response to multiple concentrations of adenosine diphosphate (ADP), epinephrine, arachidonic acid, thrombin receptor activating peptide and, collagen. Clopidogrel was stopped and platelet function was reassessed 1 week, 1
The findings provided in this report indicate that prevalence of prescribing aspirin or other antiplatelet medications at outpatient health-care visits is low for patients who have been recommended to receive these medications based on the presence of ischemic vascular disease or certain risk factors. Despite the low prevalence of aspirin prescribing identified in this analysis, other studies using the same data sources have demonstrated that aspirin and other antiplatelet medication prescribing among patients with ischemic vascular disease was only 32.8% in 2003 (16). Previous reports have estimated that for every 10% increase in the use of antiplatelet medication among eligible adults aged 18-79 years, an estimated 8,000 deaths per year would be prevented (21). A 2006 study that ranked clinical preventive services based on cost effectiveness and the clinically preventable burden of disease demonstrated that aspirin prevention counseling was one of three prevention services that received the ...
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Stenting and GP IIb/IIIa inhibition are promising adjunctive therapies in PCI. The Global Registry of Acute Coronary Events (GRACE) is a registry of unselected patients with acute coronary syndromes, allowing for the study of treatments in a real-world environment. Data from GRACE patients with AMI who underwent PCI were analyzed. After adjusting for demographics, baseline characteristics, and previous medications, treatment with GP IIb/IIIa inhibitors and a stent and treatment with a stent alone were significant predictors of survival at 6 months. Stents were used in 90.9% of patients. GP IIb/IIIa inhibitors were used in 59.7%; in most cases they were started after the beginning of the procedure. The in-hospital death rate (7.6%) was highest in patients undergoing urgent PCI. Mortality at 6 months following PCI was 14.4% among patients who received neither GP IIb/IIIa inhibitors nor a stent, compared to patients who received both GP IIb/IIIa inhibitors and a stent (7.3%), GP IIb/IIIa inhibitors alone
Current guidelines recommend aspirin, aspirin plus clopidogrel or aspirin plus extended-release dipyridamole for treatment of acute ischaemic stroke (IS) or transient ischaemic attack (TIA) to prevent recurrent stroke, myocardial infarction and cardiovascular death.1 The Clopidogrel in High-risk patients with Acute Non-disabling Cerebrovascular Events (CHANCE) trial randomised 5170 Chinese patients within 24 h after the onset of IS or TIA to clopidogrel plus aspirin versus aspirin plus placebo for 90 days. Clopidogrel plus … ...
This study found no significant benefit associated with clopidogrel continuation (use of clopidogrel plus aspirin) as compared with clopidogrel discontinuation (use of aspirin alone) after 6 months, in reducing the incidence of death from any cause, myocardial infarction, or cerebrovascular accident at 2 years. On the other hand, 2-year clopidogrel therapy resulted in a significant increase of actionable bleeding episodes, which included events requiring medical or surgical treatment, red blood cell transfusion, and life-threatening events. There seems to be little rationale for continuing dual antiplatelet therapy for more than a year after percutaneous coronary intervention, based on this and other available evidence.. ...
Over 1 million coronary stent procedures are performed annually in the U.S., with dual-antiplatelet therapy, which includes the use of both aspirin and clopidogrel, being a cornerstone in the management of these patients after coronary intervention. Now, recent data have surfaced demonstrating altered active metabolite levels of clopidogrel in patients harboring hepatic cytochrome gene variants. These variants, which have been validated through genome-wide association as the dominant explanation for the marked heterogeneity of clopidogrel response, are linked to a significant increase in the risk for bleeding, stent thrombosis, myocardial infarction, and death. With viable alternatives to clopidogrel now available, including higher clopidogrel maintenance and loading doses, prasugrel, and ticagrelor, clinicians can now effectively guide therapy in those with at-risk gene variants by simple genotyping. Such an individualized approach can potentially prevent tens of thousands of adverse cardiovascular
Platelet aggregation inhibitors, also known as antiplatelet therapy (APT), are prescribed for the prevention of secondary cardiovascular events (CVE) after endovascular revascularization procedures.- Platelet aggregation inhibitors are not equally effective in all patients. The phenomenon of high residual platelet reactivity despite APT is called high on-treatment platelet reactivity (HTPR); ... read more it bears an increased risk of secondary CVE.- Platelet function tests (PFT) can be used to diagnose HTPR. There are various tests available; of those, light transmission aggregometry (LTA) is considered the gold standard. Some tests are only suitable for determining the effect of a certain category of APT.- Research into the usefulness of PFTs to optimise treatment with APT has not yet produced an unambiguous conclusion.- Currently there is not yet an indication for routine use of PFT in clinical practice. However, for the treatment of certain categories of patients with thromboembolic ...
In this study of 64 294 patients undergoing PCI within the VA, the use of any contraindicated antiplatelet medications was associated with increased bleeding risk. Although the use of contraindicated medications was not significantly associated with risk-adjusted mortality, the point estimates suggested harm. Nearly 20% of patients undergoing PCI had a known contraindication to ≥1 antiplatelet medications, and ,1 in 20 of those patients received a contraindicated medication. In adjusted analyses, use of abciximab in patients with contraindications of thrombocytopenia or previous stroke likely increased the risk of major bleeding.. Although the overall rate of contraindicated mediation use among patients with PCI is low (1.1%), this study highlights the problem of medication errors in the United States. Importantly, these data illustrate that the use of contraindicated antiplatelet medications persist, despite high-profile reports and EMR built-in warnings.3 Medication errors are a major ...
The relationship between bleeding complications and increased mortality after percutaneous coronary intervention (PCI) has been well documented. Bivalirudin is superior to heparin and glycoprotein (GP) IIb/IIIa inhibitors, mainly due to the lower risk of bleeding but comparable rates of ischemic complications (1-3). Three trials presented at the 2014 American College of Cardiology Scientific Sessions raise questions regarding the superiority of bivalirudin in PCI (4-6).. In the HEAT-PPCI (Unfractionated Heparin Versus Bivalirudin in Primary Percutaneous Coronary Intervention) trial, 1,829 patients from a single center with ST-segment elevation myocardial infarction (STEMI) referred for primary PCI were randomized to heparin (70 U/kg bolus) or bivalirudin, with GP IIb/IIIa inhibitor only used for bail out (15.5% vs. 13.5%, p = NS) (4). The majority of the PCI (,80%) were performed transradially. Nearly all patients (99.6%) were pre-loaded with dual antiplatelet therapy; 60% of patients received ...
Keywords: platelet, IIIa antagonist, abciximab, eptifibatide, tirofiban, lamifiban, thrombocytopenia, angioplasty. Abstract: The activation of platelets and the resultant aggregation have been shown to play important role in the pathogenesis of cardiovascular, cerebrovascular and peripheral vascular diseases and in acute coronary syndromes. Hence platelet adhesion and aggregation have been identified as promising targets for the development of anti-thrombotic drugs. Glycoprotein (GP) IIb / IIIa antagonism exerts a strong anti-platelet effect, because this interference inhibits the final common pathway of platelet aggregation and is not dependent on a single activation pathway. Three GPIIb / IIIa antagonists have been approved by the US Food and Drug administration. They include abciximab (the chimeric monoclonal antibody 7E3 Fab fragment), eptifibatide (the cyclic heptapeptide based on the KGD amino acid sequence) and tirofiban (a nonpeptide tyrosine derivative). In addition, nonpeptide oral ...
High residual platelet reactivity (HRPR) on clopidogrel treatement is associated with an increased risk of adverse events after percutaneous coronary intervention (PCI) and the three REsponsiveness to CLopidogrel and Stent Thrombosis (RECLOSE) studies showed this relationship, the futility of a tailored therapy with increasing dose of clopidogrel, and that nonresponsiveness to clopidogrel is a modifiable risk factor.. RECLOSE-1 1,2. This study is based on a cohort of of 804 patients who had successful sirolimus- or paclitaxel-eluting stent implantation. All patients received a loading dose of 600 mg of clopidogrel, and residual platelet reactivity was assessed by light transmittance aggregometry (LAT) using 10 µmol of adenosine diphosphate as agonist. Patients with platelet aggregation by 10 µmol ADP ≥70% were defined as nonresponders. All patients received chronic dual antiplatelet treatment (aspirin 325 mg and clopidogrel 75 mg daily) for 6 months. The primary end point was the incidence ...
Initial platelet activity may predict efficacy after chronic oral glycoprotein IIb/IIIa blockade: should we still consider uniform treatment regimens?
Eptifibatide, a platelet glycoprotein IIb/IIIa inhibitor substantially reduces ischemic complications in coronary stent interventions and could become a routine pre-treatment in stent coronary implantation, concludes a study published in 16 December Lancet (Lancet 2000 356:2037).In a prospective study, Dr James Tcheng and colleagues from Duke University Medical Centre in North Carolina recruited 2064 patients who were undergoing coronary stent implantation. Immediately before the procedure, pati
Bristol-Myers Squibb (NYSE: BMY) is no longer offering its $37-a-month Plavix® Co-Pay Discount Card. And some patients are not happy about this. Additionally, according to the companys web site for Patient Assistance Programs, the company is no longer making this life-saving drug available to patients who cannot afford it. This, of course, has something to do with the fact that brand-name Plavix has gone off patent and generic versions have been available since May 2012. (See our Patient Alert: How to Get the Best Price on New Generic Plavix.) But are the generic versions of clopidogrel really the same?. Plavix (clopidogrel) is a critical component of all drug-eluting stent implantations. One year of Dual AntiPlatelet Therapy or DAPT (aspirin plus clopidogrel or prasugrel or ticagrelor or even the older ticlopidine) is a package deal with drug-eluting stents: you cant have one without the other. Thats why Financial Assistance for Plavix has been one of the most popular topics in ...
The central role played by the alphaIIb beta3 receptor in platelet aggregation, and hence in platelet thrombosis, has led to the development of a number of parenteral and oral glycoprotein (GP) IIb/IIIa inhibitors for use in cardiovascular disease states, such as acute coronary syndromes and stroke. The predominant effect of these agents is to inhibit platelet aggregation, although studies of alphaIIb beta3 receptor function and various GP IIb/IIIa inhibitors have demonstrated the potential for these agents to produce effects on other aspects of platelet function, in addition to non-platelet effects. Overall, clinical studies have demonstrated an impressive beneficial effect for parenteral agents in reducing ischemic complications following percutaneous intervention, and a more modest beneficial effect in the treatment of patients with acute coronary syndromes. Trials with oral GP IIb/IIIa inhibitors in similar patient populations have demonstrated toxicity, manifested by an increased mortality ...
The study sought to evaluate the presence of a clinically relevant rebound phenomenon after dual antiplatelet therapy discontinuation in randomized trials.
Clinical and economic studies of eptifibatide in coronary stenting Tilak Pasala, Prasongchai Sattayaprasert, Pradeep K Bhat, Ganesh Athappan, Sanjay Gandhi The Heart and Vascular Center, Case Western Reserve University/MetroHealth, Cleveland, OH, USA Abstract: Platelet adhesion and aggregation at the site of coronary stenting can have catastrophic clinical and economic consequences. Therefore, effective platelet inhibition is vital during and after percutaneous coronary intervention. Eptifibatide is an intravenous antiplatelet agent that blocks the final common pathway of platelet aggregation and thrombus formation by binding to glycoprotein IIb/IIIa receptors on the surface of platelets. In clinical studies, eptifibatide was associated with a significant reduction of mortality, myocardial infarction, or target vessel revascularization in patients with acute coronary syndrome undergoing percutaneous coronary intervention. However, recent trials conducted in the era of dual antiplatelet therapy and
CHAPTER 131 ANTIPLATELET THERAPY Williams Hematology CHAPTER 131 ANTIPLATELET THERAPY HARVEY J. WEISS Antiplatelet Drugs Aspirin Inhibitors of Thromboxane A2 Synthesis or Binding Prostaglandin I2 and Analogues Dipyridamole Ticlopidine and Clopidogrel Inhibitors of the Platelet GPIIB/IIIA Receptor Other Antiplatelet Agents Antiplatelet Drugs in Clinical Medicine Ischemic Heart Disease Valvular Heart Disease Cerebrovascular Disease Peripheral Vascular…
Interactions for ASPIRIN AND EXTENDED-RELEASE DIPYRIDAMOLE (capsule) explain how Aspirin and Extended-Release Dipyridamole works in concert with other medications and substances. This section outlines the advice given to doctors and pharmacists when prescribing and dispensing Aspirin and Extended-Release Dipyridamole
Background: Antiplatelet treatment remains the first choice for primary and secondary prevention of vascular diseases; even so, expected benefits may be offset by risk of bleeding, particularly cerebral hemorrhage. The aim of this study was to assess the influence of antiplatelet treatment on clinical outcome at hospital discharge. Materials and Methods: Consecutive patients with first-ever stroke due to a primary intraparenchymal hemorrhage were prospectively identified over a 4-year period (2000â€2003). Data on hemorrhage location, vascular risk factors, and antiplatelet and anticoagulant treatment were collected. At discharge, outcome was measured using the modified Rankin Scale (disabling stroke ≥3). Patients treated with anticoagulant therapy were excluded from the study. Results: Of 457 consecutive patients with cerebral hemorrhage, 94 (20.5%) had been taking antiplatelet agents. The treated patients (mean age for antiplatelet group 78.9 ± 9.0 years) were older than the ...
The article discusses the therapy for patients with acute coronary syndromes (ACS). It provides information on prasugrel, a new antiplatelet agent which offers an alternative pharmacological treatment and was recently cleared for marketing by the U.S. Food and Drug Administration. It also notes that by inhibiting platelet activation, the thienopyridine antiplatelet agents play a crucial role in the adjunctive treatment of patients with ACS ...
Interactions between heparins, glycoprotein IIb/IIIa antagonists, and coronary intervention. The Global Registry of Acute Coronary Events (GRACE).