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Association between antiplatelet medication and cerebral microbleeds in stroke-free population

Journal of Geriatric Cardiology 2022年第6期19卷 409-417页

作者： Miao-Xin YU Ya-Nan JIA Dan-Dan YANG Run-Hua ZHANG Yong JIANG Gui-Tao ZHANG Hui-Yu QIAO Hua-Lu HAN Rui SHEN Zi-Han NING Xi-Hai ZHAO Gai-Fen LIU Yong-Jun WANG Department of Neurology Beijing Tiantan HospitalCapital Medical UniversityBeijingChina Department of Neurology the Third Hospital of Hebei Medical UniversityShijiazhuangChina Department of Radiology Beijing Geriatric HospitalBeijingChina China National Clinical Research Center for Neurological Diseases BeijingChina Center for Biomedical Imaging Research Department of Biomedical EngineeringTsinghua UniversityBeijingChina Beijing Institute of Brain Disorders Capital Medical UniversityBeijingChina

BACKGROUND Cerebral microbleeds(CMBs)may increase the risk of future intracerebral hemorrhage and ischemic stroke.However,It is unclear whether antiplatelet medication is associated with CMBs.This study aimed to investigate the association between antiplatelet medication and CMBs in a community-based stroke-free population.METHODS In this cross-sectional study,stroke-free participants aged 18-85 years were recruited from a community in Beijing,China.Demographic,clinical,and antiplatelet medication data were collected through a questionnaire,and all participants underwent blood tests and brain magnetic resonance imaging at 3.0T.The presence,count,and location of CMBs were evaluated using susceptibility-weighted imaging.The association between antiplatelet medication and the presence of CMBs was analyzed using multivariable logistic regression.The associations between antiplatelet medication and CMBs by location(lobar,deep brain or infratentorial,and mixed regions)were also analyzed using multinomial logistic regression.A linear regression analysis was conducted to determine the association between antiplatelet medication and the log-transformed number of CMBs.RESULTS Of the 544 participants(mean age:58.65±13.66 years,217 males),119 participants(21.88%)had CMBs,and 64 participants(11.76%)used antiplatelet medication.antiplatelet medication was found to be associated with CMBs at any location[odds ratio(OR)=2.39,95%CI:1.24-4.58]and lobar region(OR=2.83,95%CI:1.36-5.86),but not with the number of CMBs(β=0.14,95%CI:-0.21-0.48).Among antiplatelet medications,aspirin use was found to be associated with any CMB(OR=3.17,95%CI:1.49-6.72)and lobar CMBs(OR=3.61,95%CI:1.57-8.26).CONCLUSIONS antiplatelet medication was associated with CMBs in stroke-free participants,particularly lobar CMBs.Among antiplatelet medications,aspirin use was associated with any CMB and lobar CMBs.Our findings suggest that it might be essential to optimize the management of antiplatelet medication in the stroke-free population with a higher burden o

关键词： medication 3.0T antiplatelet

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Protein extract of kenaf seed exhibits anticoagulant,antiplatelet and antioxidant activities

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Asian Pacific Journal of Tropical Biomedicine 2022年第2期12卷 47-58页

作者： Sujatha M.Hanumegowda Chandramma Srinivasa Ashwini Shivaiah Manjula M.Venkatappa Ramesha Hanumanthappa Rajesh Rangappa Ramesh K.Laxmaiah Sathisha J.Gonchigar Devaraja Sannaningaiah Department of Biochemistry Jnansahydri Kuvempu UniversityShankarghatta-577451ShivamoggaKarnatakaIndia Department of Studies and Research in Biochemistry and Centre for Bioscience and Innovation Tumkur UniversityTumkurKarnatakaIndia Liveon Biolabs Private Limited Tumkur-572106India Department of Food Science and Nutrition Maharani's Science College for WomenMysoreIndia

Objective:To explore the anticoagulant,antiplatelet and antioxidant activities of protein extract of kenaf seed(PEKS).Methods:Sodium dodecyl sulphate polyacrylamide gel electrophoresis and reverse-phase high-performance liquid chromatography techniques were employed for protein characterization.Antioxidant activity of PEKS was assessed using 1,1-diphenyl-2-picrylhydrazyl(DPPH)assay.The protective effect of PEKS on sodium nitrite(NaNO2)induced oxidative stress was evaluated using the in vitro red blood cell model,while the effect of PEKS on diclofenacinduced oxidative stress was examined in vivo in rats.Platelet-rich plasma and platelet-poor plasma were used for anticoagulant and antiplatelet activities of PEKS.Results:PEKS revealed similar protein bands on SDS-PAGE under reduced and non-reduced conditions.Several acidic proteins were present in native PAGE.PEKS showed antioxidant properties by scavenging DPPH with an IC50 of 24.58μg.PEKS exhibited a protective effect on NaNO2 induced oxidative stress in red blood cells by restoring the activity of stress markers.In addition,PEKS alleviated diclofenac-induced tissue damage of the liver,kidney,and small intestine.PEKS showed an anticoagulant effect in both in vivo and in vitro experiments by enhancing normal clotting time.PEKS did not affect prothrombin time but increase activated partial thromboplastin time.Furthermore,PEKS inhibited adenosine diphosphate and epinephrine-induced platelet aggregation.Conclusions:PEKS protects tissues from oxidative stress and exhibits antithrombotic activity.

关键词： Protein Extract Kenaf seed Oxidative stress Antioxidant Anticoagulant antiplatelet

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antiplatelet Effect of Active Components Derived from Chinese Herbal Medicine

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Chinese Journal of Integrative Medicine 2018年第8期24卷 632-640页

作者： ZHANG Ying MA Xiao-juan SHI Da-zhuo Graduate School Beijing University of Chinese Medicine Cardiovascular Diseases Center Xiyuan HospitalChina Academy of Chinese Medical Sciences China Heart Institute of Chinese Medicine China Academy of Chinese Medical Sciences

Atherothrombosis is the major cause of acute coronary syndromes and cardiovascular deaths.Platelets participate in the processes of forming and extending atherosclerotic plaques.Therefore,antiplatelet therapy is a milestone in the primary and second prevention of atherothrombotic diseases.Along with the longterm use of antiplatelet agents,the safety and drug resistance has become a big concern in clinic and new drugs possessing higher effectiveness and fewer adverse effects are needed.Abundant recent data support that traditional Chinese herbs may be a good alternative and complementary choice of new antiplatelet drugs.This review highlights the progress of antiplatelet effect of active components derived from traditional Chinese herbs based on their chemical structures.

关键词： Chinese herbal medicine antiplatelet active components

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antiplatelet therapy in very elderly and comorbid patients with acute coronary syndromes

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Journal of Geriatric Cardiology 2019年第2期16卷 103-113页

作者： Roberta De Rosa Federico Piscione Gennaro Galasso Stefano De Servi Stefano Savonitto Department of Medicine Surgery and DentistrySchola Medica SalemitanaUniversity of SalernoItaly IRCCS Multimedica Sesto San Giovanni(MI)Italy Cardiovascular Department Alessandro Manzoni HospitalLeccoItaly

With population ageing and rise of life expectancy,a progressively increasing proportion of patients presenting with an acute coronary syndrome(ACS)are older adults,including those at extreme chronological age.Increasing amounts of data,including randomized clinical trials,have shown that the benefits of an early revascularization are maintained also at very old age,resulting in improved outcome after an acute coronary event.On the contrary,the optimal antiplatelet therapy(APT)remains unclear in these patients,because of both safety and efficacy concerns.Indeed,age-related multiple organ dysfunction and high prevalence of comorbidities may on the one hand reduce the therapeutic effects of administered drugs;on the other hand,it leads to increased vulnerability to drug toxicity and side effects.Therefore,management of APT is particularly challenging in elderly patients because of higher risk of both ischemic and bleeding events.The aim of the present paper is to review the current evidence,gaps in knowledge and ongoing research regarding APT in the setting of an ACS in elderly and very elderly patients,and in those with significant comorbidities including chronic kidney disease,diabetes mellitus and frailty.

关键词： Acute coronary syndrome antiplatelet therapy The elderly

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2018 update of expert consensus statement on antiplatelet therapy in East Asian patients with ACS or undergoing PCI

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Science Bulletin 2019年第3期64卷 166-179页

作者： Yong Huo Young-Hoon Jeong Yanjun Gong Daowen Wang Ben He Jiyan Chen Guosheng Fu Yundai Chen Jianping Li Yi Li Shinya Goto Udaya S.Tantry Paul A.Gurbel Jong-Hwa Ahn Hyo-Soo Kim Myung Ho Jeong Yaling Han Sidney C.Smith Jr. Junbo Ge Department of Cardiology Peking University First Hospital Department of Internal Medicine Gyeongsang National University School of Medicine and Cardiovascular Center Gyeongsang National University Changwon Hospital Division of Cardiology Internal Medicine Department Tongji Hospital Tongji Medical College Huazhong University of Science and Technology Department of Cardiology Shanghai Chest Hospital affiliated to Shanghai Jiaotong University Department of Cardiology Guangdong General Hospital Department of Cardiology Sir Run Run Shaw Hospital Zhejiang University School of Medicine Department of Cardiology Chinese PLAG General Hospital Department of Cardiology General Hospital of Northern Theater Command Department of Medicine (Cardiology) Tokai University School of Medicine Inova Center for Thrombosis Research and Drug Development Inova Heart and Vascular Institute Cardiovascular Center Department of Internal Medicine Seoul National University Hospital The Heart Research Center Nominated by Korea Ministry of Health and Welfare Chonnam National University Hospital Division of Cardiology University of North Carolina Department of Cardiology Fudan University Zhongshan Hospital

East Asians are the most populous race in the world and their health status is an important global issue.Compared with Caucasian populations, East Asian patients have a different benefit/risk ratio when using antithrombotic treatment. Despite this observation, treatment strategies in East Asian patients are mostly based on the American and European guidelines. Despite a lower platelet inhibitory response to clopidogrel, East Asian patients show a similar or even a lower rate of ischemic event occurrence and higher bleeding risk compared with Caucasian patients. For potent P2Y_(12) inhibitors(ticagrelor and prasugrel),East Asian patients have shown less favorable net clinical benefits compared with Caucasian patients,which may be related to differences in pharmacokinetic/pharmacodynamic profiles and therapeutic zone of antiplatelet effect. This updated consensus mainly focuses on state-of-the-art and current controversies in the East Asian population. In addition, when East Asian patients are administered potent P2Y_(12) receptor inhibitors, the strategies and ongoing trials to overcome the related hurdles are discussed.

关键词： East Asian Coronary artery disease antiplatelet Bleeding

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Clinical Impact of Dual antiplatelet Therapy Use in Patients Following Everolimus-eluting Stent Implantation： Insights from the SEEDS Study

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Chinese Medical Journal 2015年第6期128卷 714-720页

作者： Yao-Jun Zhang Ye-Lin Zhao BO Xu Ya-Ling Han Bao Li Qiang Liu Xi Su Si Pang Shu-Zheno Lu Xiao-Feng Guo Yue-Jin Yang Department of Cardiology Nanjing First Hospital Nanjing Medical University Nanjing Jiangsu 210006 China DePartment of Cardiology Fuwai 14ospital National Center for Cardiovascular Diseases Beiing 100037 China Department of Cardiology General Hospital of Shenyang Military Region Shenyang Liaoning 110015 China Department of Cardiology Shanxi Provincial Cardiovascular Institute Taiyuan Shanxi 030024 China Department of Cardiology Shenzhen Sun Yat-Sen Cardiovascular HospitalShenzhen Guangdong 5i 8020 China Department of Cardiology Wuhan Asia Heart Hospital Wuhan Hubei 430022~ China Department of Cardiology Affiliated Anzhen Hospital of Capital Medical University Beijing 100029 China Department of Biostatistics CCRF Beijing 100027 China

Background:Studies have suggested that use of prolonged dual antiplatelet therapy (DAPT) following new generation drug-eluting stent implantation may increase costs and potential bleeding events.This study aimed to investigate the association of DAPT status with clinical safety in patients undergoing everolimus-eluting stent (EES) implantation in the SEEDS study (A Registry to Evaluate Safety and Effectiveness of Everolimus Drug-eluting Stent for Coronary Revascularization) at 2-year follow-up.Methods:The SEEDS study is a prospective,multicenter study,where patients (n =1900) with small vessel,long lesion,or multi-vessel diseases underwent EES implantation.Detailed DAPT status was collected at baseline,6-month,1-and 2-year.DAPT interruption was defined as any interruption of aspirin and/or clopidogrel more than 14 days.The net adverse clinical events (NACE,a composite endpoint of all-cause death,all myocardial infarction (MI),stroke,definite/probable stent thrombosis (ST),and major bleeding (Bleeding Academic Research Consortium Ⅱ-Ⅴ)) were investigated according to the DAPT status at 2-year follow-up.Results:DAPT was used in 97.8％ of patients at 6 months,69.5％ at 12 months and 35.4％ at 2 years.It was observed that the incidence of NACE was low (8.1％) at 2 years follow-up,especially its components of all-cause death (0.9％),stroke (1.1％),and definite/probable ST (0.7％).DAPT was not an independent predictor of composite endpoint of all-cause death/MI/stroke (hazard ratio [HR]:0.693,95％confidence interval [CI]:0.096-4.980,P =0.715) and NACE (HR:1.041,95％ CI:0.145-7.454,P =0.968).Of 73 patients who had DAPT interruption,no patient had ST at 12-month,and only 1 patient experienced ST between 1-and 2-year (1.4％).There was a high frequency of major bleeding events (53/65,82.5％) occurred in patients receiving DAPT treatment.Conclusions:Prolonged DAPT use was not associated with improved clinical safety.The study emphasized that duration of DAPT needs to be shortened in Chinese patients following EES implantation (Clinical

关键词： Bleeding Dual antiplatelet Therapy Everolimus-eluting Stent Net Adverse Clinical Events Stent Thrombosis

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Antithrombotic and antiplatelet therapies in relation to risk stratification in patients with non-ST elevation acute coronary syndrome： insights from the Sino-Global Registry of Acute Coronary Events

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Chinese Medical Journal 2009年第5期122卷 502-508页

作者： ZHANG Li-jie CHEN Yun-dai SONG Xian-tao ZHAO Fu-hai Lü Shu-zheng Department of Cardiology Beijing Anzhen Hospital Capital Medical University Beijing 100029 China Department of Cardiology Chinese People's Liberation Army General Hospital Beijing 100853 China Department of Cardiology Xiyuan Hospital of China Academy of Chinese Medical Science Beijing 100091 China

Background Antithrombotic and antiplatelet therapies have been proposed to treat non-ST elevation acute coronary syndrome （NSTEACS）, yet limited information is available about their applications from a multicenter ＂real-world＂ clinical procedure, especially in China. This study was undertaken to characterize the use of antithrombotic and antiplatelet agents in relation to the risk levels of the NSTEACS patients who were enrolled in Sino-Global Registry of Acute Coronary Events （GRACEs） registry study. Methods We analyzed the data from 618 Chinese NSTEACS patients stratified into low-（n=151）, intermediate-（n=233）, and high-risk groups （n=-234） based on GRACE risk scores. The baseline characteristics, clinical presentations, antithrombotic and antiplatelet agents were recorded and compared among the three groups. Results The administration rates of low-molecular-weight heparins （LMWHs）（86.08%） and thienopyridines （85.92%） were higher whereas the administration rate of glycoprotein Ⅱb/Ⅲa inhibitor （1.78%） was much lower than those reported previously. Meanwhile, within the first 24 hours of admission, the use of heparin/LMWHs in the high-risk group was more than that in the intermediate- and low-risk groups （73.50% vs 63.09% vs 55.63%, P=0.001）. Furthermore, the combination of antithrombotic and antiplatelet medications showed no significant differences in all groups. Conclusions In the ＂real world＂ practice of China, the antithrombotic and antiplatelet therapies on NSTEACS are well adherent to the current guidelines except for several gaps, such as the very low use of glycoprotein Ⅱb/Ⅲa inhibitor. Moreover, these antithrombotic and antiplatelet treatments usually tend to be underused for the high-risk ones.

关键词： non-ST elevation acute coronary syndromes risk stratification antithrombotic antiplatelet

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Risk of bleeding in patients with continued dual antiplatelet therapy during orthopedic surgery

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Chinese Medical Journal 2019年第8期132卷 943-947页

作者： San-Bao Hu Yong Hai Jie-Fu Tang Tao Liu Bing-Xin Liang Bo-Qiong Xue Department of Orthopaedics Beijing Anzhen HospitalCapital Medical UniversityBeijing 100029China Department of Orthopaedics Beijing Chaoyang HospitalCapital Medical UniversityBeijing 100020China Department of Orthopaedics No.2 Clinical Hospital of Hunan University of MedicineHuaihuaHunan 418000China

Background:To prevent risk of life-threatening stent thrombosis,all patients need to undergo dual antiplatelet therapy(DAPT)for at least 6 weeks to 12 months after stent implantation.If DAPT is continued during noncardiac surgery,there is a risk of severe bleeding at the surgical site.Our study was to assess the risk of bleeding in patients with continued DAPT during orthopedic surgery.Methods:The clinical data of 78 patients with coronary heart disease who underwent orthopedic surgery from February 2006 to July 2018 were retrospectively analyzed.Prior to orthopedic surgery,DAPT was continued in 16 patients(groupⅠ),24 patients were treated with single antiplatelet therapy(groupⅡ),and 26 patients received low-molecular-weight heparin therapy for more than 5 days after the discontinuation ofall antiplatelet therapies(groupⅢ).Twelve patients were excluded,as they had undergone minimally invasive surgery such as transforaminal endoscopy and vertebroplasty.The perioperative blood loss of each patient was calculated using Nadler's formula and Gross5 formula.The intraoperative bleeding volume,total volume of intraoperative bleeding in addition to postoperative drainage,and total blood loss were compared between groups.The level of significance was set at P0.05).Six patients experienced postoperative cardiovascular complications due to the delayed restart of antiplatelet therapy;one of these patients in group III died from myocardial infarction.Conclusions:Continued DAPT or single antiplatelet treatment during orthopedic surgery does not increase the total intraoperative and perioperative bleeding compared with switching from antiplatelet therapy to low-molecular-weight heparin.However,the discontinuation of antiplatelet therapy increases the

关键词： Dual antiplatelet therapy Non-cardiac surgery Orthopedic surgery Bleeding

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Feasibility of gastric endoscopic submucosal dissection with continuous low-dose aspirin for patients receiving dual antiplatelet therapy

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World Journal of Gastroenterology 2019年第4期25卷 457-467页

作者： Hideaki Harada Satoshi Suehiro Daisuke Murakami Ryotaro Nakahara Takuya Nagasaka Tetsuro Ujihara Ryota Sagami Yasushi Katsuyama Kenji Hayasaka Yuji Amano Department of Gastroenterology New Tokyo Hospital Department of Endoscopy New Tokyo Hospital

BACKGROUND Endoscopic submucosal dissection(ESD) for gastric neoplasms during continuous low-dose aspirin(LDA) administration is generally acceptable according to recent guidelines. This retrospective study aimed to investigate the effect of continuous LDA on the postoperative bleeding after gastric ESD in patients receiving dual antiplatelet therapy(DAPT).AIM To investigate the feasibility of gastric ESD with continuous LDA in patients with DAPT.METHODS A total of 597 patients with gastric neoplasms treated with ESD between January2010 and June 2017 were enrolled. The patients were categorized according to type of antiplatelet therapy(APT).RESULTS The postoperative bleeding rate was 6.9%(41/597) in all patients. Patients were divided into the following two groups: no APT(n = 443) and APT(n = 154). APT included single-LDA(n = 95) and DAPT(LDA plus clopidogrel, n = 59)subgroups. In the single-LDA and DAPT subgroups, 56 and 39 patients were received continuous LDA, respectively. The bleeding rate with continuous singleLDA(10.7%) was similar to that with discontinuous single-LDA(10.3%)(P >0.99). Although the bleeding rate with continuous LDA in patients receiving DAPT(23.1%) was higher than that with discontinuous LDA in patients receiving DAPT(5.0%), no significant difference was observed(P = 0.141).CONCLUSION The bleeding rate with continuous LDA in patients receiving DAPT was not statistically different from that with discontinuous LDA in patients receiving DAPT. Therefore, continuous LDA administration may be acceptable for ESD in patients receiving DAPT, although patients should be carefully monitored for possible bleeding.

关键词： Dual antiplatelet therapy Endoscopic submucosal dissection Low-dose aspirin Postoperative bleeding Thienopyridine

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Optimal duration for dual antiplatelet therapy with COMBO dual therapy stent

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Journal of Geriatric Cardiology 2019年第11期16卷 840-843页

作者： Aydin Huseynov Michael Behnes Uzair Ansari Stefan Baumann Dirk Lossnitzer Ibrahim El-Battrawy Christian Fastner Martin Borggrefe Ibrahim Akin First Department of Medicine University Medical Centre Mannheim (UMM) University of Heidelberg

The COMBO stent(OrbusNeich Medical BV,the Netherlands)is a stainless-steel platform with the biodegradable abluminal coating containing antiproliferative sirolimus(5 mg/mm)and the luminal stent surface covered with anti-CD-34 antibody.The CD-34 antibodies essentially capture endothelial progenitor cells resulting in rapid re-endothelialization of the treated segment.

关键词： Adverse events antiplatelet therapy Combo stent

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