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Efficacy and safety of individually tailored antiplatelet therapy in patients with acute coronary syndrome after coronary stenting： a single center, randomized, feasibility study

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Journal of Geriatric Cardiology 2015年第1期12卷 23-29页

作者： Hong-Chang ZHU Yi LI Shao-Yi GUAN Jing LI Xiao-Zeng WANG Quan-Min JING Zu-Lu WANG Ya-Ling HAN Second Affiliated Hospital of Dalian Medical University Dalianl 16023 Shandong Province China Cardiovascular Institute General Hospital of Shenyang Military Region Shenyang 110016 Liaoning Province China

Background Low responsiveness to clopidogrel （LRC） is associated with increased risk of ischemic events. This study was aimed to explore the feasibility of tailored antiplatelet therapy according to the responsiveness to clopidogrel. Methods A total of 305 clopidogrel naive patients with acute coronary syndromes （ACS） undergoing coronary stenting were randomly assigned to receive standard （n = 151） or tailored （n = 154） antiplatelet therapy. The ADP-induced platelet aggregation tests by light transmission aggregometry were performed to identify LRC patients assigned to the tailored group. The standard antiplatelet regimen was dual antiplatelet therapy with aspirin and clopidogrel. The tailored antiplatelet therapy was standard regimen for non-LRC patients and an additional 6-month cilostazol treatment for LRC patients. The primary efficacy outcome was the composite of cardiovascular death, myocardial infarction or stroke at one year. Results LCR was present in 26.6% （41/154） of patients in the tailored group. The percentage platelet aggregation for LCR patients was significantly decreased at three days after adjunctive cilostazol treatment （77.5% ± 12.1% vs. 64.5% ± 12.1%, P 〈 0.001）. At one year follow-up, a non-significant 37% relative risk reduction of primary events were observed in the tailored group as compared to the standard group （5.8% vs. 9.3%, P = 0.257）. There were no differences in the rates of stent thrombosis and hemorrhagic events between the two groups. Conclusions Tailored antiplatelet therapy for ACS patients after coronary stenting according to responsiveness to clopidogrel is feasible. However, its efficacy and safety need further confirmation by clinical trials with larger sample sizes.

关键词： Acute coronary syndrome antiplatelet therapy Clopidogrel Coronary stenting

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Efficacy and safety of aspirin antiplatelet therapy within 48 h of symptom onset in patients with acute stroke

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World Journal of Clinical Cases 2023年第32期11卷 7814-7821页

作者： Jian-Quan Zhang Zhi-Bin Pan Department of Emergency Medicine The First Affiliated Hospital of Jiangxi Medical CollegeShangrao 334000Jiangxi ProvinceChina Department of Neurology Jiujiang First People's HospitalJiujiang 332100Jiangxi ProvinceChina

BACKGROUND Aspirin is a widely used antiplatelet agent that reduces the risk of recurrent ischemic stroke and other vascular ***,the optimal timing and dose of aspirin initiation after an acute stroke remain *** To evaluate the efficacy and safety of aspirin antiplatelet therapy within 48 h of symptom onset in patients with acute *** We conducted a randomized,open-label,controlled trial in 60 patients with acute ischemic or hemorrhagic stroke who were admitted to our hospital within 24 h of symptom *** were randomly assigned to receive either aspirin 300 mg daily or no aspirin within 48 h of stroke *** primary outcome was the occurrence of recurrent stroke,myocardial infarction,or vascular death within 90 *** secondary outcomes were functional outcomes at 90 d measured using the modified Rankin Scale(mRS),incidence of bleeding complications,and mortality *** The mean age of the patients was 67.8 years and 55%of them were *** median time from stroke onset to randomization was 12 *** baseline characteristics were well balanced between the two *** primary outcome occurred in 6.7%of patients in the aspirin group and 16.7%of patients in the no aspirin group(relative risk=0.40,95%confidence interval:0.12-1.31,P=0.13).The mRS score at 90 d was significantly lower in the aspirin group than in the no aspirin group(median,2 vs 3,respectively;P=0.04).The incidence of bleeding complications was similar between the groups(6.7%vs 6.7%,P=1.00).The mortality rates were also comparable between the two groups(10%vs 13.3%,P=0.69).CONCLUSION Aspirin use is associated with favorable functional outcomes but does not significantly reduce the risk of recurrent vascular *** acceptable safety profile is comparable to that of no *** studies with larger sample sizes and longer follow-up periods are needed to confirm these findings.

关键词： Aspirin Acute stroke antiplatelet therapy Recurrent stroke Recurrent vascular events Myocardial infarction

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Early antiplatelet therapy used for acute ischemic stroke and intracranial hemorrhage

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World Journal of Clinical Cases 2024年第4期12卷 677-680页

作者： Venkata Buddhavarapu Rahul Kashyap Salim Surani Department of Medicine Banner Baywood Medical CenterMesaAZ 85206United States Department of Research Wellspan HealthYorkPA 17403United States Department of Medicine&Pharmacology Texas A&M UniversityCollege StationTX 77843United States

In this editorial we comment on the article published by Zhang et al in the recent issue of World Journal of Clinical *** evaluate their claims on the benefit of use of Aspirin in the early management of patients with ischemic *** also comment on their contention of using aspirin in the early management of patients with intracranial hemorrhage,a practice not seen in modern *** clinical trials such as the International Stroke Trial and the Chinese Acute Stroke Trial have shown the benefit of Aspirin use within 48 h of patients with Acute Ischemic *** findings were corroborated in the open-label trial performed by Zhang et al in a smaller sample group of 25 patients where they showed improvement in functional scores at 90 days without an increase in adverse *** such,this intervention is also recommended by the American Heart Association stroke guidelines from *** regard to Intracranial hemorrhage,traditional practice has been to discontinue or avoid antiplatelet therapy in these patient ***,no studies have been done to evaluate this management strategy that is more borne out of the mechanism behind Aspirin’s effect on the coagulation *** et al evaluate the benefits of Aspirin on patients with low-volume intracranial hemorrhage,i.e.,less than 30 mL on computed tomo-graphy imaging,and show no increase in *** caveat of this finding is that all outcomes were pooled into one group for results,and the number of patients was *** more studies with larger patient groups are required,the data from Zhang et al suggests that patients with small-volume intracranial hemorrhages may benefit from Aspirin administration in the acute phase of management.

关键词： Aspirin Ischemic stroke Intracranial hemorrhage CVA antiplatelet therapy

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Safety and efficacy of dual antiplatelet therapy after percutaneous coronary interventions in patients with end-stage liver disease

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World Journal of Cardiology 2021年第11期13卷 599-607页

作者： Zvonimir Ostojic Ana Ostojic Josko Bulum Anna Mrzljak Department of Cardiology University Clinical Hospital ZagrebZagreb 10000Croatia Department of Gastroenterology and Hepatology University Hospital CenterZagreb 10000Croatia Department of Cardiovascular Diseases University Hospital Center ZagrebUniversity Clinical Hospital ZagrebZagreb 10000Croatia School of Medicine University of ZagrebZagreb 10000Croatia

The prevalence of coronary artery disease(CAD)increases in patients with endstage liver disease,with part of them receiving the percutaneous coronary intervention(PCI)as a treatment *** antiplatelet therapy(DAPT),a standard of care after PCI,could result in catastrophic consequences in this *** PCI and the start of DAPT,it is recommended to assess patient bleeding *** on novel findings,liver cirrhosis does not necessarily lead to a significant increase in bleeding ***,conventional methods,such as the international normalized ratio,might not be appropriate in assessing individual bleeding *** highest bleeding risk among cirrhotic patients has a subgroup with severe thrombocytopenia(50×10^(9)/L and prevent variceal *** is no solid evidence for DAPT in patients with ***,randomized trials investigating short(one month)DAPT duration after PCI with new drug-eluting stents(DES)in a high bleeding risk patient population can be implemented in patients with *** on retrospective studies(with older stents and protocols),PCI and DAPT appear to be safe but with a higher risk of bleeding complications with longer DAPT ***,novel methods in assessing CAD severity should be performed to avoid unnecessary PCI and potential risks associated with *** indicated,PCI should be performed over radial artery using contemporary *** medical therapy,such as proton pump inhibitors and beta-blockers,should be prescribed for lower bleeding risk *** approaches,such as thromboelastography and“preventive”upper endoscopies in PCI circumstances,warn clinical confirmation.

关键词： End-stage liver disease Cirrhosis Liver transplantation Coronary artery disease Percutaneous coronary intervention antiplatelet therapy

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In-Stent Thrombosis after antiplatelet therapy Conversion while Awaiting Coronary Bypass

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Cardiovascular Innovations and Applications 2020年第4期5卷 139-143页

作者： Nathan Burke Tawanna Charlton Hussam Hawamdeh Ki Park Division of Cardiovascular Medicine University of Florida College of MedicineGainesvilleFloridaUSA

In-stent thrombosis(IST)is a rare yet dangerous complication that may occur despite optimized coronary intervention in the cardiac catheterization *** is a case of an 81-year-old man who presented with ST-elevation myocardial *** coronary artery(RCA)occlusion was *** angiography and percutaneous coronary intervention were *** left coronary artery disease was subsequently *** cardiothoracic surgeon request,the patient was transitioned from ticagrelor to clopidogrel therapy in preparation for coronary artery bypass *** patient experienced IST the day before surgery while receiving *** examine this case,which highlights the complexity of antiplatelet therapy choice and the role of genetic testing in evaluation of IST risk.

关键词： Acute myocardial infarction/ST-elevation myocardial infarction antiplatelet therapy genetics platelet biology drug-eluting stent drugs/pharmacotherapy

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Peripheral interventions and antiplatelet therapy: Role in current practice

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World Journal of Cardiology 2017年第7期9卷 583-593页

作者： Pahul Singh Yenal Harper Carrie S Oliphant Mohamed Morsy Michelle Skelton Raza Askari Rami N Khouzam Department of Medicine Division of Cardiovascular DiseasesUniversity of Tennessee Health Science Center Methodist University Hospital Department of Clinical Pharmacy University of Tennessee College of Pharmacy Department of Biology Emory University

Peripheral arterial disease(PAD) is a common disorder associated with a high risk of cardiovascular mortality and continues to be under-recognized. The major risk factors for PAD are similar to those for coronary and cerebrovascular disease. Management includes exercise program, pharmacologic therapy and revascularization including endovascular and surgical approach. The optimal revascularization strategy, endovascular or surgical intervention, is often debated due to the paucity of head to head randomized controlled studies. Despite significant advances in endovascular interventions resulting in increased utilization over surgical bypass, significant challenges still remain. Platelet activation and aggregation after percutaneous transluminal angioplasty of atherosclerotic arteries are important risk factors for re-occlusion/restenosis and life-threatening thrombosis following endovascular procedures. antiplatelet agents are commonly prescribed to reduce the risk of myocardial infarction, stroke and death from cardiovascular causes in patients with PAD. Despite an abundance of data demonstrating efficacy of antiplatelet therapy in coronary artery disease and cerebrovascular disease, there is a paucity of clinical information, clinical guidelines and randomized controlled studies in the PAD population. Hence, data on antiplatelet therapy in coronary interventions is frequently extrapolated to peripheral interventions. The aim of this review article is to elucidate the current data on revascularization and the role and duration of antiplatelet and anticoagulant therapy in re-vascularized lower limb PAD patients.

关键词： Peripheral arterial disease Peripheral vascular disease antiplatelet therapy Revascularization

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Study on the Guidance of Platelet Inhibition Rate Detected with Thrombelastogram in antiplatelet therapy for Acute Non-Cardiogenic Stroke

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Journal of Clinical and Nursing Research 2022年第5期6卷 40-44页

作者： Yong Liu Xuemei Feng Juan Wang Department of Neurology in the Fourth People's Hospital of Yibin Yibin 644000Sichuan ProvinceChina

Objective:To investigate the application value of thrombelastogram(TEG)in the detection of platelet inhibition rate for antiplatelet therapy for acute non-cardiogenic ***:A total of 100 patients with ischemic non-cardiogenic stroke were selected for this study from September 2020 to October *** were randomly divided into experimental group and control group,with 50 cases for each *** and after 1 week of antiplatelet drug treatment,the platelet inhibition rate in the experimental group was measured with arachidonic acid(AA)and adenosine diphosphate(ADP)by TEG;no platelet inhibition rates detection was conducted for the control *** dose and type of drugs were adjusted for the experimental group according to the platelet functions and medication based on the clinical experience conducted for the control *** neurological deficits of the discharged patients were scored with NIHSS score,mRS score,stroke recurrence,hemorrhage,and other events were followed up at the 3rd month of ***:In the experimental group,the inhibition rates of AA and ADP were significantly higher than those before treatment(both Pantiplatelet patients were higher than those of monoclonal antiplatelets(both Pantiplatelet therapy in patients with acute non-cardiogenic stroke reduces the recurrences of cerebral infarction and the risk of hemorrhage and improves patients’clinical prognosis.

关键词： Thrombelastogram Platelet inhibition rate Ischemic stroke antiplatelet therapy

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Protective effects of long term antiplatelet and anticoagulant therapy in hospitalized patients with inflammatory bowel disease

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World Journal of Gastrointestinal Pharmacology and Therapeutics 2024年第6期15卷 28-38页

作者： Madhav Changela Sagar Pandey Janak Bahirwani Nishit Patel Maulik Kaneriya Sanket D Basida Anish Shah Rahul Thakur Krishna Bodrya Suruchi Jai Kumar Ahuja Yecheskel Schneider Department of Internal Medicine One Brooklyn Health System/Interfaith Medical CenterBrooklynNY 11213United States Department of Gastroenterology St.Luke's University Health NetworkBethlehemPA 18015United States Department of Internal Medicine University of MissouriColumbiaMO 65212United States Department of Internal Medicine Bronxcare Health SystemBronxNY 10457United States Department of Internal Medicine Albert Einstein College of Medicine/Jacobi Medical CenterBronxNY 10461United States Department of Internal Medicine Lehigh Valley Health NetworkEastonPA 18045United States Department of Data Sciences Sarepta TherapeuticsCambridgeMA 02124United States

BACKGROUND Inflammatory bowel disease(IBD),with its rising prevalence rates is associated with an increased risk of cardiovascular and thromboembolic *** and/or anticoagulants agents are often prescribed but the literature on the impact of long-term anticoagulation and/or antiplatelet use among patients hospitalized with IBD is *** aim of this study is to assess the outcomes of patients hospitalized with IBD on antiplatelet and/or anticoagulant *** To investigate the effects of long-term use of antiplatelets/anticoagulants on clinical outcomes in patients hospitalized with *** We conducted a retrospective cohort study using the Nationwide Inpatient Sample database,including all adult IBD patients hospitalized in the United States from 2016 to *** cohorts were stratified based on antiplatelet/anticoagulant therapy *** regression analysis was done to assess outcomes,adjusting for potential *** primary outcome was mortality,whereas length of stay(LOS),total parenteral nutrition,acute kidney injury,sepsis,shock,gastrointestinal bleeding,need for colonoscopy/sigmoidoscopy,abdominal surgery and total hospitalization charges were secondary *** Among 374744 hospitalized IBD patients,antiplatelet or anticoagulant therapy alone was associated with significantly lower in-hospital mortality and reduced healthcare utilization,including shorter LOS and decreased hospitalization *** therapy was associated with a protective effect on mortality,but did not reach statistical ***,therapy did not exacerbate disease severity or complications,although higher odds of gastrointestinal bleeding were *** Our study highlights the potential benefits of long-term anticoagulation/antiplatelet therapy in hospitalized IBD patients,with improved mortality outcomes and healthcare *** concerns regarding gastrointestinal bleeding exist,the overall safety pr

关键词： Inflammatory bowel disease Anticoagulation antiplatelet therapy Healthcare utilization Mortality

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Safety of laparoscopic surgery in digestive diseases with special reference to antithrombotic therapy: A systematic review of the literature

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World Journal of Clinical Cases 2018年第14期6卷 767-775页

作者： Takahisa Fujikawa Kenji ando Department of Surgery Kokura Memoria Hospital Department of Cardiology Kokura Memorial Hospital

AIMTo elucidate the effect of antithrombotic therapy （ATT） on bleeding and thromboembolic complications during or after laparoscopic digestive *** articles or internationally accepted abstracts between 2000 and 2017 were searched from PubMed, Cochrane Database, and Google Scholar, and studies involving laparoscopic digestive surgery and antiplatelet therapy （APT） and/or anticoagulation therapy （ACT） were included after careful review of each study. Data such as study design, type of surgical procedures, antithrombotic drugs used, and surgical outcome （both bleeding and thromboembolic complications） were extracted from each *** published articles and two internationally accepted abstracts were eligible for inclusion in the systematic review. Only one study concerning elective laparoscopic cholecystectomy in patients with peri-operative heparin bridging for ACT showed that the risk of postoperative bleeding was higher compared with those without ACT. The remaining 14 studies reported no signifcant differences in the incidence of bleeding complications between the ATT group and the group without ATT. The risk of thromboembolic events （TE） associated with laparoscopic digestive surgery in patients receiving ATT was not signifcantly higher than those with no ATT or interrupted *** T et al . Laparoscopic digestive surgery and antithrombotic therapyCONCLUSIONLaparoscopic digestive surgery in ATT-burdened patients for prevention of bleeding and TE showed satisfactory results. The risk of hemorrhagic complication during or after these procedures in patients with continued APT or heparin bridging was not signifcantly higher than in patients with no ATT or interrupted APT.

关键词： Thromboembolic complication Bleeding complication Laparoscopic surgery Anticoagulation therapy Digestive surgery Antithrombotic therapy antiplatelet therapy

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Safety of pancreatic surgery with special reference to antithrombotic therapy:A systematic review of the literature

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World Journal of Clinical Cases 2021年第23期9卷 6747-6758页

作者： Takahisa Fujikawa Shigetoshi Naito Department of Surgery Kokura Memorial HospitalKitakyushu 802-8555Japan

BACKGROUND Postpancreatectomy hemorrhage(PPH)is the most severe type of complication after pancreatic surgery,although the effect of antithrombotic therapy(ATT)on PPH is largely *** safety and efficacy of chemical thromboprophylaxis for venous thromboembolism(VTE)remains *** To elucidate the effect of ATT on *** Published articles between 2013 and 2020 were searched from PubMed and Google Scholar,and after careful reviewing of all studies,studies concerning ATT and pancreatic surgery were *** such as study design,type of surgical procedures,type of antithrombotic drugs,and surgical outcome were extracted from the *** Nineteen published articles with a total of 37863 patients who underwent pancreatic surgery were included in the systematic *** were cohort studies,with only three being prospective in *** studies demonstrated that in patients receiving chronic ATT,which were mostly managed by heparin bridging,the risk of PPH was higher compared with those without ATT,and one study showed that patients with direct-acting oral anticoagulants managed by heparin bridging had significantly higher postoperative bleeding rates than *** remaining six studies reported that pancreatic surgery can be safely performed in patients receiving chronic ATT,even under preoperative aspirin *** chemical thromboprophylaxis for VTE,most studies have shown a potentially high risk of PPH in patients undergoing chemical thromboprophylaxis;however,its effectiveness against VTE has not been statistically demonstrated,particularly among Asian *** Pancreatic surgery in chronically ATT-received patients can be safely performed without an increase in the occurrence of PPH,although the safety and efficacy of chemical thromboprophylaxis for VTE during pancreatic surgery is still *** investigation using reliable studies with good design is required to establish definite pr

关键词： Antithrombotic therapy Pancreatic surgery Perioperative management antiplatelet therapy Anticoagulation therapy Pancreaticoduodenectomy

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