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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 *** 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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Modern Antiplatelet Therapy:When Is Clopidogrel the Right Choice?

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Cardiovascular Innovations and Applications 2018年第B7期3卷 175-202页

作者： Punag Divanji Kendrick Shunk The University of California San Francisco and The San Francisco Veteran Affairs Hospital 505 Parnassus AveM1182San FranciscoCA 94143-0124USA

Platelet inhibition with aspirin is the cornerstone of medical therapy for coronary artery *** the era of percutaneous coronary intervention with drug-eluting stents,dual anti-platelet therapy with the addition of clopidogrel(Plavix,Bristol-Myers Squibb,New York,NY)became the mainstay of ***,with the advent of newer oral antiplatelet medications,including prasugrel(Effient?,Eli Lilly,Indianapolis,Indiana)and ticagrelor(Brilinta?,Astra-Zeneca,Cambridge,United Kingdom),choosing the appropriate platelet inhibitor has become more *** optimal regimen differs based on patient characteristics,clinical situation,and the condition being treated,with differing risk and safety profiles for these *** review explores the appropriate use of antiplatelet therapy for stable ischemic heart disease,acute coronary syndrome,stroke,and peripheral vascular ***,we evaluate the data behind the use of antiplatelet therapy in patients on oral *** understanding the biochemistry of platelet aggregation,the pharmacology of platelet inhibitors,and the extensive clinical trial data that informs current guideline recommendations we aim to better understand the role of clopidogrel in patients with cardiovascular disease.

关键词： antiplatelet therapy P2Y12 inhibitor thienopyridine acute coronary syndrome stable coronary artery disease

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Clopidogrel in ischemic heart disease: A critical appraisal

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Health 2013年第3期5卷 465-468页

作者： Mohammed A. Al-Otaiby Abdulrahman M. Al-Moghairi Adult Cardiology Department Prince Sultan Cardiac Center (PSCC) Riyadh Saudi Arabia Adult Cardiology Department Prince Sultan Cardiac Center (PSCC) Riyadh Saudi Arabia.

Aspirin and clopidogrel are the commonest dual antiplatelet agents being used in the secondary prevention of cardiovascular disease. In high risk patients with coronary heart disease, the use of aspirin was associated with a significant risk reduction of myocardial infarction, stroke and vascular death. The use of clopidogrel alone was slightly superior to aspirin, and associated with reduced risk of vascular death, ischemic stroke and myocardial infarction. Dual antiplatelet therapy has been well studied in patients with acute coronary syndrome and those undergoing percutaneous coronary intervention (PCI). In patients with stable coronary heart disease or multiple risk factors the combination of clopidogrel plus aspirin was not significantly more effective than aspirin alone in reducing MI, stroke or death from cardiovascular causes.

关键词： Clopidogrel Ischemic Heart Disease thienopyridine Platelets Inhibition

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