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Chen Zhenguang - - 2011
The susceptibility of hypertrophied myocardium to ischemia-reperfusion injury is associated with increased risk of postoperative arrhythmias. We investigate the effects of ischemic preconditioning (IP) on post-ischemic reperfusion arrhythmias in hypertrophic rabbit hearts. Thirty-three rabbit models of myocardial hypertrophy were randomly divided into three groups of 11 each: non-ischemia-reperfusion group (group ...
Kern Karl B - - 2011
Cronier and co-workers provide additional evidence that routine use of mild therapeutic hypothermia combined with emergent coronary angiography and percutaneous intervention results in excellent survival with intact neurological function for post-resuscitation patients with ventricular fibrillation.
Shahin Jason - - 2011
Acute haemodynamic complications are common after cardiac surgery and optimal perioperative use of inotropic agents, typically guided by haemodynamic variables, remains controversial. The aim of this study was to examine the relationship of inotrope use to hospital mortality and renal dysfunction. A retrospective cohort study of 1,326 cardiac surgery patients ...
Western David G DG Department of Mechanical Engineering, University College London, London WC1E 7JE, UK. - - 2011
Periodic breathing patterns known as Central Sleep Apnea (CSA) are often observed in congestive heart failure. This phenomenon is associated with increased risk of sudden cardiac death, but the mechanism for that outcome has not been exposed. Endocardial electrograms were recorded during spontaneous episodes of CSR and PB in patients ...
Steg Philippe Gabriel - - 2010
Aspirin and clopidogrel are recommended for patients with acute coronary syndromes (ACS) or undergoing coronary stenting. Ticagrelor, a reversible oral P2Y12-receptor antagonist, provides faster, greater, and more consistent platelet inhibition than clopidogrel and may be useful for patients with acute ST-segment elevation (STE) ACS and planned primary percutaneous coronary intervention. ...
Singh Param Puneet - - 2010
The current guidelines for percutaneous coronary intervention do not address the prolonged postprocedural use of unfractionated heparin (UFH) to prevent acute occlusion. However, recently published small studies have yielded mixed results, leaving the question unanswered. Hence, we performed a meta-analysis of the existing evidence to assess the safety and efficacy ...
Sibbald Matthew - - 2010
Smoking induces CYP1A2, thereby enhancing clopidogrel conversion to its active metabolite. We sought to determine the association between clopidogrel use and clinical outcomes in smokers versus nonsmokers with a broad spectrum of acute coronary syndrome (ACS). We examined the association between early clopidogrel use in-hospital and 6-month outcomes among 44,426 ...
Sciahbasi Alessandro - - 2012
Glycoprotein (GP) IIb/IIIa inhibitors reduce ischemic complications in patients with non-ST-elevation acute coronary syndromes (NSTEACS) who undergo invasive procedures. However the optimal timing of therapy (upstream - at hospital admission in all patients prior to coronary catheterization, or downstream - after coronary angiography selectively in patients prior to percutaneous coronary ...
Campo Gianluca - - 2010
OBJECTIVES: The purpose of this study was to investigate the long-term outcome after elective percutaneous coronary intervention in low-risk patients screened for aspirin and/or clopidogrel responsiveness in the 3T/2R (Tailoring Treatment With Tirofiban in Patients Showing Resistance to Aspirin and/or Resistance to Clopidogrel) trial. BACKGROUND: The impact of aspirin and/or ...
Cho Jung Sun - - 2010
The efficacy of low molecular weight heparin (LMWH) with low dose unfractionated heparin (UFH) during percutaneous coronary intervention (PCI) with or without glycoprotein (Gp) IIb/IIIa inhibitor compared to UFH with or without Gp IIb/IIIa inhibitor has not been elucidated. Between October 2005 and July 2007, 2,535 patients with ST elevation ...
Hirschl Michael M - - 2012
Patients with acute myocardial infarction are at high risk of dying within the first hours after onset of coronary ischemia. Therefore, pharmacological intervention should be started in the prehospital setting. This study investigates the effect of the prehospital administration of bivalirudin on short-term morbidity and mortality compared to heparin plus ...
Rich Jonathan D - - 2010
The purpose of this study was to determine whether patients taking aspirin before an acute coronary syndrome (ACS) are at higher risk of recurrent events or mortality. Controversy exists whether prior aspirin use is an independent predictor of worse outcomes in patients who experience an ACS. We evaluated 66,443 ACS ...
Manson Stephanie C - - 2010
Cardiovascular disease (CVD) is a leading cause of death in the US and Western Europe, but regular use of preventive low-dose aspirin has proven effective in preventing CVD events. The purpose of this study was to explore the potential economic impact in the US if preventive aspirin usage were to ...
Dudek Dariusz - - 2010
Early rapid platelet inhibition with abciximab before primary percutaneous coronary intervention (PPCI) for ST-segment elevation myocardial infarction (STEMI) is suggested as beneficial. In previous studies on early abciximab administration clopidogrel was administered in cathlab in low loading dose. We investigated the role of early abciximab administration on top of early ...
Ye Yumei - - 2010
Statins and antiplatelet agents are currently used as therapeutic agents for patients with acute myocardial infarction. Statins limit myocardial infarct size by activating phosphatidylinositol-3-kinase (PI3K), ecto-5'-nucleotidase, Akt/endothelial nitric oxide synthase (eNOS), and the downstream effectors inducible nitric oxide synthase (iNOS) and cyclooxygenase-2 (COX-2). Inhibition of PI3K, adenosine receptors, eNOS, iNOS, ...
Krishnaswamy Amar - - 2011
Unfractionated heparin is an anticoagulant used in the treatment of myocardial infarction, pulmonary embolism and other thrombotic disorders. However, with anticoagulation comes the risk of bleeding and adverse events. These risks increase with supratherapeutic dosing. In this review, we discuss the reasons for supratherapeutic dosing, and the incidence of adverse ...
- - 2010
Clopidogrel and aspirin are widely used for patients with acute coronary syndromes and those undergoing percutaneous coronary intervention (PCI). However, evidence-based guidelines for dosing have not been established for either agent. We randomly assigned, in a 2-by-2 factorial design, 25,086 patients with an acute coronary syndrome who were referred for ...
Ferrieres Jean - - 2010
The Antiplatelet Therapy Observational Registry (APTOR) is a prospective observational study of acute coronary syndrome (ACS) patients undergoing percutaneous coronary intervention (PCI) in a 'real world' clinical setting. Here the authors report on the management of ACS patients in three European countries during the hospital phase and through 12-months' follow-up, ...
Singh Arun K - - 2011
Cardiac reoperations are challenging and time-consuming and incur a high incidence of perioperative complications because of injuries to cardiac structures, bleeding, and hemodynamic instability. Some centers are using extracorporeal circulation with heparinization at the time of resternotomy, but it leads to prolonged anticoagulation, platelet dysfunction, fibrinolysis, coagulopathy, and morbidity. The ...
Zhang Zhiyong - - 2011
Essential thrombocythemia (ET) can cause systemic vascular thrombosis but rarely cause obstruction of coronary arteries or acute myocardial infarction (MI). Treatment of acute MI in patients with ET may be a problem due to the important role of platelets in the pathogenesis of infarction. In this report, a 63-year-old man ...
Kumar Dinesh - - 2010
Clinical outcomes in patients with acute coronary syndromes randomized in the Acute Catheterization and Urgent Intervention Triage Strategy (ACUITY) trial who underwent percutaneous coronary intervention (PCI) of saphenous vein grafts (SVGs) were examined. The ACUITY trial assessed the safety and efficacy of bivalirudin alone versus bivalirudin plus a glycoprotein (GP) ...
Saucedo Jorge F - - 2010
Selecting appropriate antiplatelet therapy requires close attention to the delicate balance between reducing risk of ischemic events while minimizing bleeding risk. The broad range of available agents, while permitting tailoring of pharmacotherapy to individual patients, also complicates selection of optimal regimens. Platelet physiology provides an underpinning for the rationale behind ...
Schwalm Jon-David R JD Department of Medicine, Division of Cardiology, Hamilton Health Sciences and McMaster University, 5th Floor, McMaster Clinic, 237 Barton Street East, Hamilton, ON L8L 2X2, Canada. - - 2010
In the current era of early revascularization and routine use of dual antiplatelet therapy, the incremental benefit of warfarin to reduce the incidence of left ventricular thrombus (LVT) in patients with impaired left ventricular ejection fraction post anterior ST-elevation myocardial infarction (aSTEMI), remains uncertain. The purpose of this study is ...
Cohen Mauricio G - - 2010
BACKGROUND: The ideal anticoagulant should prevent ischemic complications without increasing the risk of bleeding. Controlled anticoagulation is possible with the REG1 system, an RNA aptamer pair comprising the direct factor IXa inhibitor RB006 and its active control agent RB007. METHODS AND RESULTS: This phase 2a study included a roll-in group ...
Chin Chee Tang - - 2010
Practice guidelines recommend dual antiplatelet therapy with aspirin and clopidogrel for patients with non-ST-segment elevation acute coronary syndromes (NSTE ACS) regardless of in-hospital management strategy. Prasugrel-a thienopyridine adenosine diphosphate receptor antagonist that provides higher and less variable levels of platelet inhibition than clopidogrel-has demonstrated benefit when used to treat ACS ...
Eberli Daniel - - 2010
PURPOSE: The perioperative treatment of patients on dual antiplatelet therapy after myocardial infarction, cerebrovascular event or coronary stent implantation represents an increasingly frequent issue for urologists and anesthesiologists. We assess the current scientific evidence and propose strategies concerning treatment of these patients. MATERIALS AND METHODS: A MEDLINE and PubMed search ...
Cheng Cheng-I - - 2010
BACKGROUND: Benefits of antiplatelet agents in preventing future cardiovascular events have been well established. However, the prescription pattern of antiplatelet usage in patients with acute coronary syndrome (ACS) is rarely investigated. Hence, Taiwan ACute CORonary Syndrome Descriptive Registry (T-ACCORD Registry) aimed to evaluate medical practices in Taiwan in managing ACS ...
Desai Nihar R NR Cardiovascular Division, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, - - 2010
The ability to mechanically dilate and treat stenoses in the coronary arteries opened a new chapter in cardiovascular medicine. Percutaneous coronary intervention (PCI) has been shown to improve outcomes among patients with acute coronary syndromes as well as improve symptoms among patients with stable coronary artery disease. Adjunctive antiplatelet therapy ...
Sorich M J - - 2010
Prasugrel is a newly marketed antiplatelet drug with improved cardiac outcomes as compared with clopidogrel for acute coronary syndromes involving percutaneous coronary intervention (PCI). Analysis of a subset of the TRITON-TIMI 38 trial demonstrated that cytochrome P450 2C19 (CYP2C19) reduced-function genotypes are associated with differential clinical responses to clopidogrel, but ...
Damani Samir B - - 2010
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 ...
Gündüz Sabahattin - - 2011
We report a case of a 60-year-old man with obstructive aortic prosthetic valve thrombosis (APVT). He was treated with low-dose (25 mg) slow infusion (6 hours) of intravenous tissue plasminogen activator (t-PA), and he suffered acute anterior myocardial infarction (MI) at the fourth hour of t-PA infusion. Infusion was kept ...
Curran Monique P - - 2010
Bivalirudin is a synthetic 20 amino acid polypeptide that directly inhibits both fibrin-bound and soluble thrombin. In the randomized, open-label, multicentre HORIZONS-AMI trial in patients with ST-segment elevation myocardial infarction (STEMI) who were undergoing primary percutaneous coronary intervention (PCI), compared with unfractionated heparin (UFH) plus a glycoprotein (GP) IIb/IIIa inhibitor, ...
Crown Natalie - - 2010
PURPOSE: The safety of fixed-dose combination aspirin-extended-release (ER) dipyridamole for stroke prevention in patients with ischemic heart disease is reviewed. SUMMARY: Randomized controlled trials have established the superiority of aspirinER dipyridamole over aspirin alone for secondary stroke prevention. One limitation of this product is the potential risk of worsening angina ...
Hennekens Charles H - - 2010
BACKGROUND: "Aspirin resistance" has been defined as the occurrence of cardiovascular events despite regular intake of aspirin. One major analytic study suggesting that "aspirin resistance" is a clinical reality was unable to control for confounding by nonadherence or nonsteroidal anti-inflammatory drugs (NSAIDs). METHODS: We formulated a hypothesis from subgroup analyses ...
Rao Sunil V - - 2010
BACKGROUND: Factor Xa and factor IIa (thrombin) play roles in thrombotic complications after percutaneous coronary intervention. M118 is a novel low-molecular-weight heparin that has been rationally designed to capture the desired attributes of unfractionated heparin (UFH) and low-molecular-weight heparin: Potent activity against factor Xa and IIa, predictable pharmacokinetics after both ...
Tsujita Kenichi - - 2010
The aim of this study was to assess the impact of baseline anemia on the outcomes of patients with ST elevation myocardial infarctions who underwent primary percutaneous coronary intervention in relation to contemporary adjunctive antithrombotic therapy and gender. In the Harmonizing Outcomes With Revascularization and Stents in Acute Myocardial Infarction ...
Chu J W - - 2010
Coronary patients resistant to aspirin may have increased risk for ischemic events. Little data were available for patients presenting acutely with chest pain. We used the VerifyNow Aspirin to determine aspirin responsiveness of 314 patients regularly taking aspirin 75-300 mg daily for >or=4 weeks who presented with suspected acute coronary ...
Park Seung-Jung - - 2010
BACKGROUND: The potential benefits and risks of the use of dual antiplatelet therapy beyond a 12-month period in patients receiving drug-eluting stents have not been clearly established. METHODS: In two trials, we randomly assigned a total of 2701 patients who had received drug-eluting stents and had been free of major ...
Gibler Kyle B - - 2010
Clopidogrel improves outcomes in patients with ST-segment elevation myocardial infarction (STEMI) and is recommended in the guidelines. We sought to determine the incremental cost-effectiveness of clopidogrel therapy in this patient population. We used primary patient-level resource use and clinical outcomes data from 3491 STEMI patients treated with fibrinolysis and either ...
Menown Ian - - 2010
INTRODUCTION: In patients receiving fibrinolytic therapy for ST-elevation myocardial infarction (STEMI), adjunct treatment with enoxaparin has been shown to provide superior net clinical benefit compared with unfractionated heparin (UFH) in the Enoxaparin and Thrombolysis Reperfusion for Acute Myocardial Infarction Treatment - Thrombolysis in Myocardial Infarction (ExTRACT-TIMI) 25 study. The objective ...
Haq Salman A - - 2010
BACKGROUND: Antiplatelet therapy is the principal component of the antithrombotic regimen after acute myocardial infarction. It remains unclear whether additional chronic oral anticoagulation (OAC) improves outcomes. We set out to evaluate the risk and benefit of long-term OAC after myocardial infarction. METHODS: We pooled 10 randomized clinical trials comparing warfarin-containing ...
Parodi Guido - - 2010
Previous studies have compared bivalirudin and unfractionated heparin (UFH) plus the routine use of glycoprotein IIb/IIIa inhibitors. They have demonstrated that bivalirudin can decrease bleeding complications without a significant increase in ischemic complications, resulting in a better net clinical outcome, as defined by the efficacy (ischemic complications) or safety (bleeding ...
Schulz Stefanie S Deutsches Herzzentrum, Technische Universität, Munich, Germany. - - 2010
In ISAR-REACT 3, 30-day outcomes in 4570 biomarker negative patients undergoing percutaneous coronary intervention (PCI) > or =2 h after pre-treatment with 600 mg of clopidogrel revealed less bleeding with bivalirudin compared with unfractionated heparin, but no difference in 30-day net clinical benefit. The objective of the present analysis was ...
Goto Kenji - - 2010
Outcomes of patients presenting with acute coronary syndromes are improved with an early invasive approach; however, approximately one third of these patients are treated medically after angiographic screening. We sought to assess the predictors of adverse cardiac events in patients with acute coronary syndrome assigned to medical management. This substudy ...
Zairis Michael N - - 2010
Because clopidogrel is converted to its active metabolite by P450 isoenzymes, which are also involved in the metabolism of omeprazole, there is concern regarding whether the action of clopidogrel would be reduced in patients also taking omeprazole. To evaluate the impact of omeprazole administration on the effectiveness of clopidogrel drug ...
Niccoli Giampaolo - - 2010
Myocardial no-reflow may negate the benefit of urgent coronary revascularization in patients with acute ST-elevation myocardial infarction (STEMI). Among its pathogenetic mechanisms, distal embolization is of prominent importance and several studies have shown that a high coronary thrombotic burden is associated with distal embolization. We aimed at assessing predictors of ...
Schulman S - - 2010
The antithrombotic treatment of coronary artery disease is becoming increasingly complex. Aspirin is often combined with more potent antiplatelet agents such as thienopyridines and glycoprotein IIb/IIIa inhibitors. The classic anticoagulant unfractionated heparin is giving way to low-molecular-weight heparin, the pentasaccharide fondaparinux and the direct thrombin inhibitor bivalirudin. Warfarin (or another ...
Solomon Scott - - 2010
Prasugrel was associated with a statistically significant reduction in rates of cardiac ischemic events in patients with ACS who had undergone PCI. Rates of post-PCI death from cardiovascular causes, nonfatal MI, or nonfatal stroke were also significantly reduced with the use of prasugrel versus clopidogrel. Major bleeding was significantly increased ...
Ghaffari Samad - - 2010
Unlike essential thrombocytosis, which is associated with thrombotic and hemorrhagic complications, reactive thrombocytosis (RT) is usually considered a benign process without thrombotic complications. We describe a case of acute myocardial infarction in a young heavy smoker with RT following splenectomy. Coronary angiography showed a linear filling defect at mid-part of ...
Menown Ian A - - 2010
During 2009, multiple major cardiology trials have been presented or published. In this paper, we summarize and place in clinical context the new trial findings regarding anticoagulation (dabigatran), antiplatelet therapy (ticagrelor, clopidogrel, prasugrel and aspirin), percutaneous coronary management (thrombectomy, multivessel/left main disease and biodegradable polymers), medical therapy for coronary disease ...
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