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Beiras-Fernandez Andres - - 2009
The glycoprotein IIb/IIIa (GP IIb/IIIa) receptor antagonists prevent platelet aggregation and thrombus formation, improving outcomes of patients with acute coronary syndrome. Therapy with these agents may lead to bleeding complications and thrombocytopenia, challenging the perioperative management of patients undergoing coronary surgery. We report the successful management of an acute profound ...
White Harvey D - - 2009
Bivalirudin has been associated with decreased bleeding, with similar rates of ischemia in patients with stable angina, unstable angina, non-ST elevation myocardial infarction and elective percutaneous coronary intervention (PCI). The Harmonizing Outcomes with Revascularization and Stents in Acute Myocardial Infarction trial tested whether with primary PCI, bivalirudin--compared with unfractionated heparin ...
Mukherjee Debabrata - - 2009
BACKGROUND: Bivalirudin, a direct thrombin inhibitor, has unique attributes including predictable pharmacokinetics, a reduction in bleeding complications and avoidance of heparin induced thrombocytopenia. OBJECTIVE: We critically review the role of bivalirudin in the management of patients with acute coronary syndrome in light of the Acute Catheterization and Urgent Intervention Triage ...
Iijima Raisuke - - 2009
AIMS: The aim of this study was to identify a subset of patients at high risk of bleeding or myocardial infarction from a percutaneous coronary intervention and to investigate whether such high-risk subsets derive preferential benefit from heparin or bivalirudin. METHODS AND RESULTS: This study included 4570 patients with coronary ...
Sarkees Michael L - - 2009
In people with acute coronary syndrome (ACS) the incidence of serious adverse outcomes (such as death, acute myocardial infarction [MI], or refractory angina requiring emergency revascularisation) is 5-10% within the first 7 days and about 15% at 30 days. Between 5-14% of people with acute coronary syndrome die in the ...
Toth Peter P - - 2009
Acute coronary syndromes (ACS) are life-threatening manifestations of coronary artery disease, occurring when a thrombus forms at the site of atherosclerotic plaque rupture or fissuring. Almost all patients discharged from the hospital after an ACS (myocardial infarction or unstable angina) in the United States receive antiplatelet therapy. Current recommendations for ...
Bousser Marie-Germaine - - 2009
The role of antithrombotic drugs in the prevention of cerebral infarction is well established: antiplatelet drugs, at present mostly aspirin, clopidogrel, and aspirin + extended-release dipyridamole, decrease the relative risk of cerebral infarction, myocardial infarction and vascular death by 25% in patients with a cerebral ischemic event due to large- ...
Terpening Chris - - 2009
Combination antiplatelet therapy, typically with clopidogrel and aspirin, is commonly used for the prevention of cardiovascular events. When used for appropriate indications and duration, its benefits clearly outweigh its risks. However, it is not uncommon for the combination to be used outside of recommended indications or for longer than recommended ...
Schwarz Arne Kristian - - 2009
The inhibition of thrombin plays a key role as adjunct therapy in the management of patients with primary percutaneous coronary intervention for ST elevation myocardial infarction. Enoxaparin provides a more predictable and constant level of anticoagulation compared with the current standard unfractionated heparin. The available data from smaller studies and ...
Notaro Lawrence A - - 2009
Patients with coronary artery disease (CAD) commonly have varying degrees of coexisting cerebrovascular disease (CVD) and chronic kidney disease (CKD), and proper management is complicated partly because of a lack of unifying guidelines. The aim of this article is to review the current literature and propose the optimal treatment regimen ...
Mitrovska S - - 2009
OBJECTIVES: We compared the incidence of adverse cardiac outcomes of enoxaparin vs unfractionated heparin in the management of ACS-NSTE. BACKGROUND: Low-molecular-weight heparins are the potential new standard in the treatment of acute coronary syndromes without ST-segment elevation (ACS-NSTE). The benefit is addressed to significant diminution of the adverse clinical events--recurrent ...
Aronow Wilbert S - - 2009
Thienopyridine derivatives such as clopidogrel have been shown to reduce the incidence of death in patients undergoing percutaneous coronary intervention when used in conjunction with aspirin. Recently, a new thienopyridine, prasugrel, significantly reduced the primary endpoint of cardiovascular death, non-fatal myocardial infarction or non-fatal stroke to 9.9% compared to 12.1% ...
Latour-Perez Jaime - - 2009
BACKGROUND: Fondaparinux has been shown to reduce the risk of major bleeding and 30-day mortality compared with enoxaparin, in patients with non-ST-elevation acute coronary syndrome (NSTE-ACS). However, its cost effectiveness is not well known. OBJECTIVE: To evaluate the effectiveness and economic attractiveness of fondaparinux relative to enoxaparin in patients with ...
Trenk D - - 2009
Guidelines from national and international cardiac societies recommend dual antiplatelet therapy with aspirin and thienopyridines (clopidogrel, ticlopidine) in patients with acute coronary syndrome and patients undergoing percutaneous coronary intervention. The most-feared complication of antiplatelet therapy is hemorrhage. Long-term treatment with aspirin increased bleeding rates compared to placebo and similar bleeding ...
PostuĊ‚a Marek - - 2009
The role of antiplatelet therapy in the management of coronary artery disease and its sequalae is of great significance. Acetil Salycilic Acid (ASA) has continued to dominate the field as a potent antiplatelet agent, due to its ease of use and cost effectiveness. In addition to this, clopidogrel has also ...
Sharma Rakesh K - - 2009
Patients undergoing coronary artery stenting receive an antiplatelet regimen to reduce the risk of antithrombotic complications. Current guidelines recommend the use of acetyl salicylic acid (aspirin) and clopidogrel as evidenced by large clinical trials. There has been a concern about variable responses of patients to aspirin and clopidogrel which may ...
Camporese Giuseppe - - 2009
Parnaparin is a low-molecular-weight heparin that has widely shown its efficacy and safety in prevention of venous thromboembolism, in the treatment of chronic venous disorders, and in the treatment of venous and arterial (stable and unstable angina, acute ST-segment elevation myocardial infarction) thrombosis. Parnaparin at the respective dosages of 3200, ...
Motovska Zuzana - - 2009
Dual oral antiplatelet therapy, aspirin plus thienopyridine, has permitted a rapid increase in the use of coronary intervention procedures. Clopidogrel is the thienopyridine of choice for dual antiplatelet therapy in patients treated with percutaneous coronary intervention. However, there are two issues with clopidogrel: (1) clopidogrel's antiplatelet activity is delayed because ...
Heer Tobias - - 2009
In randomized clinical trials enoxaparin in non ST-elevation acute coronary syndromes (NSTE-ACS) has been shown to be more effective than unfractionated heparin in preventing the combined endpoint of death and myocardial infarction. Clopidogrel in combination with aspirin reduced the combined endpoint of death, myocardial infarction and stroke in NSTE-ACS patients ...
Gibson C Michael - - 2008
Balance between efficacy and safety is a major concern in therapeutic interventions of patients with acute coronary syndromes. Identifying and managing the risks that may negatively affect this balance can potentially minimize the incidence of morbidity and/or mortality among patients with acute coronary syndromes. Unstable angina and non-ST-elevation myocardial infarction ...
Skoric Bosko - - 2010
INTRODUCTION: A proportion of patients with acute ST-segment elevation myocardial infarction (STEMI) undergoing primary percutaneous coronary angiography (PCI) presents with patent infarct-related artery (IRA) on initial angiography. We tested the hypothesis that stronger platelet response to aspirin in these patients at admission might be associated with higher initial coronary flow ...
Pinto Duane S - - 2008
OBJECTIVES: The aim of this study was to determine the economic impact of several anticoagulation strategies for moderate- and high-risk non-ST-segment elevation acute coronary syndrome (NSTE-ACS) patients managed invasively. BACKGROUND: The ACUITY (Acute Catheterization and Urgent Intervention Triage Strategy) trial demonstrated that bivalirudin monotherapy yields similar rates of ischemic complications ...
Ortolani Paolo - - 2009
AIMS: To evaluate the clinical impact of early administration of glycoprotein IIb/IIIa agents (IIb/IIIa agents) in the context of a dedicated hub and spoke network allowing very prompt pharmacological/mechanical interventions. METHODS AND RESULTS: Using a prospective database, we conducted a cohort study of ST-elevation myocardial infarction (STEMI) patients (n = ...
Wiviott Stephen D - - 2008
Platelet activation and aggregation play key roles in the management of ischemic complications of acute coronary syndromes and percutaneous coronary intervention. Dual antiplatelet therapy with aspirin and the thienopyridine clopidogrel has become the standard of care for prevention of such complications. Prasugrel, a novel thienopyridine antiplatelet agent, has been demonstrated ...
La Vecchia Luigi - - 2008
Percutaneous coronary intervention (PCI) is routinely performed in patients with non-ST elevation acute coronary syndromes after pretreatment with clopidogrel and periprocedural administration of unfractionated heparin on a weight-adjusted basis. Although activated clotting time (ACT) monitoring is encouraged to verify the adequacy of anticoagulation during the procedures, this is not a ...
Rigattieri Stefano - - 2008
We describe the case of a 64-year-old patient with glucose-6-phosphate dehydrogenase deficiency who was referred to our hospital because of an acute inferior myocardial infarction.Given the possible risk of acute haemolytic anaemia, aspirin was not given in the acute phase, and the patient was successfully treated by balloon angioplasty of ...
Raju Nina C - - 2008
Aspirin is the foundation antiplatelet therapy for patients at risk of cardiovascular events. The thienopyridine, clopidogrel, is modestly more effective than aspirin and in patients with stroke seems to be as effective as the combination of aspirin and dipyridamole. The addition of clopidogrel to aspirin further reduces the risk of ...
Terkelsen Christian J - - 2009
Pregnancy-associated plasma protein-A (PAPP-A) is a putative plaque instability marker. In acute coronary syndromes, the disrupted culprit plaque contains abundant PAPP-A, and circulating PAPP-A levels predict clinical outcomes. Determinants of circulating PAPP-A levels, however, are not fully understood, and the potential role of concomitant heparin administration has not previously been ...
Vande Griend Joseph P - - 2008
Stroke is a leading cause of death and the primary cause of serious, long-term disability in the United States. Joint guidelines from the American Heart Association (AHA) and American Stroke Association (ASA), as well as recent guidelines from the Eighth American College of Chest Physicians (ACCP) Conference on Antithrombotic and ...
Alwi Idrus - - 2008
Non-ST elevation myocardial infarction (NSTEMI) is a subset clinical manifestation of acute coronary syndrome (ACS), which is usually caused by disruption of vulnerable atherosclerotic plaque, followed by thrombosis resulting various degree of occlusions in coronary arteries. The exposure of tissue factors following the plaque rupture causes activation of coagulation cascades ...
Lotrionte Marzia - - 2008
PURPOSE OF REVIEW: Drug compliance is important to maximize benefits and minimize risks; however, the importance of adherence to acetylsalicylic acid (i.e. aspirin) is pivotal in patients with or at risk of coronary artery disease. Given the recent developments in this research field, the high prevalence of coronary artery disease ...
Zimmermann Norbert - - 2008
Aspirin reduces major atherothrombotic events across a wide spectrum of patients with atherosclerotic disease. The occurrence of ischemic events despite of aspirin treatment is a failure of therapy, often denoted 'clinical aspirin resistance'. This is distinguished from laboratory assays showing an insufficient inhibition of platelet function, which indicate 'laboratory aspirin ...
Wiviott Stephen D - - 2008
BACKGROUND: Patients with diabetes mellitus (DM) are at high risk for recurrent cardiovascular events after acute coronary syndromes, in part because of increased platelet reactivity. The Trial to Assess Improvement in Therapeutic Outcomes by Optimizing Platelet Inhibition With Prasugrel-Thrombolysis in Myocardial Infarction 38 (TRITON-TIMI 38) showed an overall reduction in ...
Kastrati Adnan - - 2008
BACKGROUND: Whether bivalirudin is superior to unfractionated heparin in patients with stable or unstable angina who undergo percutaneous coronary intervention (PCI) after pretreatment with clopidogrel is unknown. METHODS: We enrolled 4570 patients with stable or unstable angina (with normal levels of troponin T and creatine kinase MB) who were undergoing ...
Angiolillo Dominick J - - 2008
Antiplatelet therapy plays a key role in preventing atherothrombotic complications in patients with acute coronary syndromes and/or undergoing percutaneous coronary interventions. Despite such clinical benefit, currently available agents may present limitations. Several novel antiplatelet medications are currently under advanced clinical testing. Results from ongoing clinical studies will determine the efficacy ...
Fitchett David - - 2008
Acute coronary syndromes usually result from thrombotic occlusion of a coronary artery at the site of atherosclerotic plaque disruption. The mainstay of treatment is the use of antiplatelet and antithrombotic therapy to maintain patency of the artery. In patients with non-ST segment elevation acute coronary syndromes, antithrombotic therapy followed by ...
Mood Girish R - - 2008
Clopidogrel has become increasingly important in the management of patients with coronary stents. Clopidogrel is an oral agent that acts on the adeno-sine diphosphate receptor to irreversibly inhibit platelet aggregation. Along with aspirin, clopidogrel has a significant role in the treatment of atherothrombotic diseases. Recent concerns about late stent thrombosis ...
Jennings Lisa K - - 2008
PURPOSE OF REVIEW: Platelet activation and aggregation are important pathophysiologic elements of both non-ST-elevation acute coronary syndromes and the ischemic complications of percutaneous coronary intervention, making antiplatelet agents necessary components of the pharmacotherapeutic treatment paradigm for these patients. This review evaluates and interprets the role of oral antiplatelet agents, glycoprotein ...
Cohen Marc - - 2008
INTRODUCTION: Early risk stratification of patients with acute coronary syndromes (ACS), unstable angina, or non-ST-elevation myocardial infarction ensures patients receive appropriate care. MATERIALS AND METHODS: Many risk-stratification models have been developed to identify high-risk ACS patients who would benefit most from an early invasive strategy and to determine patients at ...
Romero Steven C - - 2008
OBJECTIVES: Coronary heart disease (CHD) is the number one cause of death in adults in the industrialized world, and several large studies show that aspirin is helpful for the primary prevention of this disease. Unfortunately, few physicians are aware of its benefit, resulting in the underutilization of aspirin for the ...
Durmaz Tahir - - 2008
Aspirin resistance as defined by failure to effectively inhibit thromboxane synthesis is associated with a higher risk of recurrent myocardial ischemia and cardiovascular death. Heart rate variability (HRV) analysis has been extensively used to identify patients at risk for increased cardiac mortality. The aim of this study was to evaluate ...
Sobieszczyk Piotr - - 2008
BACKGROUND: Acute coronary syndrome (ACS) is caused by reduced perfusion of the myocardium and characterized by chest pain. The primary goals of treatment for ACS are to restore blood flow through occluded coronary arteries and prevent recurrent coronary events. Antiplatelet and anticoagulant therapies play a crucial role in the treatment ...
Tanaka Shinichiro - - 2008
Aspirin and anti-platelet drugs are used commonly for patients with coronary heart disease. Proton pump inhibitor (PPI) and high-dose H2-blocker were recommended for preventing NSAIDs-related ulcer. Previously H2-blocker reported to have some negative cardiovascular effects. Additionally, a recent in vitro study showed that PPI reduced cardiac contractility. In this study, ...
Zhang Zefeng - - 2009
BACKGROUND: The COMMIT trial demonstrated that clopidogrel produced a 9% relative reduction in death, reinfarction or stroke (9.2% vs. 10.1%, 95% CI: 0.86-0.97) in ST-elevated myocardial infarction (STEMI) patients. METHODS: Between 08/1999 and 05/2005, 45,852 STEMI patients were randomized to clopidogrel (n=22,961) or matching placebo (n=22,891) in addition to aspirin. ...
Coons James C - - 2008
OBJECTIVE: To summarize key changes in the 2007 American College of Cardiology/American Heart Association (ACC/AHA) guideline recommendations for pharmacologic therapy as they relate to antiplatelets and anticoagulants, and to evaluate the evidence from several landmark trials that was used to support the guideline updates for these agents. DATA SOURCES: Literature ...
Valgimigli Marco - - 2008
PURPOSE: To assess whether glycoprotein IIb/IIIa inhibition using tirofiban in low risk patients undergoing percutaneous coronary intervention (PCI) may reduce the risk of periprocedural myocardial infarction compared to standard care in poor responders to aspirin and/or clopidogrel. METHODS: We will enroll patients at ten European sites or more to participate ...
Mazzaferri Ernest L EL - - 2008
The glycoprotein (GP) IIb/IIIa receptor serves as the final common pathway of platelet-thrombus formation. Thus, the GP IIb/IIIa receptor has been identified as a target for the prevention of thrombus formation during acute coronary syndromes and/or percutaneous coronary intervention. While there are several intravenous GP IIb/IIIa inhibitors available, abciximab has ...
Antman Elliott M - - 2008
OBJECTIVES: We evaluated the relative contributions of the loading and maintenance doses of prasugrel on events in a TRITON-TIMI 38 (TRial to Assess Improvement in Therapeutic Outcomes by Optimizing Platelet InhibitioN with Prasugrel-Thrombolysis In Myocardial Infarction) analysis. BACKGROUND: Prasugrel is superior to clopidogrel in preventing ischemic events in patients with ...
Stone Gregg W - - 2008
BACKGROUND: Treatment with the direct thrombin inhibitor bivalirudin, as compared with heparin plus glycoprotein IIb/IIIa inhibitors, results in similar suppression of ischemia while reducing hemorrhagic complications in patients with stable angina and non-ST-segment elevation acute coronary syndromes who are undergoing percutaneous coronary intervention (PCI). The safety and efficacy of bivalirudin ...
De Luca G - - 2008
Even though time-to-treatment has been shown to be a determinant of mortality in primary angioplasty, the potential benefits from early pharmacological reperfusion by glycoprotein (Gp) IIb-IIIa inhibitors are still unclear. The aim of this meta-analysis was to combine individual data from all randomised trials conducted on facilitated primary angioplasty by ...
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