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Shitole AA, Giram PS, Raut PW, Rade PP, Khandwekar AP, Sharma N, Garnaik B. Clopidogrel eluting electrospun polyurethane/polyethylene glycol thromboresistant, hemocompatible nanofibrous scaffolds. J Biomater Appl 2019; 33:1327-1347. [DOI: 10.1177/0885328219832984] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Biomaterials used as blood-contacting material must be hemocompatible and exhibit lower thrombotic potential while maintaining hemostasis and angiogenesis. With the aim of developing thromboresistant, hemocompatible nanofibrous scaffolds, polyurethane/polyethylene glycol scaffolds incorporated with 1, 5, and 10 wt% Clopidogrel were fabricated and evaluated for their physiochemical properties, biocompatibility, hemocompatibility, and antithrombotic potential. The results of physicochemical characterization revealed the fabrication of nanometer-sized scaffolds with smooth surfaces. The incorporation of both polyethylene glycol and Clopidogrel to polyurethane enhanced the hydrophilicity and water uptake potential of polyurethane/polyethylene glycol/Clopidogrel scaffolds. The dynamic mechanical analysis revealed the enhancement in mechanical strength of the polyurethane/polyethylene glycol scaffolds on incorporation of Clopidogrel. The polyurethane/polyethylene glycol/Clopidogrel scaffolds showed a tri-phasic drug release pattern. The results of hemocompatibility assessment demonstrated the excellent blood compatibility of the polyurethane/polyethylene glycol/Clopidogrel scaffolds, with the developed scaffolds exhibiting lower hemolysis, increased albumin and plasma protein adsorption while reduction in fibrinogen adsorption. Further, the platelet adhesion was highly suppressed and significant increase in coagulation period was observed for Clopidogrel incorporated scaffolds. The results of cell adhesion and cell viability substantiate the biocompatibility of the developed nanofibrous scaffolds with the HUVEC cell viability on polyurethane/polyethylene glycol, polyurethane/polyethylene glycol/Clopidogrel-1, 5, and 10% at day 7 found to be 12.35, 13.36, 14.85, and 4.18% higher as compared to polyurethane scaffolds, and the NIH/3T3 cell viability found to be 35.27, 70.82, 36.60, and 7.95% higher as compared to polyurethane scaffolds, respectively. Altogether the results of the study advocate the incorporation of Clopidogrel to the polyurethane/polyethylene glycol blend in order to fabricate scaffolds with appropriate antithrombotic property, hemocompatibility, and cell proliferation capacity and thus, might be successfully used as antithrombotic material for biomedical application.
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Affiliation(s)
- Ajinkya A Shitole
- Symbiosis School of Biological Sciences, Symbiosis International (Deemed University), Pune, India
| | - Prabhanjan S Giram
- Polymer Science and Engineering Division, CSIR- National Chemical Laboratory, Pune, India
- Academy of Scientific and Innovative Research (AcSIR), Ghaziabad, Uttar Pradesh, India
| | - Piyush W Raut
- Symbiosis School of Biological Sciences, Symbiosis International (Deemed University), Pune, India
| | - Priyanka P Rade
- Polymer Science and Engineering Division, CSIR- National Chemical Laboratory, Pune, India
- Academy of Scientific and Innovative Research (AcSIR), Ghaziabad, Uttar Pradesh, India
| | - Anand P Khandwekar
- School of Engineering, Ajeenkya DY Patil University (ADYPU), Pune, India
| | - Neeti Sharma
- Symbiosis School of Biological Sciences, Symbiosis International (Deemed University), Pune, India
| | - Baijayantimala Garnaik
- Polymer Science and Engineering Division, CSIR- National Chemical Laboratory, Pune, India
- Academy of Scientific and Innovative Research (AcSIR), Ghaziabad, Uttar Pradesh, India
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Domingues R, Bruniera G, Brunale F, Mangueira C, Senne C. Lumbar puncture in patients using anticoagulants and antiplatelet agents. ARQUIVOS DE NEURO-PSIQUIATRIA 2017; 74:679-86. [PMID: 27556380 DOI: 10.1590/0004-282x20160098] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/20/2016] [Accepted: 05/25/2016] [Indexed: 12/26/2022]
Abstract
The use of anticoagulants and antiplatelet agents has largely increased. Diagnostic lumbar puncture in patients taking these drugs represents a challenge considering the opposing risks of bleeding and thrombotic complications. To date there are no controlled trials, specific guidelines, nor clear recommendations in this area. In the present review we make some recommendations about lumbar puncture in patients using these drugs. Our recommendations take into consideration the pharmacology of these drugs, the thrombotic risk according to the underlying disease, and the urgency in cerebrospinal fluid analysis. Evaluating such information and a rigorous monitoring of neurological symptoms after lumbar puncture are crucial to minimize the risk of hemorrhage associated neurological deficits. An individualized patient decision-making and an effective communication between the assistant physician and the responsible for conducting the lumbar puncture are essential to minimize potential risks.
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Affiliation(s)
| | - Gustavo Bruniera
- Senne Líquor Diagnóstico, São Paulo SP, Brasil;,Hospital Israelita Albert Einstein, Laboratório de Patologia Clínica, São Paulo SP, Brasil
| | - Fernando Brunale
- Senne Líquor Diagnóstico, São Paulo SP, Brasil;,Hospital Israelita Albert Einstein, Laboratório de Patologia Clínica, São Paulo SP, Brasil
| | - Cristóvão Mangueira
- Hospital Israelita Albert Einstein, Laboratório de Patologia Clínica, São Paulo SP, Brasil
| | - Carlos Senne
- Senne Líquor Diagnóstico, São Paulo SP, Brasil;,Hospital Israelita Albert Einstein, Laboratório de Patologia Clínica, São Paulo SP, Brasil
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Schweickert PA, Gaughen JR, Kreitel EM, Shephard TJ, Solenski NJ, Jensen ME. An overview of antithrombotics in ischemic stroke. Nurse Pract 2016; 41:48-55. [PMID: 27153001 DOI: 10.1097/01.npr.0000483077.47966.6e] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
The use of antithrombotic medications is an important component of ischemic stroke treatment and prevention. This article reviews the evidence for best practices for antithrombotic use in stroke with focused discussion on the specific agents used to treat and prevent stroke.
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Affiliation(s)
- Patricia A Schweickert
- Patricia A. Schweickert is general faculty and an NP at the University of Virginia, Department of Radiology, Interventional Neuroradiology, Charlottesville, Va.; adjunct faculty of nursing at the University of Virginia School of Nursing, Charlottesville, Va; adjunct faculty at Old Dominion University School of Nursing, Norfolk, Va; and contributing faculty of nursing at Walden University School of Nursing, Minneapolis, MN. John R. Gaughen is an interventional neuroradiologist at Sentara Martha Jefferson Hospital, Charlottesville, Va. Elizabeth M. Kreitel is a doctor of pharmacy. Timothy J. Shephard is an administrative coordinator for neuroradiology at the University of Virginia Department of Radiology, Interventional Neuroradiology, Charlottesville, Va. Nina J. Solenski is a stroke neurologist at the University of Virginia, Department of Neurology, Vascular Neurology, Charlottesville, Va. Mary E. Jensen is an interventional neuroradiologist at the University of Virginia, Department of Radiology, Interventional Neuroradiology, Charlottesville, Va
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Volonghi I, Padovani A, Zotto ED, Giossi A, Costa P, Morotti A, Poli L, Pezzini A. Secondary prevention of ischaemic stroke. World J Neurol 2013; 3:97-114. [DOI: 10.5316/wjn.v3.i4.97] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/29/2013] [Revised: 10/08/2013] [Accepted: 10/18/2013] [Indexed: 02/06/2023] Open
Abstract
In spite of a documented reduction in incidence in high-income countries over the last decades, stroke is still a leading cause of death and disability worldwide. With the ageing of the population stroke-related economic burden is expected to increase, because of residual disability and its complications, such as cognitive impairment, high risk of falls and fractures, depression and epilepsy. Furthermore, because of the substantial rate of early and long-term vascular recurrences after the first event, secondary prevention after cerebral ischaemia is a crucial issue. This is even more important after minor stroke and transient ischaemic attack (TIA), in order to reduce the risk of potentially more severe and disabling events. To accomplish this aim, acute long-term medical and surgical treatments as well as lifestyle modifications are strongly recommended. However, apart from the well-established indications to thrombolysis, studies in acute phase after a first stroke or TIA are scarce and evidence is lacking. More trials are available for long-term secondary prevention with different classes of drugs, including antithrombotic medications for ischaemic events of arterial and cardiac origin, especially related to atrial fibrillation (antiplatelets and anticoagulants, respectively), lipid lowering agents (mainly statins), blood pressure lowering drugs, surgical and endovascular revascularization procedures.
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Sjölander M, Eriksson M, Glader EL. The association between patients' beliefs about medicines and adherence to drug treatment after stroke: a cross-sectional questionnaire survey. BMJ Open 2013; 3:e003551. [PMID: 24068768 PMCID: PMC3787491 DOI: 10.1136/bmjopen-2013-003551] [Citation(s) in RCA: 76] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
OBJECTIVES Adherence to preventive drug treatment is a clinical problem and we hypothesised that patients' beliefs about medicines and stroke are associated with adherence. The objective was to examine associations between beliefs of patients with stroke about stroke and drug treatment and their adherence to drug treatment. DESIGN Cross-sectional questionnaire survey. SETTING Patients with stroke from 25 Swedish hospitals were included. MEASUREMENTS Questionnaires were sent to 989 patients to assess their perceptions about stroke (Brief Illness Perception Questionnaire, Brief IPQ), beliefs about medicines (Beliefs about Medicines Questionnaires, BMQ) and adherence to treatment (Medication Adherence Report Scale, MARS) 3 months after stroke onset. Only patients living at home were included in the analysis. The primary outcome was self-reported adherence as measured on MARS. MARS scores were dichotomised into adherent/non-adherent. Background and clinical data from the Swedish Stroke register were included. RESULTS 811 patients were still living at home and 595 answered the questionnaire. Complete MARS data were available for 578 patients and 72 (12.5%) of these were classified as non-adherent. Non-adherent patients scored lower on positive beliefs as measured on BMQ-necessity (OR = 0.90, 95% CI 0.83 to 0.98) and BMQ-benefit (OR=0.77, 95% CI 0.68 to 0.87), and higher on negative beliefs as measured on BMQ-concern (OR=1.12, 95% CI 1.05 to 1.21), BMQ-overuse (OR=1.29, 95% CI 1.14 to 1.45), and BMQ-harm (OR=1.12, 95% CI 1.01 to 1.24). The Brief IPQ showed that non-adherent patients believed their current treatment to be less useful (p=0.001). CONCLUSIONS This study showed associations between beliefs of Swedish patients with stroke about medicines and adherence. Positive beliefs were less common and negative more common among non-adherent. To improve adherence, patients' beliefs about medicines should be considered.
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Affiliation(s)
- Maria Sjölander
- Department of Public Health and Clinical Medicine, Umeå University, Umeå, Sweden
- Department of Pharmacology and Clinical Neuroscience, Umeå University, Umeå, Sweden
| | - Marie Eriksson
- Department of Statistics, Umeå School of Business and Economics, Umeå University, Umeå, Sweden
| | - Eva-Lotta Glader
- Department of Public Health and Clinical Medicine, Umeå University, Umeå, Sweden
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Del Gaudio C, Ercolani E, Galloni P, Santilli F, Baiguera S, Polizzi L, Bianco A. Aspirin-loaded electrospun poly(ε-caprolactone) tubular scaffolds: potential small-diameter vascular grafts for thrombosis prevention. JOURNAL OF MATERIALS SCIENCE. MATERIALS IN MEDICINE 2013; 24:523-532. [PMID: 23135411 DOI: 10.1007/s10856-012-4803-3] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/20/2012] [Accepted: 10/19/2012] [Indexed: 06/01/2023]
Abstract
Thrombosis is the main cause of failure of small-diameter synthetic vascular grafts when used for by-pass procedures. The development of bioresorbable vascular scaffolds with localized and sustained intra-luminal antithrombotic drug release could be considered a desirable improvement towards a valuable solution for this relevant clinical need. For this aim, we present the fabrication and characterization of aspirin-loaded electrospun poly(ε-caprolactone) tubular scaffolds as a vascular drug-delivery graft. Three different drug concentrations were considered (i.e., 1, 5 or 10 % w/w). Although a fibrous structure was clearly observed for all the collected scaffolds, aspirin content was directly implied in the final microstructure leading to a bimodal fiber diameter distribution and fused fibers at crossing-points (5 or 10 % w/w). Mechanical response highlighted a direct relationship for modulus and stress at break with the aspirin content, while the elongation at break was not remarkably different for the investigated cases. The temporal drug release was strongly dependent from the amount of loaded aspirin, reaching a steady state release after about 50 h. Finally, the adhesion assay confirmed the capability of the electrospun scaffolds to reduce platelet adhesion/aggregation onto aspirin loaded polymeric fibers. Aspirin-loaded electrospun tubular scaffold could represent a feasible candidate to develop a novel bioresorbable drug-releasing graft for small-diameter vessel replacements.
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Affiliation(s)
- Costantino Del Gaudio
- Department of Industrial Engineering, University of Rome "Tor Vergata", INSTM Research Unit Roma Tor Vergata, Via del Politecnico 1, 00133, Rome, Italy.
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Benzon H, McCarthy R, Benzon H, Kendall M, Robak S, Lindholm P, Kallas P, Katz J. Determination of residual antiplatelet activity of clopidogrel before neuraxial injections. Br J Anaesth 2011; 107:966-71. [DOI: 10.1093/bja/aer298] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Beloosesky Y, Weiss A, Mansur N. Validity of the Medication-Based Disease Burden Index Compared with the Charlson Comorbidity Index and the Cumulative Illness Rating Scale for Geriatrics. Drugs Aging 2011; 28:1007-14. [DOI: 10.2165/11597040-000000000-00000] [Citation(s) in RCA: 40] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022]
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Do aspirin and other antiplatelet drugs reduce the mortality in critically ill patients? THROMBOSIS 2011; 2012:720254. [PMID: 22110915 PMCID: PMC3216368 DOI: 10.1155/2012/720254] [Citation(s) in RCA: 48] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/06/2011] [Accepted: 10/03/2011] [Indexed: 11/17/2022]
Abstract
Platelet activation has been implicated in microvascular thrombosis and organ failure in critically ill patients. In the first part the present paper summarises important data on the role of platelets in systemic inflammation and sepsis as well as on the beneficial effects of antiplatelet drugs in animal models of sepsis. In the second part the data of retrospective and prospective observational clinical studies on the effect of aspirin and other antiplatelet drugs in critically ill patients are reviewed. All of these studies have shown that aspirin and other antiplatelet drugs may reduce organ failure and mortality in these patients, even in case of high bleeding risk. From the data reviewed here interventional prospective trials are needed to test whether aspirin and other antiplatelet drugs might offer a novel therapeutic option to prevent organ failure in critically ill patients.
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