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Rasu RS, Phadnis MA, Xavier C, Dai J, Hunt SL, Jain N. P2Y12 Inhibitors Refill Gap Predicts Death in Medicare Beneficiaries on Chronic Dialysis. Kidney Int Rep 2024; 9:2125-2133. [PMID: 39081724 PMCID: PMC11284433 DOI: 10.1016/j.ekir.2024.04.053] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2023] [Revised: 04/09/2024] [Accepted: 04/25/2024] [Indexed: 08/02/2024] Open
Abstract
Introduction Oral P2Y12 inhibitors (P2Y12-I) are commonly used antiplatelet drugs in patients with end-stage kidney disease (ESKD) on chronic dialysis. Although gaps in prescription refills are quite common in patients with ESKD, it remains unclear whether P2Y12-I prescription refill patterns are associated with adverse clinical outcomes. Methods We used the United States Renal Data System (USRDS) registry for patients with ESKD to capture new P2Y12-I prescriptions from 2011 to 2015. The primary exposure was prescription refill patterns and the primary outcome was all-cause death. Results Among the 31,243 patients with new P2Y12-I prescription, median age was 64 years; 54% were male; and 39% were Caucasian, 37% African American, and 18% Hispanic. We observed 3 P2Y12-I refill patterns as follows: continuous users (45.1%), noncontinuous users (3.6%), and users with ≥30 days refill gap (51.4%). Prescription refill pattern with ≥30 days refill gap (vs. continuous use) was associated with all-cause death (adjusted hazard ratio [HR]: 1.18; 95% confidence interval [CI]: 1.13-1.23). Age and race were the most important risk factors associated with prescription refill pattern. African Americans (vs. Caucasians) were more likely to demonstrate ≥30 days refill gap, (adjusted odds ratio [OR]: 1.43; 95% CI: 1.36-1.51). In addition, younger patients (vs. older) were more likely to demonstrate ≥30 day refill gap (adjusted OR/decade: 0.9; 95% CI: 0.89-0.92). Conclusion Nonadherence to P2Y12-I prescriptions is quite common, and disproportionately affects minorities. Younger individuals with ESKD are independently associated with a higher risk of death. The odds of having a refill gap are decreasing for older patients who are more compliant than younger patients. Future studies should investigate whether phenotyping subgroups of patients with ESKD based on prescription refill patterns can help in improving adverse clinical outcomes.
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Affiliation(s)
- Rafia S. Rasu
- Department of Pharmacotherapy, College of Pharmacy, University of North Texas Health Sciences, Fort Worth, Texas, USA
| | - Milind A. Phadnis
- Department of Biostatistics and Data Science, University of Kansas School of Medicine, Kansas City, Kansas, USA
| | - Christy Xavier
- Department of Pharmacotherapy, College of Pharmacy, University of North Texas Health Sciences, Fort Worth, Texas, USA
| | - Junqiang Dai
- Department of Biostatistics and Data Science, University of Kansas School of Medicine, Kansas City, Kansas, USA
| | - Suzanne L. Hunt
- Department of Biostatistics and Data Science, University of Kansas School of Medicine, Kansas City, Kansas, USA
| | - Nishank Jain
- Department of Internal Medicine, University of Arkansas for Medical Sciences, Little Rock, Arkansas, USA
- Central Arkansas Veterans Affairs Medical Center, Little Rock, Arkansas, USA
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Wang B, Su Y, Ma C, Xu L, Mao Q, Cheng W, Lu Q, Zhang Y, Wang R, Lu Y, He J, Chen S, Chen L, Li T, Gao L. Impact of perioperative low-molecular-weight heparin therapy on clinical events of elderly patients with prior coronary stents implanted > 12 months undergoing non-cardiac surgery: a randomized, placebo-controlled trial. BMC Med 2024; 22:171. [PMID: 38649992 PMCID: PMC11036782 DOI: 10.1186/s12916-024-03391-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/12/2023] [Accepted: 04/15/2024] [Indexed: 04/25/2024] Open
Abstract
BACKGROUND Little is known about the safety and efficacy of discontinuing antiplatelet therapy via LMWH bridging therapy in elderly patients with coronary stents implanted for > 12 months undergoing non-cardiac surgery. This randomized trial was designed to compare the clinical benefits and risks of antiplatelet drug discontinuation via LMWH bridging therapy. METHODS Patients were randomized 1:1 to receive subcutaneous injections of either dalteparin sodium or placebo. The primary efficacy endpoint was cardiac or cerebrovascular events. The primary safety endpoint was major bleeding. RESULTS Among 2476 randomized patients, the variables (sex, age, body mass index, comorbidities, medications, and procedural characteristics) and percutaneous coronary intervention information were not significantly different between the bridging and non-bridging groups. During the follow-up period, the rate of the combined endpoint in the bridging group was significantly lower than in the non-bridging group (5.79% vs. 8.42%, p = 0.012). The incidence of myocardial injury in the bridging group was significantly lower than in the non-bridging group (3.14% vs. 5.19%, p = 0.011). Deep vein thrombosis occurred more frequently in the non-bridging group (1.21% vs. 0.4%, p = 0.024), and there was a trend toward a higher rate of pulmonary embolism (0.32% vs. 0.08%, p = 0.177). There was no significant difference between the groups in the rates of acute myocardial infarction (0.81% vs. 1.38%), cardiac death (0.24% vs. 0.41%), stroke (0.16% vs. 0.24%), or major bleeding (1.22% vs. 1.45%). Multivariable analysis showed that LMWH bridging, creatinine clearance < 30 mL/min, preoperative hemoglobin < 10 g/dL, and diabetes mellitus were independent predictors of ischemic events. LMWH bridging and a preoperative platelet count of < 70 × 109/L were independent predictors of minor bleeding events. CONCLUSIONS This study showed the safety and efficacy of perioperative LMWH bridging therapy in elderly patients with coronary stents implanted > 12 months undergoing non-cardiac surgery. An alternative approach might be the use of bridging therapy with half-dose LMWH. TRIAL REGISTRATION ISRCTN65203415.
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Affiliation(s)
- Bin Wang
- Department of Comprehensive Surgery, The Second Medical Center & National Clinical Research Center for Geriatric Diseases, Chinese PLA General Hospital, Beijing, 100853, China
| | - Yanhui Su
- Department of Comprehensive Surgery, The Second Medical Center & National Clinical Research Center for Geriatric Diseases, Chinese PLA General Hospital, Beijing, 100853, China
| | - Cong Ma
- Health Management Institute, The Second Medical Center & National Clinical Research Center for Geriatric Diseases, Chinese PLA General Hospital, Beijing, China
| | - Lining Xu
- Department of Comprehensive Surgery, The Second Medical Center & National Clinical Research Center for Geriatric Diseases, Chinese PLA General Hospital, Beijing, 100853, China
| | - Qunxia Mao
- National Research Institute for Family Planning, Beijing, China
| | - Wenjia Cheng
- Department of Comprehensive Surgery, The Second Medical Center & National Clinical Research Center for Geriatric Diseases, Chinese PLA General Hospital, Beijing, 100853, China
| | - Qingming Lu
- Department of Comprehensive Surgery, The Second Medical Center & National Clinical Research Center for Geriatric Diseases, Chinese PLA General Hospital, Beijing, 100853, China
| | - Ying Zhang
- Department of Comprehensive Surgery, The Second Medical Center & National Clinical Research Center for Geriatric Diseases, Chinese PLA General Hospital, Beijing, 100853, China
| | - Rong Wang
- Department of Comprehensive Surgery, The Second Medical Center & National Clinical Research Center for Geriatric Diseases, Chinese PLA General Hospital, Beijing, 100853, China
| | - Yan Lu
- Department of Comprehensive Surgery, The Second Medical Center & National Clinical Research Center for Geriatric Diseases, Chinese PLA General Hospital, Beijing, 100853, China
| | - Jing He
- Department of Comprehensive Surgery, The Second Medical Center & National Clinical Research Center for Geriatric Diseases, Chinese PLA General Hospital, Beijing, 100853, China
| | - Shihao Chen
- Department of Comprehensive Surgery, The Second Medical Center & National Clinical Research Center for Geriatric Diseases, Chinese PLA General Hospital, Beijing, 100853, China
| | - Lei Chen
- Department of Thoracic Surgery of The First Medical Center, General Hospital of Chinese People's Liberation Army, Beijing, 100853, China.
| | - Tianzhi Li
- Department of Comprehensive Surgery, The Second Medical Center & National Clinical Research Center for Geriatric Diseases, Chinese PLA General Hospital, Beijing, 100853, China.
| | - Linggen Gao
- Department of Comprehensive Surgery, The Second Medical Center & National Clinical Research Center for Geriatric Diseases, Chinese PLA General Hospital, Beijing, 100853, China.
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Ghorai RP, Panaiyadiyan S, Singh P, Nayak B. Management conundrum in a case of renal cell cancer (RCC) on dual antiplatelet therapy (DAPT) for recently placed coronary drug-eluting stent (DES). BMJ Case Rep 2024; 17:e257750. [PMID: 38423578 PMCID: PMC10910470 DOI: 10.1136/bcr-2023-257750] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/02/2024] Open
Abstract
A man in his 50s presented in an emergency with breathlessness and chest discomfort. On evaluation, he was diagnosed with coronary artery disease, with more than 80% narrowing of the right coronary and left circumflex arteries. The patient underwent percutaneous coronary intervention and was started on dual antiplatelet (DAPT) therapy. After starting DAPT, the patient developed gross haematuria with a drop in haematocrit. Further evaluation revealed a left renal mass with urinary bladder clots. Because of the risk of stent thrombosis on stopping DAPT, radical nephrectomy was deferred, and the patient underwent left renal artery angioembolisation and bladder clot evacuation. On the follow-up, the patient was stable with a gradual decrease in renal mass size, and after a year, the patient underwent definitive surgery. The patient is doing well in 4 years of follow-up with no metastasis.
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Affiliation(s)
- Rudra Prasad Ghorai
- Department of Urology, All India Institute of Medical Sciences, New Delhi, India
| | - Sridhar Panaiyadiyan
- Department of Urology, All India Institute of Medical Sciences, New Delhi, India
- Department of Urology, National Cancer Institute - All India Institute of Medical Sciences, Jhajjar, Haryana, India
| | - Prabhjot Singh
- Department of Urology, All India Institute of Medical Sciences, New Delhi, India
| | - Brusabhanu Nayak
- Department of Urology, All India Institute of Medical Sciences, New Delhi, India
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Fiocca L, Rossini R, Carioli G, Carobbio A, Piazza I, Collaku E, Giubilato S, Amico F, Molfese M, De Benedictis M, Calabria P, Limbruno U, Valente S, Ferlini M, Spezzano T, Senni M, Gavazzi A. Adherence of ticagrelOr in real world patients with aCute coronary syndrome: The AD-HOC study. IJC HEART & VASCULATURE 2022; 42:101092. [PMID: 35873861 PMCID: PMC9301572 DOI: 10.1016/j.ijcha.2022.101092] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2022] [Revised: 06/19/2022] [Accepted: 07/13/2022] [Indexed: 10/24/2022]
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Wu F, Ma K, Xiang R, Han B, Chang J, Zuo Z, Luo Y, Mao M. Efficacy and safety of a bridging strategy that uses intravenous platelet glycoprotein receptor inhibitors for patients undergoing surgery after coronary stent implantation: a meta-analysis. BMC Cardiovasc Disord 2022; 22:125. [PMID: 35331138 PMCID: PMC8953042 DOI: 10.1186/s12872-022-02563-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2021] [Accepted: 03/09/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Current guidelines indicate we can consider a bridging strategy that uses intravenous, reversible glycoprotein inhibitors for patients that required surgery following recent stent implantation. However, no strong clinical evidence exists that demonstrates the efficacy and safety of this treatment. Therefore, in this study, the efficacy and safety of a bridging strategy that uses intravenous platelet glycoprotein receptor inhibitors will be evaluated. METHODS A meta-analysis was performed on preoperative bridging studies in patients undergoing coronary stent surgery. The primary outcome was the success rate of no major adverse cardiovascular events (MACE). The secondary outcomes were the success rate of no reoperations to stop bleeding. RESULTS A total of 10 studies that included 382 patients were used in this meta-analysis. For the primary endpoint, the success rate was 97.7% (95% CI 94.4-98.0%) for glycoprotein IIb/IIIa inhibitors, 98.8% (95% CI 96.0-100%) for tirofiban (6 studies) and 95.8% (95% CI 90.4-99.4%) for eptifibatide (4 studies). For secondary endpoints, the success rate was 98.0% (95% CI 94.8-99.9%) for glycoprotein IIb/IIIa inhibitors, 99.7% (95% CI 97.1-100%) for tirofiban (5 studies), and 95.3% (95% CI 88.5-99.4%) for eptifibatide (4 studies). CONCLUSION The results of this study showed that the use of intravenous platelet glycoprotein IIb/IIIa inhibitors as a bridging strategy might be safe and effective for patients undergoing coronary stent implantation that require surgery soon after.
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Affiliation(s)
- Fan Wu
- Department of Cardiology, The First Affiliated Hospital of Chongqing Medical University, No. 1, Youyi Road, Yuanjiagang, Yuzhong District, Chongqing, 400016, China
| | - Kanghua Ma
- Department of Cardiology, The First Affiliated Hospital of Chongqing Medical University, No. 1, Youyi Road, Yuanjiagang, Yuzhong District, Chongqing, 400016, China
| | - Rui Xiang
- Department of Cardiology, The First Affiliated Hospital of Chongqing Medical University, No. 1, Youyi Road, Yuanjiagang, Yuzhong District, Chongqing, 400016, China
| | - Baoru Han
- College of Medical Informatics, Chongqing Medical University, Chongqing, 401135, China
| | - Jing Chang
- Department of Cardiology, The First Affiliated Hospital of Chongqing Medical University, No. 1, Youyi Road, Yuanjiagang, Yuzhong District, Chongqing, 400016, China
| | - Zhong Zuo
- Department of Cardiology, The First Affiliated Hospital of Chongqing Medical University, No. 1, Youyi Road, Yuanjiagang, Yuzhong District, Chongqing, 400016, China
| | - Yue Luo
- Department of Cardiology, The First Affiliated Hospital of Chongqing Medical University, No. 1, Youyi Road, Yuanjiagang, Yuzhong District, Chongqing, 400016, China
| | - Min Mao
- Department of Cardiology, The First Affiliated Hospital of Chongqing Medical University, No. 1, Youyi Road, Yuanjiagang, Yuzhong District, Chongqing, 400016, China.
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Shenoy A, Panicker P, Vijayan A, George AL. Prospective Comparative Evaluation of Post-extraction Bleeding in Cardiovascular-Compromised Patients with and without Antiplatelet Medications. J Maxillofac Oral Surg 2021; 20:486-495. [PMID: 34408378 PMCID: PMC8313627 DOI: 10.1007/s12663-019-01315-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2019] [Accepted: 11/30/2019] [Indexed: 12/01/2022] Open
Abstract
BACKGROUND AND OBJECTIVE A considerable number of patients consulting a dental surgeon are on antiplatelet therapy, and an interruption of these agents for 3 to 7 days has been practised by majority of them prior to dental surgical intervention fearing excessive bleeding, risking the patient for the occurrence of adverse thrombotic events. The dental and medical literature shows a very low risk of excessive bleeding associated on the continuation of antiplatelet therapy. The objective of this study is to compare the bleeding following single-firm molar tooth extraction in patients who interrupt and those who continue antiplatelet therapy perioperatively. METHODOLOGY This is a prospective descriptive study on 170 patients on long-term low-dose antiplatelet therapy with 2 groups, each containing 85 patients-Group 1 with patients who interrupted antiplatelet therapy for 5 days before extraction and Group 2, patients who continued it perioperatively. A single molar tooth extraction was done under local anaesthesia with a vasoconstrictor. Gauze pressure pack was placed for 60 min. Socket was observed every 15 min for 1 h to look for excessive post-extraction bleeding. RESULTS No statistically significant differences were found in post-extraction bleeding between the patients who stopped antiplatelet therapy and those who continued it. CONCLUSION The bleeding risk when continuing long-term low-dose antiplatelet therapy following a single molar tooth extraction is minimal. Bleeding, if excessive, can be easily controlled by gauze pressure pack or other local haemostatic agents. Thus, dental extractions can be performed on these patients without interrupting the antiplatelet drug pre-operatively provided a thorough medical history, physician's consent and coagulation profile have been obtained prior to the procedure.
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Affiliation(s)
- Archana Shenoy
- Victoria Dental Centre, No. 201, 2nd Floor Divya Deepa Towers, Mangalore, Karnataka India
| | - Prasanth Panicker
- Department of Oral and Maxillofacial Surgery, Sree Anjaneya Institute of Dental Sciences, Calicut, Kerala India
- Indira Gandhi Hospital, Ernakulam, Kochi, Kerala India
| | - Ajoy Vijayan
- Department of Oral and Maxillofacial Surgery, Mahe Institute of Health Sciences, Mahé, Kerala India
| | - Ashford Lidiya George
- Department of Oral and Maxillofacial Surgery, Sree Anjaneya Institute of Dental Sciences, Calicut, Kerala India
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Limbruno U, De Sensi F, Cresti A, Picchi A, Lena F, De Caterina R. Optimal Antithrombotic Treatment of Patients with Atrial Fibrillation Early after an Acute Coronary Syndrome-Triple Therapy, Dual Antithrombotic Therapy with an Anticoagulant… Or, Rather, Temporary Dual Antiplatelet Therapy? J Clin Med 2020; 9:jcm9082673. [PMID: 32824861 PMCID: PMC7464261 DOI: 10.3390/jcm9082673] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2020] [Revised: 08/09/2020] [Accepted: 08/12/2020] [Indexed: 12/20/2022] Open
Abstract
The combination of atrial fibrillation (AF) and acute coronary syndrome (ACS) is a complex situation in which a three-dimensional risk-cardioembolic, coronary, and hemorrhagic-has to be carefully managed. Triple antithrombotic therapy (TAT) is burdened with a high risk of serious bleeding, while dual antithrombotic therapy with an anticoagulant (DAT) likely provides only suboptimal coronary protection early after stent implantation. Moreover, TAT precludes the advantages provided by the use of the latest and more potent P2Y12 inhibitors in ACS patients. Here, we aimed to simulate and compare the expected coronary, cardioembolic, and hemorrhagic outcomes offered by DAT, TAT, or modern dual antiplatelet therapy (DAPT) with aspirin plus one of the latest P2Y12 inhibitors in AF patients early after an ACS. The comparison of numbers needed to treat to prevent major adverse events with the various antithrombotic regimens suggests that AF-ACS patients at high ischemic and hemorrhagic risk and at moderately low embolic risk (CHA2DS2VASc score 2-4) might safely withhold anticoagulation after revascularization for one month taking advantage of a modern DAPT, with a favorable risk-to-benefit ratio. In conclusion, this strategy, not sufficiently addressed in recent European and North American guidelines or consensus documents, adds to the spectrum of treatment options in these difficult patients; it might be the best choice in a substantial number of patients; and should be prospectively tested in a randomized controlled trial.
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Affiliation(s)
- Ugo Limbruno
- Cardioneurovascular Department, Azienda USL Toscana Sudest, 58100 Grosseto, Italy; (U.L.); (F.D.S.); (A.C.); (A.P.)
| | - Francesco De Sensi
- Cardioneurovascular Department, Azienda USL Toscana Sudest, 58100 Grosseto, Italy; (U.L.); (F.D.S.); (A.C.); (A.P.)
| | - Alberto Cresti
- Cardioneurovascular Department, Azienda USL Toscana Sudest, 58100 Grosseto, Italy; (U.L.); (F.D.S.); (A.C.); (A.P.)
| | - Andrea Picchi
- Cardioneurovascular Department, Azienda USL Toscana Sudest, 58100 Grosseto, Italy; (U.L.); (F.D.S.); (A.C.); (A.P.)
| | - Fabio Lena
- Pharmacy Department, Azienda USL Toscana Sudest, 58100 Grosseto, Italy;
| | - Raffaele De Caterina
- Cardio-Thoracic and Vascular Department, Pisa University Hospital and University of Pisa, 56124 Pisa, Italy
- Fondazione VillaSerena per la Ricerca, Città Sant’Angelo, 65013 Pescara, Italy
- Correspondence: ; Tel.: +39-050-996-751
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Velders MA, Hagström E, James SK. Temporal Trends in the Prevalence of Cancer and Its Impact on Outcome in Patients With First Myocardial Infarction: A Nationwide Study. J Am Heart Assoc 2020; 9:e014383. [PMID: 32067596 PMCID: PMC7070202 DOI: 10.1161/jaha.119.014383] [Citation(s) in RCA: 26] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/05/2019] [Accepted: 12/19/2019] [Indexed: 12/24/2022]
Abstract
Background Coexistence of cancer and cardiovascular disease is increasingly frequent, but nationwide data covering cancer patients with myocardial infarction (MI) are scarce. We sought to investigate the prevalence of cancer in patients with first MI, and its impact on cardiovascular and bleeding outcome. Methods and Results Using nationwide Swedish quality registries, all patients admitted for first MI between 2001 and 2014 were identified. Data on comorbidity, cancer, and outcome were obtained from the national cancer and patient registries. Stratification was performed according to cancer during the 5 years before MI. Multivariable Cox proportional hazards analyses adjusting for cardiovascular risk factors and invasive treatment assessed the association of cancer with outcome. In total, 175 146 patients with first MI were registered, of whom 9.3% (16 237) had received care for cancer in the 5 years before admission. The cancer rate increased from 6.7% in the years 2001-2002 to 10.7% in 2013-2014, independent of sex and cancer type. The presence of a new cancer diagnosis within 5 years increased from 4.9% to 6.2%. During a median follow-up of 4.3 years, cancer was associated with all-cause mortality (hazard ratio, 1.44; 95% CI, 1.40-1.47), recurrent MI (hazard ratio, 1.08; 95% CI, 1.04-1.12), heart failure (hazard ratio, 1.10; 95% CI, 1.06-1.13), and major bleeding (hazard ratio, 1.45; 95% CI, 1.34-1.57). Risk for adverse events varied strongly according to cancer extent, timing, and type. Conclusions Cancer as a comorbid disorder is increasing and is strongly associated with mortality, severe bleeding, and adverse cardiovascular outcome after first MI.
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Affiliation(s)
| | - Emil Hagström
- Department of Medical SciencesUppsala UniversityUppsalaSweden
- Uppsala Clinical Research CentreUppsala UniversityUppsalaSweden
| | - Stefan K. James
- Department of Medical SciencesUppsala UniversityUppsalaSweden
- Uppsala Clinical Research CentreUppsala UniversityUppsalaSweden
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Park LG, Ng F, K Shim J, Elnaggar A, Villero O. Perceptions and experiences of using mobile technology for medication adherence among older adults with coronary heart disease: A qualitative study. Digit Health 2020; 6:2055207620926844. [PMID: 32489672 PMCID: PMC7241207 DOI: 10.1177/2055207620926844] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2019] [Accepted: 03/30/2020] [Indexed: 12/11/2022] Open
Abstract
OBJECTIVE Medication non-adherence is linked to adverse clinical outcomes (i.e. rehospitalization, mortality) among patients with coronary heart disease. Given its global adoption and growing popularity among older adults, mobile technology may be an effective strategy to improve medication adherence. The aim of this article is to present the perceptions, attitudes, and beliefs of individuals with coronary heart disease about using text messaging and mobile phone applications for medication adherence. METHODS We recruited 28 participants (veterans and non-veterans) with a history of coronary heart disease and antiplatelet medication use in Northern California. We formed six focus groups of individuals who participated in three sessions (total 18 sessions). We analyzed our data using grounded theory. RESULTS The median age was 69.5 ± 10.8 years for non-veterans (50% male) and 70 ± 8.6 years for veterans (100% male). In the first session, we found that participants perceived text message reminders as a convenient, easy, and flexible tool to establish a routine for taking medications. In the second session, participants were eager to use applications for their greater interactivity, individualized health monitoring, and personalized medication information. The third session, participants shared preferred features (i.e. drug interactions, tracking symptoms) after using two applications at home for 2 weeks. CONCLUSIONS Older adults are engaged and can be proficient mobile technology users. Text messaging and mobile phone applications are perceived as helpful tools for medication adherence. Future research should include rigorous clinical trials to test the efficacy of mobile health technology to promote medication adherence in populations that require strict medication adherence.
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Affiliation(s)
- Linda G Park
- Department of Veterans Affairs Medical Center, USA
- University of California, San Francisco School of Nursing, USA
- Department of Community Health Systems, University of California, USA
| | - Fion Ng
- University of California, San Francisco School of Nursing, USA
- Department of Family Health Care Nursing, University of California, USA
| | - Janet K Shim
- University of California, San Francisco School of Nursing, USA
- Department of Social and Behavioral Sciences, University of California, USA
| | - Abdelaziz Elnaggar
- University of California, San Francisco School of Nursing, USA
- Department of Community Health Systems, University of California, USA
| | - Ofelia Villero
- University of California, San Francisco School of Nursing, USA
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Cangrelor Bridging Within 6 Months of a Drug-Eluting Stent in a Patient for Emergency Cervical Spine Surgery: A Case Report. A A Pract 2019; 13:69-73. [PMID: 30864953 DOI: 10.1213/xaa.0000000000000994] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
The recommended duration of dual antiplatelet therapy after drug-eluting stent placement presents a dilemma for patients with recent stenting who require urgent or emergency noncardiac surgery. We present the case of a patient with recent drug-eluting stent placement (<6 months) on dual antiplatelet therapy who underwent successful emergency cervical spine surgery with antiplatelet therapy bridged using cangrelor, an intravenous P2Y12 inhibitor antiplatelet agent. Our experience illustrates the multidisciplinary approach to a patient with high thrombotic and bleeding risk who underwent neurosurgery off both aspirin and a P2Y12 inhibitor.
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Smartphone and social media-based cardiac rehabilitation and secondary prevention in China (SMART-CR/SP): a parallel-group, single-blind, randomised controlled trial. LANCET DIGITAL HEALTH 2019; 1:e363-e374. [DOI: 10.1016/s2589-7500(19)30151-7] [Citation(s) in RCA: 51] [Impact Index Per Article: 10.2] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/16/2019] [Revised: 09/06/2019] [Accepted: 09/13/2019] [Indexed: 02/07/2023]
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12
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Winter MP, von Lewinski D, Wallner M, Prüller F, Kolesnik E, Hengstenberg C, Siller-Matula JM. Incidence, predictors, and prognosis of premature discontinuation or switch of prasugrel or ticagrelor: the ATLANTIS - SWITCH study. Sci Rep 2019; 9:8194. [PMID: 31160687 PMCID: PMC6547711 DOI: 10.1038/s41598-019-44673-7] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2018] [Accepted: 05/13/2019] [Indexed: 02/06/2023] Open
Abstract
Aim of the present study was to investigate the frequency and predictors of premature discontinuation or switch of ADP receptor blockers and its association with serious adverse events. For this purpose 571 consecutive ACS patients receiving ticagrelor (n = 258, 45%) or prasugrel (n = 313, 55%) undergoing PCI were enrolled in this prospective, observational, multicenter ATLANTIS-SWITCH substudy. Predictors of premature discontinuation or switch of antiplatelet therapy and their association with major adverse cardiovascular events and TIMI bleeding events were evaluated. Premature stop/switch was found in 72 (12.6%) patients: 34 (5.9%) stopped and 38 (6.7%) switched the ADP blocker. Ticagrelor treated patients were significantly more likely to stop/switch therapy as compared to prasugrel (15.9% vs. 9.2%, p = 0.016). We identified 4 independent predictors for stop/switch of ADP blocker: major surgery, need for oral anticoagulation (OAC), TIMI major bleeding and drug intolerance. TIMI major bleeding was a driver of stop/switch actions and occurred in 4.3% vs 0.2% in patients with vs without stop/switch (p = 0.001). The majority of stop/switch actions (75%) were physicians driven decisions. Importantly, stop/switch of therapy was not associated with increased risk of MACE (p = 0.936). In conclusion premature switch/stop of ADP blockers appears to be safe when mainly driven by physician’s decision and clinical indication.
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Affiliation(s)
- Max-Paul Winter
- Department of Cardiology, Medical University of Vienna, Vienna, Austria
| | | | - Markus Wallner
- Department of Cardiology, Medical University of Graz, Graz, Austria.,Lewis Katz School of Medicine, Temple University, Cardiovascular Research Center, Philadelphia, PA, USA
| | - Florian Prüller
- Clinical Institute of Medical and Chemical Laboratory Diagnostics, Medical University of Graz, Graz, Austria
| | - Ewald Kolesnik
- Department of Cardiology, Medical University of Graz, Graz, Austria
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13
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Jiang T, Xie Z, Wu F, Chen J, Liao Y, Liu L, Zhao A, Wu J, Yang P, Huang N. Hyaluronic Acid Nanoparticle Composite Films Confer Favorable Time-Dependent Biofunctions for Vascular Wound Healing. ACS Biomater Sci Eng 2019; 5:1833-1848. [PMID: 33405557 DOI: 10.1021/acsbiomaterials.9b00295] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
Vascular stent implantation is the primary treatment for coronary artery disease. Surface modification of coronary stents is a topic of interest to prevent thrombosis and restenosis and to promote endothelization. However, bioactive coatings on implants have not yet been fully developed for the time-ordered biological requirements of vascular stents. The first month after vascular stent implantation, the pathological changes in the injured vascular tissue are complex and time-ordered. Therefore, vascular stents possess time-dependent biofunctions with early phase anticoagulant and anti-inflammatory properties. In the later stage, inhibitory effects on smooth muscle cell proliferation and the promotion of endothelial cell adhesion might meet the requirements of vascular repair. We fabricated three types of hyaluronic acid nanoparticles (HA-NPs) by subjecting HA and poly(ether imide) to ethyl(dimethylaminopropyl) carbodiimide/N-hydroxysuccinimide coupling reaction. The HA-NPs prepared by HA with a molecular weight of 100 kDa showed the best stability in a hyaluronidase environment. HA-NP composite films (HA-NCFs) were then fabricated by coimmobilizing selected HA-NPs (100 kDa) and HA molecules (100 kDa) through amide reaction on PDA/HD coated 316 L stainless steel surfaces. The detachment behavior of HA-NPs (100 kDa) in PBS for 20 days indicated that the HA-NPs (100 kDa) gradually detached from the surface. In vitro tests (anticoagulant and anti-inflammatory tests, endothelial cells, and smooth muscle cells seeding, and bacterial adhesion test) indicated that the newly fabricated HA-NCFs have inhibitory effects on the adhesion of fibrinogen, platelets, macrophages, bacteria, SMCs, and ECs. As the HA-NPs detached from the surface, the HA-NCFs showed excellent gradual comprehensive biocompatibility, which promoted adhesion and proliferation of ECs while still exerting inhibitory effects on the platelets, macrophages, and SMCs. Finally, in vivo SS wire implantation test (aortic implantation in healthy Sprague-Dawley rats) showed that HA-NCFs possessed anti-inflammatory properties, inhibited the proliferation of smooth muscle cells, and promoted re-endothelialization. In particular, HA-NCFs with time-dependent biofunctions showed better antirestenosis effects than those of surfaces modified with molecular HA, which exhibited constant biocompatibility. This study provides an important basis for the construction of HA-NP composite films with favorable time-dependent biofunctions for the time-ordered biological requirements of vascular stent.
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Affiliation(s)
- Ting Jiang
- School of Life Science and Engineering, Southwest Jiaotong University, No. 111 of the North First Section of Second Ring Road, Chengdu 610031, PR China.,Institute of Biomaterials and Surface Engineering, Key Lab. for Advanced Technologies of Materials, Ministry of Education, Southwest Jiaotong University, No. 111 of the North First Section of Second Ring Road, Chengdu 610031, PR China
| | - Zhou Xie
- Institute of Biomaterials and Surface Engineering, Key Lab. for Advanced Technologies of Materials, Ministry of Education, Southwest Jiaotong University, No. 111 of the North First Section of Second Ring Road, Chengdu 610031, PR China
| | - Feng Wu
- Institute of Biomaterials and Surface Engineering, Key Lab. for Advanced Technologies of Materials, Ministry of Education, Southwest Jiaotong University, No. 111 of the North First Section of Second Ring Road, Chengdu 610031, PR China
| | - Jiang Chen
- Institute of Biomaterials and Surface Engineering, Key Lab. for Advanced Technologies of Materials, Ministry of Education, Southwest Jiaotong University, No. 111 of the North First Section of Second Ring Road, Chengdu 610031, PR China
| | - Yuzhen Liao
- Institute of Biomaterials and Surface Engineering, Key Lab. for Advanced Technologies of Materials, Ministry of Education, Southwest Jiaotong University, No. 111 of the North First Section of Second Ring Road, Chengdu 610031, PR China
| | - Luying Liu
- Institute of Biomaterials and Surface Engineering, Key Lab. for Advanced Technologies of Materials, Ministry of Education, Southwest Jiaotong University, No. 111 of the North First Section of Second Ring Road, Chengdu 610031, PR China
| | - Ansha Zhao
- Institute of Biomaterials and Surface Engineering, Key Lab. for Advanced Technologies of Materials, Ministry of Education, Southwest Jiaotong University, No. 111 of the North First Section of Second Ring Road, Chengdu 610031, PR China
| | - Jian Wu
- School of Life Science and Engineering, Southwest Jiaotong University, No. 111 of the North First Section of Second Ring Road, Chengdu 610031, PR China
| | - Ping Yang
- Institute of Biomaterials and Surface Engineering, Key Lab. for Advanced Technologies of Materials, Ministry of Education, Southwest Jiaotong University, No. 111 of the North First Section of Second Ring Road, Chengdu 610031, PR China
| | - Nan Huang
- Institute of Biomaterials and Surface Engineering, Key Lab. for Advanced Technologies of Materials, Ministry of Education, Southwest Jiaotong University, No. 111 of the North First Section of Second Ring Road, Chengdu 610031, PR China
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14
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Howell S, Hoeks S, West R, Wheatcroft S, Hoeft A, Leva B, Plichon B, Damster S, Momeni M, Watremez C, Kahn D, Dincq AS, Danila A, Wittmann M, Struck R, Rüddel T, Kessler F, Rasche S, Matsota P, Hasani A, Gudaityte J, Karbonskiene A, Ferreira R, Carvalho S, Tomescu D, Martac C, Grintescu I, Mirea L, Serrano L, Serrano L, Sierra P, Sabaté S, Hernando D, Matute P, Trashorras M, Suñé M, Sarmiento L, Hervias A, González O, Hermina A, González O, Hermina A, Navarro Perez R, Orts M, Fernandez-Garcia R, Sanchez Pérez D, Sepulveda Gil I, Monedero P, Hidalgo F, Mbongo C, Pont A, Reyes H, Bartolo C, Galera S, Valentijn T, Stolker R, Tugrul M, Emre Demirel E, Hough M, Griffiths K, Birch S, Beardow Z, Elliot S, Thompson J, Bowrey S, Northey M, Melson H, Telford R, Nadolski M, Potter A, Fuller D, Rose A, Varma S, Simeson K, Pettit J, Smith N, Martinson V, Sleight L, Naylor C, Watt P, Raymode P, Dunk N, Twohey L, Hollos L, Davies S, Gibson A, Coleman Z, Tamm T, Joscak J, Zsisku L, Zuleika M, Carvalho P, Collyer T, Ryan J, Colling K, Dharmarajah S, Krishnan A, Paddle J, Fouracres A, Arnell K, Muhammad K. Prospective observational cohort study of the association between antiplatelet therapy, bleeding and thrombosis in patients with coronary stents undergoing noncardiac surgery. Br J Anaesth 2019; 122:170-179. [DOI: 10.1016/j.bja.2018.09.029] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2017] [Revised: 09/16/2018] [Accepted: 09/24/2018] [Indexed: 01/19/2023] Open
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15
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Laboratory Monitoring of Antiplatelet Therapy. Platelets 2019. [DOI: 10.1016/b978-0-12-813456-6.00036-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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16
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Long-Term Use of Antiplatelet Therapy in Real-World Patients with Acute Myocardial Infarction: Insights from the PIPER Study. TH OPEN 2018; 2:e437-e444. [PMID: 31249972 PMCID: PMC6524921 DOI: 10.1055/s-0038-1676529] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2018] [Accepted: 10/25/2018] [Indexed: 02/06/2023] Open
Abstract
The aim of this study was to assess long-term drug adherence and prognosis in real-world patients discharged on dual-antiplatelet therapy (DAPT) after acute myocardial infarction (AMI). A retrospective cohort analysis using administrative databases kept by eight local health units was performed. DAPT exposure (defined as ≥ 2 prescriptions), adherence, and the occurrence of major adverse events (MACE) were analyzed during a 36-month follow-up. The analysis included 11,101 patients who were discharged alive with a primary diagnosis of AMI. Of these, 5,919 patients (53.31%) were discharged on DAPT without a diagnosis of cancer or anemia, without transient DAPT discontinuation, and represented the study population. DAPT discontinuation occurred in 2,200 patients (37.2%) and in 1,995 (33.7%) after the first 6 and 12 months, respectively, whereas 423 patients (7.1%) were still on DAPT after 36 months. Patients who maintained DAPT up to 12 months had a significantly lower overall mortality, compared with patients who discontinued DAPT after 6 months. Exposure to DAPT at 3 years was associated with reduced all-cause mortality (hazard ratio [HR]: 0.067, 95% confidence interval [CI]: 0.027–0.162,
p
< 0.001) and reduced recurrent AMI (HR: 0.02, 95% CI: 0.003–0.173,
p
< 0.001). In conclusion, this study shows that prolonged DAPT over 12 months is maintained in a relevant number of patients after AMI. However, adherence to antiplatelet therapy in first 12 months after AMI is still unsatisfactory and efforts to enhance patients' compliance are warranted. Exposure to prolonged DAPT at 3 years seems to be associated with a significant reduction in all-cause mortality and AMI.
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Plümer L, Seiffert M, Punke MA, Kersten JF, Blankenberg S, Zöllner C, Petzoldt M. Aspirin Before Elective Surgery-Stop or Continue? DEUTSCHES ARZTEBLATT INTERNATIONAL 2018; 114:473-480. [PMID: 28764836 DOI: 10.3238/arztebl.2017.0473] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/02/2016] [Revised: 10/02/2016] [Accepted: 04/13/2017] [Indexed: 02/07/2023]
Abstract
BACKGROUND Cessation of long-term aspirin treatment before noncardiac surgery can cause adverse cardiac events in patients at risk, particularly in those with previous percutaneous coronary interventions (PCI) with stent implantation. The factors influencing the clinical decision to stop aspirin treatment are currently unknown. METHODS In a single-center, cross-sectional study (retrospective registration: NCT03049566) carried out from February to December 2014, we took a survey among patients scheduled for noncardiac surgery who were under long-term aspirin treatment, and among their treating anesthesiologists using standardized questionnaires on preoperative aspirin use, comorbidities, and risk-benefit assessments. The main objective was to identify factors associated with the decision to stop aspirin treatment. The results of multivariable logistic regressions and intraclass correlations are presented. RESULTS 805 patients were included in the study, and 636 questionnaires were returned (203 of which concerned patients with coronary stents). 46.8% of the patients stopped their long-term aspirin treatment before surgery; 38.7% of these patients stopped it too early (>10 days before surgery) or too late (≤ 3 days before surgery). A prior PCI with stent implantation lowered the probability of aspirin cessation (odds ratio [OR] = 0.47 [0.31; 0.72]; p <0.001). On the other hand, patients were more likely to stop their long-term aspirin treatment if it had already been discontinued once before (OR = 4.58 [3.06; 6.84]; p <0.001), if there was a risk of bleeding into a closed space (OR = 4.54 [2.02; 10.22]; p <0.001), if they did not know why they were supposed to take aspirin (OR = 2.12 [1.05; 4.28]; p = 0.036), or if the preoperative consultation with the anesthesiologist occurred <2 days before surgery (OR = 1.60 [1.08; 2.37]; p = 0.018). Patients often assessed the risks related to aspirin cessation lower than their physicians did. CONCLUSION This study reveals discordance between guideline recommendations and everyday clinical practice in patients with coronary stents. The early integration of cardiologists and anesthesiologists and a more widespread use of stent implant cards could promote adherence to the guidelines.
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Affiliation(s)
- Lili Plümer
- Department of Anesthesiology, Center for Anesthesiology and Intensive Care Medicine, University Medical Center Hamburg-Eppendorf (UKE), Hamburg, Germany; Department of General and Interventional Cardiology, University Heart Center Hamburg (UHZ), Hamburg, Germany; Institute of Medical Biometry and Epidemiology, University Medical Center Hamburg-Eppendorf (UKE), Hamburg, Germany
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18
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The impact of in-hospital P2Y12 inhibitor switch in patients with acute coronary syndrome. CARDIOVASCULAR REVASCULARIZATION MEDICINE 2018; 19:912-916. [DOI: 10.1016/j.carrev.2018.09.007] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2018] [Accepted: 09/07/2018] [Indexed: 01/07/2023]
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19
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Mazlan-Kepli W, Dawson J, Berry C, Walters M. Cessation of dual antiplatelet therapy and cardiovascular events following acute coronary syndrome. Heart 2018; 105:67-74. [PMID: 30030335 DOI: 10.1136/heartjnl-2018-313148] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/10/2018] [Revised: 06/13/2018] [Accepted: 07/02/2018] [Indexed: 11/03/2022] Open
Abstract
OBJECTIVE To assess whether cardiovascular events are increased after cessation of dual antiplatelet therapy (DAPT) following acute coronary syndrome (ACS) and to explore predictors for recurrent events after DAPT cessation during long-term follow-up. METHODS We did a retrospective observational cohort study. We included consecutive people with ACS who were discharged from Scottish hospitals between January 2008 and December 2013 and who received DAPT after discharge followed by antiplatelet monotherapy. The rates of cardiovascular events were assessed during each 90-day period of DAPT treatment and 90-day period after stopping DAPT. Cardiovascular events were defined as a composite of death, ACS, transient ischaemic attack or stroke. Cox regression was used to identify predictors of cardiovascular events following DAPT cessation. RESULTS 1340 patients were included (62% male, mean age 64.9 (13.0) years). Cardiovascular events occurred in 15.7% (n=211) during the DAPT period (mean DAPT duration 175.1 (155.3) days) and in 16.7% (n=188) following DAPT cessation (mean of 2.7 years follow-up). Independent predictors for a cardiovascular event following DAPT cessation were age (HR 1.07; 95% CI 1.05 to 1.08; p<0.001), DAPT duration (HR 0.997; 95% CI 0.995 to 0.998; p<0.001) and having revascularisation therapy during the index admission (HR 0.58; 95% CI 0.39 to 0.85; p=0.005). CONCLUSIONS The rate of cardiovascular events was not significantly increased in the early period post-DAPT cessation compared with later periods in this ACS population. Increasing age, DAPT duration and lack of revascularisation therapy were associated with increased risk of cardiovascular events during long-term follow-up after DAPT cessation.
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Affiliation(s)
| | - Jesse Dawson
- Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow, UK
| | - Colin Berry
- Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow, UK
| | - Matthew Walters
- Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow, UK
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Gulizia MM, Colivicchi F, Abrignani MG, Ambrosetti M, Aspromonte N, Barile G, Caporale R, Casolo G, Chiuini E, Di Lenarda A, Faggiano P, Gabrielli D, Geraci G, La Manna AG, Maggioni AP, Marchese A, Massari FM, Mureddu GF, Musumeci G, Nardi F, Panno AV, Pedretti RFE, Piredda M, Pusineri E, Riccio C, Rossini R, di Uccio FS, Urbinati S, Varbella F, Zito GB, De Luca L. Consensus Document ANMCO/ANCE/ARCA/GICR-IACPR/GISE/SICOA: Long-term Antiplatelet Therapy in Patients with Coronary Artery Disease. Eur Heart J Suppl 2018; 20:F1-F74. [PMID: 29867293 PMCID: PMC5978022 DOI: 10.1093/eurheartj/suy019] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Dual antiplatelet therapy (DAPT) with aspirin and a P2Y12 receptor inhibitor is the cornerstone of pharmacologic management of patients with acute coronary syndrome (ACS) and/or those receiving coronary stents. Long-term (>1 year) DAPT may further reduce the risk of stent thrombosis after a percutaneous coronary intervention (PCI) and may decrease the occurrence of non-stent-related ischaemic events in patients with ACS. Nevertheless, compared with aspirin alone, extended use of aspirin plus a P2Y12 receptor inhibitor may increase the risk of bleeding events that have been strongly linked to adverse outcomes including recurrent ischaemia, repeat hospitalisation and death. In the past years, multiple randomised trials have been published comparing the duration of DAPT after PCI and in ACS patients, investigating either a shorter or prolonged DAPT regimen. Although the current European Society of Cardiology guidelines provide a backup to individualised treatment, it appears to be difficult to identify the ideal patient profile which could safely reduce or prolong the DAPT duration in daily clinical practice. The aim of this consensus document is to review contemporary literature on optimal DAPT duration, and to guide clinicians in tailoring antiplatelet strategies in patients undergoing PCI or presenting with ACS.
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Affiliation(s)
- Michele Massimo Gulizia
- U.O.C. di Cardiologia, Ospedale Garibaldi-Nesima, Azienda di Rilievo Nazionale e Alta Specializzazione “Garibaldi”, Catania, Italy
| | - Furio Colivicchi
- U.O.C. Cardiologia e UTIC, Ospedale San Filippo Neri, Roma, Italy
| | | | - Marco Ambrosetti
- Servizio di Cardiologia Riabilitativa, Clinica Le Terrazze Cunardo, Varese, Italy
| | - Nadia Aspromonte
- U.O. Scompenso e Riabilitazione Cardiologica, Polo Scienze Cardiovascolari, Toraciche, Policlinico Agostino Gemelli, Roma, Italy
| | | | - Roberto Caporale
- U.O.C. Cardiologia Interventistica, Ospedale Annunziata, Cosenza, Italy
| | - Giancarlo Casolo
- S.C. Cardiologia, Nuovo Ospedale Versilia, Lido di Camaiore (LU), Italy
| | - Emilia Chiuini
- Specialista Ambulatoriale Cardiologo, ASL Umbria 1, Perugia, Italy
| | - Andrea Di Lenarda
- S.C. Cardiovascolare e Medicina dello Sport, Azienda Sanitaria Universitaria Integrata di Trieste, Italy
| | | | - Domenico Gabrielli
- ASUR Marche - Area Vasta 4 Fermo, Ospedale Civile Augusto Murri, Fermo, Italy
| | - Giovanna Geraci
- U.O.C. Cardiologia Azienda Ospedali Riuniti Villa Sofia-Cervello, Palermo, Italy
| | | | | | | | - Ferdinando Maria Massari
- U.O.C. Malattie Cardiovascolari "Fondazione IRCCS Ca' Granda, Ospedale Maggiore Policlinico, Milano, Italy
| | | | | | - Federico Nardi
- S.C. Cardiologia, Ospedale Santo Spirito, Casale Monferrato (AL), Italy
| | | | | | - Massimo Piredda
- Centro Cardiotoracico, Divisione di Cardiologia, Istituto Clinico Sant'Ambrogio, Milano, Italy
| | - Enrico Pusineri
- U.O.C. di Cardiologia, Ospedale Civile di Vigevano, A.S.S.T., Pavia, Italy
| | - Carmine Riccio
- Prevenzione e Riabilitazione Cardiopatico, AZ. Ospedaliera S. Anna e S. Sebastiano, Caserta, Italy
| | | | | | - Stefano Urbinati
- U.O.C. Cardiologia, Ospedale Bellaria, AUSL di Bologna, Bologna, Italy
| | | | | | - Leonardo De Luca
- U.O.C. Cardiologia, Ospedale San Giovanni Evangelista, Tivoli, Roma, Italy
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Iliescu CA, Cilingiroglu M, Giza DE, Rosales O, Lebeau J, Guerrero-Mantilla I, Lopez-Mattei J, Song J, Silva G, Loyalka P, Paixao ARM, Yusuf SW, Perin E, Anderson VH, Marmagkiolis K. "Bringing on the light" in a complex clinical scenario: Optical coherence tomography-guided discontinuation of antiplatelet therapy in cancer patients with coronary artery disease (PROTECT-OCT registry). Am Heart J 2017; 194:83-91. [PMID: 29223438 DOI: 10.1016/j.ahj.2017.08.015] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/24/2017] [Accepted: 08/17/2017] [Indexed: 11/28/2022]
Abstract
BACKGROUND Cancer patients with recently placed drug-eluting stents (DESs) often require premature dual antiplatelet therapy (DAPT) discontinuation for cancer-related procedures. Optical coherence tomography (OCT) can identify risk factors for stent thrombosis such as stent malapposition, incomplete strut coverage and in-stent restenosis and may help guide discontinuation of DAPT. METHODS We conducted a single-center prospective study in cancer patients with recently placed (1-12 months) DES who required premature DAPT discontinuation. Patients were evaluated with diagnostic coronary angiogram and OCT. Individuals with appropriate stent strut coverage, expansion, apposition, and absence of in-stent restenosis or intraluminal masses were considered low risk and transiently discontinued DAPT to allow optimal cancer therapy. Patients who did not meet all these criteria were considered high risk and underwent further endovascular treatment when appropriate and bridging with low-molecular weight heparin. The incidence of adverse cardiovascular events was assessed after the procedure and at 12 months. RESULTS A total of 40 patients were included. Twenty-seven patients (68%) were considered low risk by OCT criteria and DAPT was transiently discontinued. Thirteen patients (32%) were considered high risk with one or more OCT findings: uncovered stent struts (4 patients, 10%); stent underexpansion (3 patients, 8%); malapposition (8 patients, 20%); in-stent restenosis (2 patients, 5%). The high-risk patients with uncovered stent struts and malapposition underwent additional stent dilatation. There were no cardiovascular events in the low-risk group. One myocardial infarction occurred in the high-risk group. Fourteen non-cardiac deaths were registered before 12 months due to cancer progression or cancer therapy. CONCLUSION OCT imaging allows identification of low-risk cancer patients with DES placed who may safely discontinue DAPT and proceed with cancer-related surgery or procedures.
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Affiliation(s)
- Cezar A Iliescu
- The University of Texas MD Anderson Cancer Center, Houston, TX.
| | | | - Dana E Giza
- The University of Texas MD Anderson Cancer Center, Houston, TX
| | | | | | | | | | - Juhee Song
- The University of Texas MD Anderson Cancer Center, Houston, TX
| | | | - Pranav Loyalka
- University of Texas Health Science Center, Memorial Hermann Hospital, Houston, TX
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22
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Musumeci G, Capodanno D, Lettieri C, Limbruno U, Tarantini G, Russo N, Calabria P, Romano M, Inashvili A, Sirbu V, Guagliumi G, Valsecchi O, Senni M, Gavazzi A, Angiolillo DJ, Rossini R. Perioperative management of oral antiplatelet therapy and clinical outcomes in coronary stent patients undergoing surgery. Thromb Haemost 2017; 113:272-82. [DOI: 10.1160/th14-05-0436] [Citation(s) in RCA: 38] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2014] [Accepted: 08/27/2014] [Indexed: 11/05/2022]
Abstract
SummaryThe aim was to investigate the perioperative risk of ischaemic and bleeding events in patients with coronary stents undergoing cardiac and non-cardiac surgery and how these outcomes are affected by the perioperative use of oral antiplatelet therapy. This was a multicentre, retrospective, observational study conducted in patients with coronary stent(s) undergoing cardiac or non-cardiac surgery. The primary efficacy endpoint was the 30-day incidence of major adverse cardiac events (MACE), defined as the composite of cardiac death, myocardial infarction (MI) or stroke. The primary safety endpoint was the 30-day incidence of Bleeding Academic Research Consortium (BARC) bleeding ≥ 2. A total of 666 patients were included. Of these, 371 (55.7 %) discontinued their antiplatelet medication(s) (all or partly) before undergoing surgery. At 30 days, patients with perioperative discontinuation of antiplatelet therapy experienced a significantly higher incidence of MACE (7.5 % vs 0.3 %, p < 0.001), cardiac death (2.7 % vs 0.3 %, p=0.027), and MI (4.0 % vs 0 %, p < 0.001). After adjustment, peri-operative antiplatelet discontinuation was the strongest independent predictor of 30-day MACE (odds ratio [OR]=25.8, confidence interval [CI]=3.37–198, p=0.002). Perioperative aspirin (adjusted OR 0.27, 95 % CI 0.11–0.71, p=0.008) was significantly associated with a lower risk of MACE. The overall incidence of BARC ≥ 2 bleeding events at 30-days was significantly higher in patients who discontinued oral antiplatelet therapy (25.6 % vs 13.9 %, p < 0.001). However, after adjustment, antiplatelet discontinuation was not independently associated with BARC ≥ 2 bleeding. In conclusion antiplatelet discontinuation increases the 30-day risk of MACE, in patients with coronary stents undergoing cardiac and non-cardiac surgery, while not offering significant protection from BARC≥ 2 bleeding.
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Ding C, Zhang J, Li R, Wang J, Hu Y, Chen Y, Li X, Xu Y. Investigation of standardized administration of anti-platelet drugs and its effect on the prognosis of patients with coronary heart disease. Exp Ther Med 2017; 14:3207-3212. [PMID: 28966689 DOI: 10.3892/etm.2017.4903] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2015] [Accepted: 10/20/2016] [Indexed: 12/17/2022] Open
Abstract
The aim of the present study was to explore the effect of adherence to standardized administration of anti-platelet drugs on the prognosis of patients with coronary heart disease. A total of 144 patients newly diagnosed with coronary heart disease at Lu'an Shili Hospital of Anhui Province (Lu'an, China) between June 2010 and June 2012 were followed up. Kaplan-Meier curves and the Cox regression model were used to evaluate the effects of standardized administration of anti-platelet drugs on primary and secondary end-point events. Of the patients with coronary heart disease, 109 (76%) patients took standard anti-platelet drugs following discharge. Kaplan-Meier curve and Cox regression analysis showed that standardized administration of anti-platelet drugs reduced the risk of primary end-point events (including all-cause mortality, non-lethal myocardial infarction and stroke) of patients with coronary heart disease [hazard ratio (HR)=0.307; 95% confidence interval (CI): 0.099-0.953; P=0.041) and all-cause mortality (HR=0.162; 95% CI: 0.029-0.890; P=0.036); however, standardized administration had no predictive value with regard to secondary end-point events. Standardized administration of anti-platelet drugs obviously reduced the risk of primary end-point events in patients with coronary heart disease, and further analysis showed that only all-cause mortality exhibited a statistically significant reduction.
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Affiliation(s)
- Chao Ding
- Department of Cardiology, Lu'an Shili Hospital of Anhui, Lu'an, Anhui 237006, P.R. China
| | - Jianhua Zhang
- Department of Cardiology, The First Affiliated Hospital of Jinan University, Guangzhou, Guangdong 510630, P.R. China
| | - Rongcheng Li
- Department of Cardiology, Lu'an Shili Hospital of Anhui, Lu'an, Anhui 237006, P.R. China
| | - Jiacai Wang
- Department of Cardiology, Lu'an Shili Hospital of Anhui, Lu'an, Anhui 237006, P.R. China
| | - Yongcang Hu
- Department of Cardiology, Lu'an Shili Hospital of Anhui, Lu'an, Anhui 237006, P.R. China
| | - Yanyan Chen
- Department of Cardiology, Lu'an Shili Hospital of Anhui, Lu'an, Anhui 237006, P.R. China
| | - Xiannan Li
- Department of Cardiology, Lu'an Shili Hospital of Anhui, Lu'an, Anhui 237006, P.R. China
| | - Yan Xu
- Department of Cardiology, The First Affiliated Hospital of Anhui Medical University, Hefei, Anhui 230022, P.R. China
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Schoos M, Chandrasekhar J, Baber U, Bhasin A, Sartori S, Aquino M, Vogel B, Farhan S, Sorrentino S, Kini A, Kruckoff M, Moliterno D, Henry TD, Weisz G, Gibson CM, Iakovou I, Colombo A, Steg PG, Witzenbichler B, Chieffo A, Cohen D, Stuckey T, Ariti C, Dangas G, Pocock S, Mehran R. Causes, Timing, and Impact of Dual Antiplatelet Therapy Interruption for Surgery (from the Patterns of Non-adherence to Anti-platelet Regimens In Stented Patients Registry). Am J Cardiol 2017; 120:904-910. [PMID: 28778417 DOI: 10.1016/j.amjcard.2017.06.016] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/23/2017] [Revised: 05/23/2017] [Accepted: 06/13/2017] [Indexed: 11/17/2022]
Abstract
Temporary interruption of dual antiplatelet therapy (DAPT) is not infrequently required in patients undergoing percutaneous coronary intervention (PCI). We sought to describe the procedures and outcomes associated with DAPT interruption in patients treated with DAPT following successful PCI from the Patterns of non-adherence to anti-platelet regimens in stented patients registry (n = 5018). DAPT interruption was prespecified as physician recommended cessation for <14 days. Of the study cohort, 490 patients (9.8%) experienced 594 DAPT interruptions over 2 years following PCI. Only 1 antiplatelet agent was interrupted in 57.2% cases and interruption was frequently recommended by noncardiologists (51.3%). Where type of surgery was reported, majority of DAPT interruptions occurred for minor surgery (68.4% vs 31.6%) and a similar cessation pattern of single versus dual antiplatelet cessation was observed regardless of minor or major surgery. Subsequent to DAPT interruption, 12 patients (2.4%) experienced 1 thrombotic event each, of which 5 (1.0%) occurred during the interruption period. All events occurred in patients who either stopped both agents (8 of 12) or clopidogrel-only (4 of 12), with no events occurring due to aspirin cessation alone. In conclusion, in the Patterns of Non-adherence to Anti-platelet Regiments in Stented Patients registry, 1 in 10 patients were recommended DAPT interruption for surgery within 2 years of PCI. Interruption was more common for a single agent rather than both antiplatelet agents regardless of severity of surgery, and was frequently recommended by noncardiologists. Only 1% of patients with DAPT interruption experienced a subsequent thrombotic event during the interruption period, which mainly occurred in patients stopping both antiplatelet agents.
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Affiliation(s)
- Mikkel Schoos
- Department of Cardiology, Icahn School of Medicine at Mount Sinai, New York, New York; Department of Cardiology, Zealand University Hospital, Denmark
| | - Jaya Chandrasekhar
- Department of Cardiology, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Usman Baber
- Department of Cardiology, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Aarti Bhasin
- Department of Cardiology, Icahn School of Medicine at Mount Sinai, New York, New York; Department of Internal Medicine, Wyckoff Heights Medical Center, New York, New York
| | - Samantha Sartori
- Department of Cardiology, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Melissa Aquino
- Department of Cardiology, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Birgit Vogel
- Department of Cardiology, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Serdar Farhan
- Department of Cardiology, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Sabato Sorrentino
- Department of Cardiology, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Annapoorna Kini
- Department of Cardiology, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Mitchell Kruckoff
- Department of Cardiology, Duke University School of Medicine, Durham, North Carolina
| | - David Moliterno
- Department of Cardiology, University of Kentucky, Lexington, Kentucky
| | - Timothy D Henry
- Department of Cardiology, Cedars-Sinai Medical Center, Los Angeles, California
| | - Giora Weisz
- Department of Cardiology, Shaare Zedek Medical Center, Jerusalem, Israel
| | - C Michael Gibson
- Department of Cardiology, Harvard Medical School, Cambridge, Massachusetts
| | - Ioannis Iakovou
- Department of Cardiology, Onassis Cardiac Surgery Centre, Athens, Greece
| | - Antonio Colombo
- Department of Cardiology, San Raffaele Hospital, Milan, Italy
| | - P Gabriel Steg
- Department of Cardiology, Hôpital Bichat-Claude Bernard, Paris, France
| | | | - Alaide Chieffo
- Department of Cardiology, San Raffaele Hospital, Milan, Italy
| | - David Cohen
- Department of Cardiology, St Luke's Mid America Heart Institute, University of Missouri-Kansas City, Kansas City, Missouri
| | - Thomas Stuckey
- Moses Cone Heart and Vascular Center, LeBauer Cardiovascular Research Foundation, Greensboro, North Carolina
| | - Cono Ariti
- Department of Medical Statistics, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - George Dangas
- Department of Cardiology, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Stuart Pocock
- Department of Medical Statistics, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Roxana Mehran
- Department of Cardiology, Icahn School of Medicine at Mount Sinai, New York, New York.
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Clinical outcomes after craniotomy for unruptured intracranial aneurysm in patients with coronary artery disease. J Clin Neurosci 2017; 46:113-117. [PMID: 28887082 DOI: 10.1016/j.jocn.2017.08.043] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2017] [Accepted: 08/14/2017] [Indexed: 01/26/2023]
Abstract
BACKGROUND Coronary artery disease (CAD) patients receiving antiplatelet agents occasionally undergo craniotomy. We aimed to clarify clinical outcomes after craniotomy for unruptured intracranial aneurysm (UIA) in patients with CAD. We also aimed to identify the possible predictive factors for morbidity and surgical complications in patients on antiplatelet treatment. METHODS We retrospectively analyzed 401 consecutive patients who had undergone craniotomy for UIA at our institution between January 2006 and December 2016. Forty-three patients (10.7%) received antiplatelet agents during the perioperative period. The underlying reasons for antiplatelet treatment were CAD in 12 patients and other diseases in 31 patients. RESULTS Severe morbidity and intracranial hemorrhage occurred more commonly and symptomatic brain infarction occurred less frequently in patients with CAD compared to patients with other underlying diseases (16.7% versus 3.2%, 16.7% versus 9.7%, and 8.3% versus 16.1%, respectively), though differences between the two groups were not significant. Univariate analysis revealed that a low preoperative baseline platelet count was significantly correlated with the occurrence of intracranial hemorrhage (cutoff value, 16.5×104/µL; odds ratio (OR), 46.67; 95% confidence interval (CI), 3.88-561.95; p=0.0005), and a high baseline platelet count tended to correlate with severe morbidity (cutoff value, 29.8×104/µL; OR, 11.33; 95% CI, 0.88-145.52; p=0.0550). CONCLUSIONS Our results suggest that surgical complications and clinical outcomes after craniotomy may depend on the underlying reason for antiplatelet treatment. Moreover, a preoperative platelet count can be useful in predicting the occurrence of intracranial hemorrhage and severe morbidity after craniotomy in patients receiving antiplatelet agents.
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Park LG, Collins EG, Shim JK, Whooley MA. Comparing Mobile Health Strategies to Improve Medication Adherence for Veterans With Coronary Heart Disease (Mobile4Meds): Protocol for a Mixed-Methods Study. JMIR Res Protoc 2017; 6:e134. [PMID: 28720557 PMCID: PMC5539386 DOI: 10.2196/resprot.7327] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2017] [Revised: 04/10/2017] [Accepted: 04/14/2017] [Indexed: 11/13/2022] Open
Abstract
Background Adherence to antiplatelet medications is critical to prevent life threatening complications (ie, stent thrombosis) after percutaneous coronary interventions (PCIs), yet rates of nonadherence range from 21-57% by 12 months. Mobile interventions delivered via text messaging or mobile apps represent a practical and inexpensive strategy to promote behavior change and enhance medication adherence. Objective The Mobile4Meds study seeks to determine whether text messaging or a mobile app, compared with an educational website control provided to all Veterans, can improve adherence to antiplatelet therapy among patients following acute coronary syndrome (ACS) or PCI. The three aims of the study are to: (1) determine preferences for content and frequency of text messaging to promote medication adherence through focus groups; (2) identify the most patient-centered app that promotes adherence, through a content analysis of all commercially available apps for medication adherence and focus groups centered on usability; and (3) compare adherence to antiplatelet medications in Veterans after ACS/PCI via a randomized clinical trial (RCT). Methods We will utilize a mixed-methods design that uses focus groups to achieve the first and second aims (N=32). Patients will be followed for 12 months after being randomly assigned to one of three arms: (1) customized text messaging, (2) mobile app, or (3) website-control groups (N=225). Medication adherence will be measured with electronic monitoring devices, pharmacy records, and self-reports. Results Enrollment for the focus groups is currently in progress. We expect to enroll patients for the RCT in the beginning of 2018. Conclusions Determining the efficacy of mobile technology using a Veteran-designed protocol to promote medication adherence will have a significant impact on Veteran health and public health, particularly for individuals with chronic diseases that require strict medication adherence. Trial Registration ClinicalTrials.gov NCT03022669
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Affiliation(s)
- Linda G Park
- Department of Veterans Affairs, Community Health Systems, University of California, San Francisco, San Francisco, CA, United States
| | - Eileen G Collins
- Edward Hines Jr., VA Hospital, Department of Biobehavioral Health Science, University of Illinois at Chicago, Chicago, IL, United States
| | - Janet K Shim
- University of California, San Francisco, Social and Behavioral Sciences, San Francisco, CA, United States
| | - Mary A Whooley
- Department of Veterans Affairs, Department of Medicine, Epidemiology and Biostatistics, University of California, San Francisco, San Francisco, CA, United States
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Velásquez JG, Guerrero Pinedo F, Estacio MA, Vergara I, Yara S, Carrillo DC. Incidencia de eventos cardiovasculares mayores asociada a la suspensión de doble terapia antiagregante en pacientes con enfermedad coronaria e implante de stent. REVISTA COLOMBIANA DE CARDIOLOGÍA 2017. [DOI: 10.1016/j.rccar.2016.10.038] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022] Open
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Schoos MM, Mehran R, Dangas GD. The Optimal Duration of Dual Antiplatelet Therapy After PCI. Interv Cardiol 2016. [DOI: 10.1002/9781118983652.ch45] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Affiliation(s)
| | - Roxana Mehran
- Department of Cardiology; Mount Sinai Medical Center; New York NY USA
| | - George D. Dangas
- Department of Cardiology; Mount Sinai Medical Center; New York NY USA
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Yasmina A, de Boer A, Deneer VHM, Souverein PC, Klungel OH. Patterns of antiplatelet drug use after a first myocardial infarction during a 10-year period. Br J Clin Pharmacol 2016; 83:632-641. [PMID: 27662521 PMCID: PMC5306486 DOI: 10.1111/bcp.13139] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2016] [Revised: 08/17/2016] [Accepted: 09/18/2016] [Indexed: 12/01/2022] Open
Abstract
AIMS The aims of the present study were to assess antiplatelet drug use patterns after a first myocardial infarction (MI) and to evaluate the determinants of antiplatelet nonpersistence. METHODS The present study was conducted in 4690 patients from the Utrecht Cardiovascular Pharmacogenetics cohort with a first MI between 1986 and 2010, who were followed for a maximum of 10 years. Medication use and event diagnosis were obtained from the Dutch PHARMO Record Linkage System. Antiplatelet drug users were classified as persistent users (gap between prescriptions ≤90 days), nonpersistent users (>90-day gap and no refills), and restarters (a new prescription after a >90-day gap). The association between potential determinants and antiplatelet nonpersistence was analysed using Cox regression. RESULTS The proportions of persistent users decreased from 84.0% at the 1-year follow-up to 32.8% at 10 years for any antiplatelet drug, and 77.3% to 27.5% for aspirin; and 39.0% to 6.4% for clopidogrel at 6 years. Most nonpersistent users restarted antiplatelet drugs later, leading to 89.3% overall antiplatelet drug users at 10 years after MI. Diabetes (hazard ratio [HR] 0.44; 0.32-0.60), hypertension (HR 0.77; 0.60-0.99), hypercholesterolaemia (HR 0.49; 0.39-0.62) and more recent MI diagnosis period (2003-2007: HR 0.69, 0.61-0.79; 2008-2010: HR 0.38, 0.19-0.77, compared to ≤ 2002 period) lowered the risk of antiplatelet nonpersistence, while vitamin K antagonist (VKA) comedication (HR 18.97; 16.91-21.28) increased this risk. CONCLUSIONS A large proportion of patients with a first MI still used antiplatelet drugs after 10 years. The frequent discontinuations during this time frame are expected to reduce the effectiveness of antiplatelet drugs as secondary prevention of cardiovascular diseases. Diabetes, hypertension, hypercholesterolaemia, VKA comedication and MI diagnosis period were determinants of antiplatelet nonpersistence.
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Affiliation(s)
- Alfi Yasmina
- Division of Pharmacoepidemiology & Clinical Pharmacology, Utrecht Institute for Pharmaceutical Sciences, Utrecht University, Utrecht, the Netherlands.,Department of Pharmacology & Therapeutics, Faculty of Medicine, Lambung Mangkurat University, Banjarmasin, Indonesia
| | - Anthonius de Boer
- Division of Pharmacoepidemiology & Clinical Pharmacology, Utrecht Institute for Pharmaceutical Sciences, Utrecht University, Utrecht, the Netherlands
| | - Vera H M Deneer
- Department of Clinical Pharmacy, St Antonius Hospital, Nieuwegein, the Netherlands
| | - Patrick C Souverein
- Division of Pharmacoepidemiology & Clinical Pharmacology, Utrecht Institute for Pharmaceutical Sciences, Utrecht University, Utrecht, the Netherlands
| | - Olaf H Klungel
- Division of Pharmacoepidemiology & Clinical Pharmacology, Utrecht Institute for Pharmaceutical Sciences, Utrecht University, Utrecht, the Netherlands
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Walters KJ, Meador A, Galdo JA, Ciarrocca K. A pharmacotherapy review of the novel, oral antithrombotics. SPECIAL CARE IN DENTISTRY 2016; 37:62-70. [PMID: 27770581 DOI: 10.1111/scd.12207] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Coagulation disorders account for a high incidence of death in the U.S. due to stroke, myocardial infarction, and venous thromboembolism. In the past few years, numerous agents have been brought to market for the treatment of thromboembolism or prevention of thromboembolism. Similar to warfarin, these agents can cause bleeding disorders, which may exacerbate dental care treatment plans. This literature review examines the newer agents for the treatment of thromboembolism disorders, common side effects and drug interactions, the specific medical conditions each agent treats, and the dental perspective on how to medically management patients prescribed these medications.
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Affiliation(s)
- Kara J Walters
- PGY-1 Community Resident, Samford University, Birmingham, AL
| | - Anna Meador
- Assistant Professor, Samford University, Birmingham, AL
| | - John A Galdo
- Assistant Professor, Samford University, Birmingham, AL (Samford) and Clinical Instructor, Augusta University College of Dental Medicine, Augusta, GA
| | - Katharine Ciarrocca
- Assistant Professor, Department of Oral Health & Diagnostic Sciences, Geriatric Dentistry, Oral Medicine/Oral Oncology, Augusta University, Augusta, GA
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Gurajala I, Gopinath R. Perioperative management of patient with intracoronary stent presenting for noncardiac surgery. Ann Card Anaesth 2016; 19:122-31. [PMID: 26750683 PMCID: PMC4900389 DOI: 10.4103/0971-9784.173028] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023] Open
Abstract
As the number of percutaneous coronary interventions increase annually, patients with intracoronary stents (ICS) who present for noncardiac surgery (NCS) are also on the rise. ICS is associated with stent thrombosis (STH) and requires mandatory antiplatelet therapy to prevent major adverse cardiac events. The risks of bleeding and ischemia remain significant and the management of these patients, especially in the initial year of ICS is challenging. The American College of Cardiologists guidelines on the management of patients with ICS recommend dual antiplatelet therapy (DAT) for minimal 14 days after balloon angioplasty, 30 days for bare metal stents, and 365 days for drug-eluting stents. Postponement of elective surgery is advocated during this period, but guidelines concerning emergency NCS are ambiguous. The risk of STH and surgical bleeding needs to be assessed carefully and many factors which are implicated in STH, apart from the type of stent and the duration of DAT, need to be considered when decision to discontinue DAT is made. DAT management should be a multidisciplinary exercise and bridging therapy with shorter acting intravenous antiplatelet drugs should be contemplated whenever possible. Well conducted clinical trials are needed to establish guidelines as regards to the appropriate tests for platelet function monitoring in patients undergoing NCS while on DAT.
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Affiliation(s)
- Indira Gurajala
- Department of Anaesthesiology and Critical Care, Nizam's Institute of Medical Sciences, Hyderabad, Telangana, India
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Rossini R, Capodanno D, Ferrero P, Gargiulo G, Capranzano P. Management issues of chronic therapy with non-vitamin K oral anticoagulants or antiplatelet agents: Different or alike? Int J Cardiol 2016; 221:695-6. [DOI: 10.1016/j.ijcard.2016.07.008] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/21/2016] [Accepted: 07/02/2016] [Indexed: 11/30/2022]
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Dillinger JG, Saeed A, Spagnoli V, Sollier CBD, Sideris G, Silberman SM, Voicu S, Drouet L, Henry P. High platelet reactivity on aspirin in patients with acute ST elevation myocardial infarction. Thromb Res 2016; 144:56-61. [DOI: 10.1016/j.thromres.2016.05.002] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2015] [Revised: 05/02/2016] [Accepted: 05/04/2016] [Indexed: 10/21/2022]
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Rossini R, Angiolillo DJ, Musumeci G, Capodanno D, Lettino M, Trabattoni D, Pilleri A, Calabria P, Colombo P, Bernabò P, Ferlini M, Ferri M, Tarantini G, De Servi S, Savonitto S. Antiplatelet therapy and outcome in patients undergoing surgery following coronary stenting: Results of the surgery after stenting registry. Catheter Cardiovasc Interv 2016; 89:E13-E25. [DOI: 10.1002/ccd.26629] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/12/2016] [Revised: 03/15/2016] [Accepted: 05/23/2016] [Indexed: 11/08/2022]
Affiliation(s)
- Roberta Rossini
- Dipartimento Cardiovascolare, ASST Papa Giovanni XXIII; Bergamo Italy
| | - Dominick J. Angiolillo
- College of Medicine-Jacksonville, University of Florida; Jacksonville Florida; Division of Cardiology, University of Florida College of Medicine-Jacksonville; Jacksonville, FL-USA
| | - Giuseppe Musumeci
- Dipartimento Cardiovascolare, ASST Papa Giovanni XXIII; Bergamo Italy
| | - Davide Capodanno
- Dipartimento Di Cardiologia, Ospedale Ferrarotto, Università Di Catania; Italy
| | - Maddalena Lettino
- U.O.C. Cardiologia Clinica I, Istituto Clinico Humanitas; Rozzano (MI) Italy; Dipartimento Cardiovascolare, Humanitas Research Hospital, Rozzano, Milano, Italy
| | - Daniela Trabattoni
- Dipartimento Di Scienze Cardiovascolari, Centro Cardiologico Monzino, IRCCS, Università Degli Studi Di Milano; Milano Italy
| | - Annarita Pilleri
- SSD Centro di valutazione e consulenza cardiologica, Azienda Ospedaliera Brotzu, Presidio San Michele; Cagliari Italy
| | - Paolo Calabria
- UO Emodinamica, Ospedale Misericordia, Grosseto; USL Toscana Sudest Italy
| | - Paola Colombo
- Dipartimento Cardiovascolare, ASST Niguarda Grande Ospedale Metropolitano; Milano Italy
| | - Paola Bernabò
- Divisione di Cardiologia, Ente Ospedaliero Ospedali Galliera; Genova Italy
| | - Marco Ferlini
- SC Cardiologia, Fondazione IRCCS Policlinico San Matteo; Pavia Italy
| | - Marco Ferri
- S.C. Di Cardiologia, Arcispedale S. Maria Nuova, IRCCS; Reggio Emilia Italy
| | - Giuseppe Tarantini
- Dipartimento Di Scienze Cardiache, Toraciche E Vascolari, Università Di Padova; Italia
| | - Stefano De Servi
- SC Cardiologia, Fondazione IRCCS Policlinico San Matteo; Pavia Italy
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Cahoon WD, Oswalt AK, Francis KE, Magee LC, Lowe DK. Cangrelor Bridge Therapy for Gastroduodenal Biopsy. J Pharm Pract 2016; 30:270-273. [PMID: 27000137 DOI: 10.1177/0897190016636750] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Dual antiplatelet therapy (DAPT) is the key for secondary prevention of acute coronary syndromes and percutaneous coronary intervention with stent placement. Premature discontinuation of DAPT can result in an increase in cardiac ischemic events and death. If early interruption of DAPT for urgent procedures or surgery is necessary, then ischemic and bleed risks must be balanced with bridging therapy. To date, no medications have a Food and Drug Administration indication for antiplatelet bridge therapy. We present a case of a woman with a history of gastrointestinal bleeding on DAPT for a drug-eluting stent who received cangrelor as bridge therapy prior to gastroduodenal biopsy.
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Affiliation(s)
- William D Cahoon
- 1 Department of Pharmacy, Virginia Commonwealth University Health System/Medical College of Virginia Hospitals, Richmond, VA, USA.,2 Virginia Commonwealth University School of Pharmacy, Richmond, VA, USA
| | - Allison K Oswalt
- 1 Department of Pharmacy, Virginia Commonwealth University Health System/Medical College of Virginia Hospitals, Richmond, VA, USA.,2 Virginia Commonwealth University School of Pharmacy, Richmond, VA, USA
| | - Kerry E Francis
- 1 Department of Pharmacy, Virginia Commonwealth University Health System/Medical College of Virginia Hospitals, Richmond, VA, USA.,2 Virginia Commonwealth University School of Pharmacy, Richmond, VA, USA
| | - Lauren C Magee
- 1 Department of Pharmacy, Virginia Commonwealth University Health System/Medical College of Virginia Hospitals, Richmond, VA, USA.,2 Virginia Commonwealth University School of Pharmacy, Richmond, VA, USA
| | - Denise K Lowe
- 1 Department of Pharmacy, Virginia Commonwealth University Health System/Medical College of Virginia Hospitals, Richmond, VA, USA.,2 Virginia Commonwealth University School of Pharmacy, Richmond, VA, USA
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Vigen R, Maddox TM, O'Donnell CI, Grunwald GK, Bhatt DL, Tsai TT, Rumsfeld JS, Ho PM. Hospital Variation in Premature Clopidogrel Discontinuation After Drug-Eluting Stent Placement in the Veterans Affairs (VA) Healthcare System. J Am Heart Assoc 2016; 5:e001376. [PMID: 27151513 PMCID: PMC4889159 DOI: 10.1161/jaha.114.001376] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/22/2014] [Accepted: 03/23/2016] [Indexed: 01/22/2023]
Abstract
BACKGROUND Premature clopidogrel discontinuation after drug-eluting stent placement is associated with adverse outcomes. Little is known about patient and hospital factors associated with premature discontinuation or whether less variation in premature discontinuation exists in integrated health care systems such as the Veterans Affairs (VA). METHODS AND RESULTS We evaluated the frequency of premature clopidogrel discontinuation, defined as a gap between clopidogrel refills of ≥90 days during the first 6 months of treatment, among 12 707 patients who received drug-eluting stents in VA hospitals between 2008 and 2010. We evaluated the association between premature discontinuation and all-cause mortality and/or acute myocardial infarction, variation in the proportion of premature discontinuation among hospitals, the patient and hospital characteristics associated with premature discontinuation, and the extent to which unexplained hospital characteristics contribute to premature discontinuation. Of the patients, 963 (7.6%) discontinued clopidogrel prematurely. Premature discontinuation was associated with acute myocardial infarction and all-cause mortality (hazard ratio 1.65, 95% CI 1.37-1.99, P<0.001). The proportion of patients with premature discontinuation varied across hospitals from 0% to 16.5% (P<0.001). We found a median of 24% greater odds of patients with identical covariates with premature discontinuation at one randomly selected hospital compared with another (median odds ratio 1.24, 95% CI 1.17-1.44). Patient factors associated with premature discontinuation included lack of cardiology follow-up within 30 days of discharge and smaller initial clopidogrel fill. CONCLUSION One in 13 patients prematurely discontinued clopidogrel, and variation in discontinuation across hospitals was observed. Patient factors were associated with premature discontinuation that may represent targets for quality improvement.
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Affiliation(s)
- Rebecca Vigen
- The University of Texas at Southwestern Medical Center, Dallas, TX
| | - Thomas M Maddox
- VA Eastern Colorado Health Care System, Denver, CO University of Colorado Denver, Aurora, CO Colorado Cardiovascular Outcomes Research (CCOR) Consortium, Denver, CO
| | | | - Gary K Grunwald
- VA Eastern Colorado Health Care System, Denver, CO University of Colorado Denver, Aurora, CO
| | - Deepak L Bhatt
- VA Boston Healthcare System, Brigham and Women's Hospital, and Harvard Medical School, Boston, MA
| | - Thomas T Tsai
- VA Eastern Colorado Health Care System, Denver, CO University of Colorado Denver, Aurora, CO Colorado Cardiovascular Outcomes Research (CCOR) Consortium, Denver, CO
| | - John S Rumsfeld
- VA Eastern Colorado Health Care System, Denver, CO University of Colorado Denver, Aurora, CO Colorado Cardiovascular Outcomes Research (CCOR) Consortium, Denver, CO
| | - P Michael Ho
- VA Eastern Colorado Health Care System, Denver, CO University of Colorado Denver, Aurora, CO Colorado Cardiovascular Outcomes Research (CCOR) Consortium, Denver, CO
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Zeymer U, Becher A, Jennings E, Johansson S, Westergaard M. Systematic review of the clinical impact of dual antiplatelet therapy discontinuation after acute coronary syndromes. EUROPEAN HEART JOURNAL-ACUTE CARDIOVASCULAR CARE 2016; 6:522-531. [DOI: 10.1177/2048872616648467] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Affiliation(s)
- Uwe Zeymer
- Klinikum Ludwigshafen, Institut für Herzinfarktforschung, Germany
| | - Anja Becher
- Research and Evaluation Unit, Oxford PharmaGenesis Ltd, UK
- School of Medicine, Pharmacy and Health, Durham University, UK
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De Servi S, Morici N, Boschetti E, Rossini R, Martina P, Musumeci G, D'Urbano M, Lazzari L, La Vecchia C, Senni M, Klugmann S, Savonitto S. Bridge therapy or standard treatment for urgent surgery after coronary stent implantation: Analysis of 314 patients. Vascul Pharmacol 2016; 80:85-90. [DOI: 10.1016/j.vph.2015.11.085] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2015] [Revised: 11/02/2015] [Accepted: 11/27/2015] [Indexed: 11/30/2022]
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Egholm G, Thim T, Madsen M, Sørensen HT, Pedersen JB, Eggert Jensen S, Jensen LO, Kristensen SD, Bøtker HE, Maeng M. Gastroscopy-related adverse cardiac events and bleeding complications among patients treated with coronary stents and dual antiplatelet therapy. Endosc Int Open 2016; 4:E527-33. [PMID: 27227109 PMCID: PMC4874801 DOI: 10.1055/s-0042-102649] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/28/2015] [Accepted: 02/01/2016] [Indexed: 01/14/2023] Open
Abstract
BACKGROUND AND STUDY AIMS Dual antiplatelet therapy (DAPT) is recommended following percutaneous coronary intervention (PCI) with drug-eluting stent (DES). DAPT is a risk factor for gastrointestinal bleeding. We aimed to quantify (1) the rate of gastroscopy within 12 months after PCI, (2) the rate of adverse cardiac events and gastroscopy-related bleeding complications within 30 days of gastroscopy, and (3) the association between antiplatelet therapy and these events. PATIENTS AND METHODS Patients receiving gastroscopy within 12 months of PCI were identified and two nested case-control analyses were performed within the PCI cohort by linking Danish medical registries. Cases were patients with adverse cardiac events (cardiac death, myocardial infarction, or stent thrombosis) or hemostatic intervention. In both studies, controls were patients with gastroscopy including biopsy without adverse cardiac events and hemostatic intervention, respectively. Medical records were reviewed to obtain information on exposure to DAPT. RESULTS We identified 22 654 PCI patients of whom 1497 patients (6.6 %) underwent gastroscopy. Twenty-two patients (1.5 %) suffered an adverse cardiac event, 93 patients (6.2 %) received hemostatic intervention during or within 30 days of the index gastroscopy. Interrupting DAPT was associated with a 3.46 times higher risk of adverse cardiac events (95 %CI 0.49 - 24.7). Discontinuation of one antiplatelet agent did not increase the risk (OR 0.65, 95 %CI 0.17 - 2.47). No hemostatic interventions were caused by endoscopic complications. CONCLUSION Gastroscopy can be safely performed in PCI patients treated with DES and single antiplatelet therapy while interruption of DAPT may be associated with an increased risk of adverse cardiac events.
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Affiliation(s)
- Gro Egholm
- Department of Cardiology, Aarhus University Hospital, Denmark,Corresponding author Gro Egholm Department of CardiologyAarhus University HospitalPalle Juul-Jensens Boulevard 998200 Aarhus NDenmark+45-78452260
| | - Troels Thim
- Department of Cardiology, Aarhus University Hospital, Denmark
| | - Morten Madsen
- Department of Clinical Epidemiology, Aarhus University Hospital, Denmark
| | | | - Jan Bech Pedersen
- Department of Surgical Gastroenterology, Aarhus University Hospital, Denmark
| | | | | | | | | | - Michael Maeng
- Department of Cardiology, Aarhus University Hospital, Denmark
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Johnston S. An evidence summary of the management of the care of patients taking novel oral antiplatelet drugs undergoing dental surgery. J Am Dent Assoc 2016; 147:271-7. [DOI: 10.1016/j.adaj.2015.11.007] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2015] [Revised: 11/02/2015] [Accepted: 11/09/2015] [Indexed: 02/02/2023]
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Pinnarelli L, Mayer F, Bauleo L, Agabiti N, Kirchmayer U, Belleudi V, Di Martino M, Autore C, Ricci R, Violini R, Fusco D, Davoli M, Perucci CA. Adherence to antiplatelet therapy after percutaneous coronary intervention: a population study in a region of Italy. J Cardiovasc Med (Hagerstown) 2016; 16:230-7. [PMID: 25325532 DOI: 10.2459/jcm.0000000000000070] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
AIMS We evaluated adherence to dual antiplatelet therapy (DAPT) after percutaneous coronary intervention (PCI) for patients in the Lazio region of Italy and the impact of discharge ward type on therapy discontinuation. METHODS From the Hospital Information System, we selected patients who underwent PCI from 2006 to 2007 and obtained Regional Drug Dispense Registry data for antiplatelet drugs prescribed for 12 months after discharge. Appropriate therapy was defined as DAPT with prescribed daily doses for each drug covering at least 75% of each individual follow-up period. The association between discharge ward type and antiplatelet therapy adherence at 12 months post discharge was estimated using multilevel logistic regression analysis. RESULTS A total of 11 186 patients with PCI were included, and fewer than half (4984; 44.56%) were on adequate DAPT. Only 2930 of 5390 patients (54.36%) with DAPT in the first 6 months post discharge continued DAPT in the second 6 months. Patients discharged from cardiology units or intensive coronary care units were more likely (odds ratio = 1.26; P = 0.003) to receive appropriate antiplatelet therapy, and elderly patients were less likely (odds ratio = 0.65; P < 0.001) to do so. CONCLUSION The proportion of PCI patients receiving appropriate DAPT after discharge is suboptimal in this region, and elderly patients are less likely to receive appropriate therapy. These findings could be important for improving patient management and ensuring adherence to clinical guidelines and indicate the need for a systematic evaluation of the appropriateness of postdischarge therapy.
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Affiliation(s)
- Luigi Pinnarelli
- aDepartment of Epidemiology, Lazio Regional Health Service bDivisione di Cardiologia, Università di Roma La Sapienza, Ospedale Sant'Andrea cDepartment of Cardiology, St Spirito Hospital dDepartment of Interventional Cardiology, Azienda Ospedaliera San Camillo Forlanini eNational Agency for Regional Health Services, Rome, Italy
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Johnston S. A New Generation of Antiplatelet, and Anticoagulant Medication and the Implications for the Dental Surgeon. ACTA ACUST UNITED AC 2016; 42:840-2, 845-6, 849-50 passim. [PMID: 26749792 DOI: 10.12968/denu.2015.42.9.840] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
The management of dental patients taking either antiplatelet medication, anticoagulant medication or both has been well established in the previous literature. Recently, new generations of drugs have emerged which are becoming increasingly common, including direct thrombin inhibitors, factor X inhibitors and a new class of oral thienopyridines. The implications of these drugs for the dental surgeon are not yet fully known. Awareness remains low and there is very little information available within the literature on safe use during surgery. This review paper aims to provide some guidance for dental practitioners performing invasive procedures. CPD/CLINICAL RELEVANCE: A new generation of anticoagulant and antiplatelet drugs have serious implications for patients undergoing surgery and their use is increasing.
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Proton Pump Inhibitors in Cardiovascular Disease: Drug Interactions with Antiplatelet Drugs. ADVANCES IN EXPERIMENTAL MEDICINE AND BIOLOGY 2016; 906:325-350. [PMID: 27628008 DOI: 10.1007/5584_2016_124] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
Aspirin and P2Y12 receptor antagonists are widely used across the spectrum of cardiovascular diseases. Upper gastrointestinal complications, including ulcer and bleeding, are relatively common during antiplatelet treatment and, therefore, concomitant proton pump inhibitor (PPI) treatment is often prescribed.PPIs provide gastroprotection by changing the intragastric milieu, essentially by raising intragastric pH. In recent years, it has been heavily discussed whether PPIs may reduce the cardiovascular protection by aspirin and, even more so, clopidogrel. Pharmacodynamic and pharmacokinetic studies suggested an interaction between PPIs and clopidogrel, and subsequent clinical studies were conducted to evaluate the clinical impact of this interaction. More recently, it was reported that PPIs may also attenuate the antiplatelet effect of aspirin. This may be clinically important, because a fixed combination of aspirin and a PPI (esomeprazole) has recently been approved and because aspirin is the most widely used drug in patients with cardiovascular disease. The antiplatelet effect of the new P2Y12 receptor antagonists, ticagrelor and prasugrel, seems less influenced by PPI co-treatment.Given the large number of patients treated with antithrombotic drugs and PPIs, even a minor reduction of platelet inhibition potentially carries considerable clinical impact. The present book chapter summarizes the evidence regarding the widespread use of platelet inhibitors and PPIs in combination. Moreover, it outlines current evidence supporting or opposing drug interactions between these drugs and discusses clinical implications.
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Capodanno D, Rossini R, Musumeci G, Lettieri C, Senni M, Valsecchi O, Angiolillo DJ, Lip GY. Predictive accuracy of CHA2DS2-VASc and HAS-BLED scores in patients without atrial fibrillation undergoing percutaneous coronary intervention and discharged on dual antiplatelet therapy. Int J Cardiol 2015; 199:319-25. [DOI: 10.1016/j.ijcard.2015.07.064] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/20/2014] [Revised: 06/13/2015] [Accepted: 07/22/2015] [Indexed: 02/06/2023]
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Increased Postoperative Bleeding Risk among Patients with Local Flap Surgery under Continued Clopidogrel Therapy. BIOMED RESEARCH INTERNATIONAL 2015; 2015:120903. [PMID: 26345612 PMCID: PMC4543372 DOI: 10.1155/2015/120903] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 05/08/2015] [Accepted: 08/02/2015] [Indexed: 12/22/2022]
Abstract
PURPOSE The purpose of the study was to evaluate the influence of a continued antiplatelet therapy with clopidogrel on postoperative bleeding risk in patients undergoing skin tumor resection and reconstruction with local flaps or skin grafts under outpatient conditions. PATIENTS AND METHODS The authors designed and implemented a retrospective clinical cohort study at the General Hospital Balingen. The primary endpoint was the bleeding ratio in patients with clopidogrel treatment in comparison to patients without any anticoagulant or antiplatelet therapy. Wound healing was evaluated on days 1, 3, 5, 7, 10, and 14. RESULTS 650 procedures were performed, 123 of them under continued clopidogrel therapy. There were significantly more postoperative bleeding complications among patients with continued antiplatelet therapy. Regarding the whole study population, malignant lesions, a larger defect size, and skin grafts were accompanied by a higher rate of bleeding incidents. However, there were no significant findings in the univariate analysis of the clopidogrel group. All bleeding incidents were easily manageable. CONCLUSION Despite an increased bleeding ratio among patients under continued clopidogrel therapy, the performance of simple surgical procedures can be recommended. However, cautious preparation and careful hemostasis are indispensable.
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Kristensen SD, Grove EL, Maeng M. Coronary stents and non-cardiac surgery: to bridge or not to bridge? Thromb Haemost 2015; 114:211-3. [PMID: 26018636 DOI: 10.1160/th15-04-0305] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2015] [Accepted: 04/13/2015] [Indexed: 11/05/2022]
Affiliation(s)
- S D Kristensen
- Prof. Steen Dalby Kristensen, Department of Cardiology, Aarhus University Hospital, DK-8200 Aarhus N, Denmark, E-mail:
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Anastasiou I, Petousis S, Hamilos M. Current strategies for bridging dual antiplatelet therapy in patients requiring surgery. Interv Cardiol 2015. [DOI: 10.2217/ica.14.75] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
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Aspirin underuse, non-compliance or cessation: Definition, extent, impact and potential solutions in the primary and secondary prevention of cardiovascular disease. Int J Cardiol 2015; 182:148-54. [PMID: 25577751 DOI: 10.1016/j.ijcard.2014.12.091] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/05/2014] [Revised: 12/01/2014] [Accepted: 12/25/2014] [Indexed: 02/08/2023]
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Zaca V, Marcucci R, Parodi G, Limbruno U, Notarstefano P, Pieragnoli P, Di Cori A, Bongiorni MG, Casolo G. Management of antithrombotic therapy in patients undergoing electrophysiological device surgery. Europace 2015; 17:840-54. [DOI: 10.1093/europace/euu357] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2014] [Accepted: 11/13/2014] [Indexed: 11/14/2022] Open
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Olmos-Carrasco O, Pastor-Ramos V, Espinilla-Blanco R, Ortiz-Zárate A, García-Ávila I, Rodríguez-Alonso E, Herrero-Sanjuán R, Ruiz-García MM, Gallego-Beuter P, Sánchez-Salgado MP, Terán-Agustín AI, Fernández-Behar M, Peña-Sainz I. Hemorrhagic Complications of Dental Extractions in 181 Patients Undergoing Double Antiplatelet Therapy. J Oral Maxillofac Surg 2015; 73:203-10. [DOI: 10.1016/j.joms.2014.08.011] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2014] [Revised: 08/05/2014] [Accepted: 08/05/2014] [Indexed: 02/01/2023]
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