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Cohen M, Jones C. Patient and Physician Perspectives on the Benefits and Risks of Antiplatelet Therapy for Acute Coronary Syndrome. Cardiol Ther 2024; 13:631-643. [PMID: 38907182 PMCID: PMC11333664 DOI: 10.1007/s40119-024-00372-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2024] [Accepted: 05/30/2024] [Indexed: 06/23/2024] Open
Abstract
This article is co-authored by a patient with acute coronary syndrome (ACS) who is receiving long-term antiplatelet therapy in the USA and a cardiologist who routinely treats patients with ACS. The patient describes his experience from diagnosis to the present day and discusses his concerns regarding treatment and management of the condition, including the balance between the benefits and risks of antiplatelet therapy. The patient also describes his work as an advocate for cardiac health. The physician perspective on treating and managing patients with ACS is provided by a cardiologist based in the USA who is and was not involved in this patient's care. The physician reviews the benefits and risks of antiplatelet therapies for the treatment of patients with ACS and discusses his own clinical experience of managing these patients, including how issues such as treatment adherence, as well as the potential inertia to prescribing certain medications that may be seen among physicians, could be overcome.
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Affiliation(s)
- Marc Cohen
- Newark Beth Israel Medical Center, 201 Lyons Avenue at Osborne Terrace, Newark, NJ, USA.
- Rutgers New Jersey Medical School, Medical Science Building, 185 South Orange Avenue, Newark, NJ, USA.
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Yang C, Gong J, Xue M, Huang W, Yuan Y, Chen C, He Y, Yang C, Sun H, Liu Y, Gong Y, Wu Y, Lai X, Zhong D, Diao X, Lu H, Zheng Y. Effects of the Thiol Methyltransferase Inhibitor (±)-2,3-Dichloro- α-Methylbenzylamine (DCMB) on the Pharmacokinetics and Metabolism of Vicagrel in Rats. Drug Metab Dispos 2024; 52:988-996. [PMID: 38997155 DOI: 10.1124/dmd.124.001739] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2024] [Revised: 06/18/2024] [Accepted: 07/08/2024] [Indexed: 07/14/2024] Open
Abstract
P2Y12 receptor inhibitors are commonly used in clinical antiplatelet therapy, typically alongside other medications. Vicagrel, a promising P2Y12 receptor inhibitor, has submitted a new drug marketing application to the United States Food and Drug Administration. Its primary metabolites and some metabolic pathways are identical to those of clopidogrel. The aim of this study was to investigate the effects of the thiol methyltransferase inhibitor (±)-2,3-dichloro-α-methylbenzylamine (DCMB) on the metabolism and pharmacokinetics of vicagrel. In vitro incubation with human and rat liver microsomes revealed that DCMB significantly inhibited the methylation of vicagrel's thiol metabolite M15-1. Rats were orally administered 6 mg/kg [14C]vicagrel (100 μCi/kg) 1 hour after peritoneal injection with or without DCMB (80 mg/kg). Compared with the control group, the plasma of DCMB-pretreated rats exhibited maximum plasma concentration (C max) decrease and time to reach C max (T max) delay for all vicagrel-related substances, the methylation product of the thiol metabolite (M9-2), and the derivatization product of the active thiol metabolite (MP-M15-2). However, no significant changes in area under the curve (AUC) or half-life (t 1/2) were observed. DCMB had negligible effect on the total radiological recovery of vicagrel within 72 hours, although the rate of vicagrel excretion slowed down within 48 hours. DCMB had a negligible impact on the metabolic pathway of vicagrel. Overall, the present study found that DCMB did not significantly affect the total exposure, metabolic pathways, metabolite profiles, or total excretion rates of vicagrel-related metabolites in rats, but led to C max decrease, T max delay, and slower excretion rate within 48 hours. SIGNIFICANCE STATEMENT: This study used liquid chromatography-tandem mass spectrometry combined with radiolabeling technology to investigate the effects of the thiol methyltransferase inhibitor (±)-2,3-dichloro-α-methylbenzylamine on the absorption, metabolism, and excretion of vicagrel in rats. This work helps to better understand the in vivo metabolism of active thiol metabolites of P2Y12 inhibitors such as clopidogrel, vicagrel, etc.
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Affiliation(s)
- Cheng Yang
- Shanghai Center for Drug Metabolism and Pharmacokinetics Research, Shanghai Institute of Materia Medica, Chinese Academy of Sciences, Shanghai, China (M.X., W.H., Y.Y., C.C., Y.H., Chen Y., D.Z., X.D., Y.Z.); School of Chinese Materia Medica, Nanjing University of Chinese Medicine, Nanjing, China (Cheng Y., Y.Y., C.C., X.D.); Department of Pharmacy, Shanghai Pudong Hospital, Fudan University Pudong Medical Center, Shanghai, China (J.G., H.L.); Jiangsu Key Laboratory for Functional Substances of Chinese Medicine, Nanjing University of Chinese Medicine, Nanjing, China (M.X.); State Key Laboratory of Natural Medicines and Center of Drug Discovery, College of Pharmacy, China Pharmaceutical University, Nanjing, China (H.S.); and Jiangsu Vcare PharmaTech Co. Ltd., Nanjing, China (Y.L., Y.G., Y.W., X.L.)
| | - Jingru Gong
- Shanghai Center for Drug Metabolism and Pharmacokinetics Research, Shanghai Institute of Materia Medica, Chinese Academy of Sciences, Shanghai, China (M.X., W.H., Y.Y., C.C., Y.H., Chen Y., D.Z., X.D., Y.Z.); School of Chinese Materia Medica, Nanjing University of Chinese Medicine, Nanjing, China (Cheng Y., Y.Y., C.C., X.D.); Department of Pharmacy, Shanghai Pudong Hospital, Fudan University Pudong Medical Center, Shanghai, China (J.G., H.L.); Jiangsu Key Laboratory for Functional Substances of Chinese Medicine, Nanjing University of Chinese Medicine, Nanjing, China (M.X.); State Key Laboratory of Natural Medicines and Center of Drug Discovery, College of Pharmacy, China Pharmaceutical University, Nanjing, China (H.S.); and Jiangsu Vcare PharmaTech Co. Ltd., Nanjing, China (Y.L., Y.G., Y.W., X.L.)
| | - Mingzhen Xue
- Shanghai Center for Drug Metabolism and Pharmacokinetics Research, Shanghai Institute of Materia Medica, Chinese Academy of Sciences, Shanghai, China (M.X., W.H., Y.Y., C.C., Y.H., Chen Y., D.Z., X.D., Y.Z.); School of Chinese Materia Medica, Nanjing University of Chinese Medicine, Nanjing, China (Cheng Y., Y.Y., C.C., X.D.); Department of Pharmacy, Shanghai Pudong Hospital, Fudan University Pudong Medical Center, Shanghai, China (J.G., H.L.); Jiangsu Key Laboratory for Functional Substances of Chinese Medicine, Nanjing University of Chinese Medicine, Nanjing, China (M.X.); State Key Laboratory of Natural Medicines and Center of Drug Discovery, College of Pharmacy, China Pharmaceutical University, Nanjing, China (H.S.); and Jiangsu Vcare PharmaTech Co. Ltd., Nanjing, China (Y.L., Y.G., Y.W., X.L.)
| | - Wensi Huang
- Shanghai Center for Drug Metabolism and Pharmacokinetics Research, Shanghai Institute of Materia Medica, Chinese Academy of Sciences, Shanghai, China (M.X., W.H., Y.Y., C.C., Y.H., Chen Y., D.Z., X.D., Y.Z.); School of Chinese Materia Medica, Nanjing University of Chinese Medicine, Nanjing, China (Cheng Y., Y.Y., C.C., X.D.); Department of Pharmacy, Shanghai Pudong Hospital, Fudan University Pudong Medical Center, Shanghai, China (J.G., H.L.); Jiangsu Key Laboratory for Functional Substances of Chinese Medicine, Nanjing University of Chinese Medicine, Nanjing, China (M.X.); State Key Laboratory of Natural Medicines and Center of Drug Discovery, College of Pharmacy, China Pharmaceutical University, Nanjing, China (H.S.); and Jiangsu Vcare PharmaTech Co. Ltd., Nanjing, China (Y.L., Y.G., Y.W., X.L.)
| | - Yali Yuan
- Shanghai Center for Drug Metabolism and Pharmacokinetics Research, Shanghai Institute of Materia Medica, Chinese Academy of Sciences, Shanghai, China (M.X., W.H., Y.Y., C.C., Y.H., Chen Y., D.Z., X.D., Y.Z.); School of Chinese Materia Medica, Nanjing University of Chinese Medicine, Nanjing, China (Cheng Y., Y.Y., C.C., X.D.); Department of Pharmacy, Shanghai Pudong Hospital, Fudan University Pudong Medical Center, Shanghai, China (J.G., H.L.); Jiangsu Key Laboratory for Functional Substances of Chinese Medicine, Nanjing University of Chinese Medicine, Nanjing, China (M.X.); State Key Laboratory of Natural Medicines and Center of Drug Discovery, College of Pharmacy, China Pharmaceutical University, Nanjing, China (H.S.); and Jiangsu Vcare PharmaTech Co. Ltd., Nanjing, China (Y.L., Y.G., Y.W., X.L.)
| | - Chong Chen
- Shanghai Center for Drug Metabolism and Pharmacokinetics Research, Shanghai Institute of Materia Medica, Chinese Academy of Sciences, Shanghai, China (M.X., W.H., Y.Y., C.C., Y.H., Chen Y., D.Z., X.D., Y.Z.); School of Chinese Materia Medica, Nanjing University of Chinese Medicine, Nanjing, China (Cheng Y., Y.Y., C.C., X.D.); Department of Pharmacy, Shanghai Pudong Hospital, Fudan University Pudong Medical Center, Shanghai, China (J.G., H.L.); Jiangsu Key Laboratory for Functional Substances of Chinese Medicine, Nanjing University of Chinese Medicine, Nanjing, China (M.X.); State Key Laboratory of Natural Medicines and Center of Drug Discovery, College of Pharmacy, China Pharmaceutical University, Nanjing, China (H.S.); and Jiangsu Vcare PharmaTech Co. Ltd., Nanjing, China (Y.L., Y.G., Y.W., X.L.)
| | - Yifei He
- Shanghai Center for Drug Metabolism and Pharmacokinetics Research, Shanghai Institute of Materia Medica, Chinese Academy of Sciences, Shanghai, China (M.X., W.H., Y.Y., C.C., Y.H., Chen Y., D.Z., X.D., Y.Z.); School of Chinese Materia Medica, Nanjing University of Chinese Medicine, Nanjing, China (Cheng Y., Y.Y., C.C., X.D.); Department of Pharmacy, Shanghai Pudong Hospital, Fudan University Pudong Medical Center, Shanghai, China (J.G., H.L.); Jiangsu Key Laboratory for Functional Substances of Chinese Medicine, Nanjing University of Chinese Medicine, Nanjing, China (M.X.); State Key Laboratory of Natural Medicines and Center of Drug Discovery, College of Pharmacy, China Pharmaceutical University, Nanjing, China (H.S.); and Jiangsu Vcare PharmaTech Co. Ltd., Nanjing, China (Y.L., Y.G., Y.W., X.L.)
| | - Chen Yang
- Shanghai Center for Drug Metabolism and Pharmacokinetics Research, Shanghai Institute of Materia Medica, Chinese Academy of Sciences, Shanghai, China (M.X., W.H., Y.Y., C.C., Y.H., Chen Y., D.Z., X.D., Y.Z.); School of Chinese Materia Medica, Nanjing University of Chinese Medicine, Nanjing, China (Cheng Y., Y.Y., C.C., X.D.); Department of Pharmacy, Shanghai Pudong Hospital, Fudan University Pudong Medical Center, Shanghai, China (J.G., H.L.); Jiangsu Key Laboratory for Functional Substances of Chinese Medicine, Nanjing University of Chinese Medicine, Nanjing, China (M.X.); State Key Laboratory of Natural Medicines and Center of Drug Discovery, College of Pharmacy, China Pharmaceutical University, Nanjing, China (H.S.); and Jiangsu Vcare PharmaTech Co. Ltd., Nanjing, China (Y.L., Y.G., Y.W., X.L.)
| | - Hongbin Sun
- Shanghai Center for Drug Metabolism and Pharmacokinetics Research, Shanghai Institute of Materia Medica, Chinese Academy of Sciences, Shanghai, China (M.X., W.H., Y.Y., C.C., Y.H., Chen Y., D.Z., X.D., Y.Z.); School of Chinese Materia Medica, Nanjing University of Chinese Medicine, Nanjing, China (Cheng Y., Y.Y., C.C., X.D.); Department of Pharmacy, Shanghai Pudong Hospital, Fudan University Pudong Medical Center, Shanghai, China (J.G., H.L.); Jiangsu Key Laboratory for Functional Substances of Chinese Medicine, Nanjing University of Chinese Medicine, Nanjing, China (M.X.); State Key Laboratory of Natural Medicines and Center of Drug Discovery, College of Pharmacy, China Pharmaceutical University, Nanjing, China (H.S.); and Jiangsu Vcare PharmaTech Co. Ltd., Nanjing, China (Y.L., Y.G., Y.W., X.L.)
| | - Yongqiang Liu
- Shanghai Center for Drug Metabolism and Pharmacokinetics Research, Shanghai Institute of Materia Medica, Chinese Academy of Sciences, Shanghai, China (M.X., W.H., Y.Y., C.C., Y.H., Chen Y., D.Z., X.D., Y.Z.); School of Chinese Materia Medica, Nanjing University of Chinese Medicine, Nanjing, China (Cheng Y., Y.Y., C.C., X.D.); Department of Pharmacy, Shanghai Pudong Hospital, Fudan University Pudong Medical Center, Shanghai, China (J.G., H.L.); Jiangsu Key Laboratory for Functional Substances of Chinese Medicine, Nanjing University of Chinese Medicine, Nanjing, China (M.X.); State Key Laboratory of Natural Medicines and Center of Drug Discovery, College of Pharmacy, China Pharmaceutical University, Nanjing, China (H.S.); and Jiangsu Vcare PharmaTech Co. Ltd., Nanjing, China (Y.L., Y.G., Y.W., X.L.)
| | - Yanchun Gong
- Shanghai Center for Drug Metabolism and Pharmacokinetics Research, Shanghai Institute of Materia Medica, Chinese Academy of Sciences, Shanghai, China (M.X., W.H., Y.Y., C.C., Y.H., Chen Y., D.Z., X.D., Y.Z.); School of Chinese Materia Medica, Nanjing University of Chinese Medicine, Nanjing, China (Cheng Y., Y.Y., C.C., X.D.); Department of Pharmacy, Shanghai Pudong Hospital, Fudan University Pudong Medical Center, Shanghai, China (J.G., H.L.); Jiangsu Key Laboratory for Functional Substances of Chinese Medicine, Nanjing University of Chinese Medicine, Nanjing, China (M.X.); State Key Laboratory of Natural Medicines and Center of Drug Discovery, College of Pharmacy, China Pharmaceutical University, Nanjing, China (H.S.); and Jiangsu Vcare PharmaTech Co. Ltd., Nanjing, China (Y.L., Y.G., Y.W., X.L.)
| | - Yong Wu
- Shanghai Center for Drug Metabolism and Pharmacokinetics Research, Shanghai Institute of Materia Medica, Chinese Academy of Sciences, Shanghai, China (M.X., W.H., Y.Y., C.C., Y.H., Chen Y., D.Z., X.D., Y.Z.); School of Chinese Materia Medica, Nanjing University of Chinese Medicine, Nanjing, China (Cheng Y., Y.Y., C.C., X.D.); Department of Pharmacy, Shanghai Pudong Hospital, Fudan University Pudong Medical Center, Shanghai, China (J.G., H.L.); Jiangsu Key Laboratory for Functional Substances of Chinese Medicine, Nanjing University of Chinese Medicine, Nanjing, China (M.X.); State Key Laboratory of Natural Medicines and Center of Drug Discovery, College of Pharmacy, China Pharmaceutical University, Nanjing, China (H.S.); and Jiangsu Vcare PharmaTech Co. Ltd., Nanjing, China (Y.L., Y.G., Y.W., X.L.)
| | - Xiaojuan Lai
- Shanghai Center for Drug Metabolism and Pharmacokinetics Research, Shanghai Institute of Materia Medica, Chinese Academy of Sciences, Shanghai, China (M.X., W.H., Y.Y., C.C., Y.H., Chen Y., D.Z., X.D., Y.Z.); School of Chinese Materia Medica, Nanjing University of Chinese Medicine, Nanjing, China (Cheng Y., Y.Y., C.C., X.D.); Department of Pharmacy, Shanghai Pudong Hospital, Fudan University Pudong Medical Center, Shanghai, China (J.G., H.L.); Jiangsu Key Laboratory for Functional Substances of Chinese Medicine, Nanjing University of Chinese Medicine, Nanjing, China (M.X.); State Key Laboratory of Natural Medicines and Center of Drug Discovery, College of Pharmacy, China Pharmaceutical University, Nanjing, China (H.S.); and Jiangsu Vcare PharmaTech Co. Ltd., Nanjing, China (Y.L., Y.G., Y.W., X.L.)
| | - Dafang Zhong
- Shanghai Center for Drug Metabolism and Pharmacokinetics Research, Shanghai Institute of Materia Medica, Chinese Academy of Sciences, Shanghai, China (M.X., W.H., Y.Y., C.C., Y.H., Chen Y., D.Z., X.D., Y.Z.); School of Chinese Materia Medica, Nanjing University of Chinese Medicine, Nanjing, China (Cheng Y., Y.Y., C.C., X.D.); Department of Pharmacy, Shanghai Pudong Hospital, Fudan University Pudong Medical Center, Shanghai, China (J.G., H.L.); Jiangsu Key Laboratory for Functional Substances of Chinese Medicine, Nanjing University of Chinese Medicine, Nanjing, China (M.X.); State Key Laboratory of Natural Medicines and Center of Drug Discovery, College of Pharmacy, China Pharmaceutical University, Nanjing, China (H.S.); and Jiangsu Vcare PharmaTech Co. Ltd., Nanjing, China (Y.L., Y.G., Y.W., X.L.)
| | - Xingxing Diao
- Shanghai Center for Drug Metabolism and Pharmacokinetics Research, Shanghai Institute of Materia Medica, Chinese Academy of Sciences, Shanghai, China (M.X., W.H., Y.Y., C.C., Y.H., Chen Y., D.Z., X.D., Y.Z.); School of Chinese Materia Medica, Nanjing University of Chinese Medicine, Nanjing, China (Cheng Y., Y.Y., C.C., X.D.); Department of Pharmacy, Shanghai Pudong Hospital, Fudan University Pudong Medical Center, Shanghai, China (J.G., H.L.); Jiangsu Key Laboratory for Functional Substances of Chinese Medicine, Nanjing University of Chinese Medicine, Nanjing, China (M.X.); State Key Laboratory of Natural Medicines and Center of Drug Discovery, College of Pharmacy, China Pharmaceutical University, Nanjing, China (H.S.); and Jiangsu Vcare PharmaTech Co. Ltd., Nanjing, China (Y.L., Y.G., Y.W., X.L.)
| | - Huiping Lu
- Shanghai Center for Drug Metabolism and Pharmacokinetics Research, Shanghai Institute of Materia Medica, Chinese Academy of Sciences, Shanghai, China (M.X., W.H., Y.Y., C.C., Y.H., Chen Y., D.Z., X.D., Y.Z.); School of Chinese Materia Medica, Nanjing University of Chinese Medicine, Nanjing, China (Cheng Y., Y.Y., C.C., X.D.); Department of Pharmacy, Shanghai Pudong Hospital, Fudan University Pudong Medical Center, Shanghai, China (J.G., H.L.); Jiangsu Key Laboratory for Functional Substances of Chinese Medicine, Nanjing University of Chinese Medicine, Nanjing, China (M.X.); State Key Laboratory of Natural Medicines and Center of Drug Discovery, College of Pharmacy, China Pharmaceutical University, Nanjing, China (H.S.); and Jiangsu Vcare PharmaTech Co. Ltd., Nanjing, China (Y.L., Y.G., Y.W., X.L.)
| | - Yuandong Zheng
- Shanghai Center for Drug Metabolism and Pharmacokinetics Research, Shanghai Institute of Materia Medica, Chinese Academy of Sciences, Shanghai, China (M.X., W.H., Y.Y., C.C., Y.H., Chen Y., D.Z., X.D., Y.Z.); School of Chinese Materia Medica, Nanjing University of Chinese Medicine, Nanjing, China (Cheng Y., Y.Y., C.C., X.D.); Department of Pharmacy, Shanghai Pudong Hospital, Fudan University Pudong Medical Center, Shanghai, China (J.G., H.L.); Jiangsu Key Laboratory for Functional Substances of Chinese Medicine, Nanjing University of Chinese Medicine, Nanjing, China (M.X.); State Key Laboratory of Natural Medicines and Center of Drug Discovery, College of Pharmacy, China Pharmaceutical University, Nanjing, China (H.S.); and Jiangsu Vcare PharmaTech Co. Ltd., Nanjing, China (Y.L., Y.G., Y.W., X.L.)
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Samaddar A, Singh R, Yang X, Ebersole KC, Forrest ML. Investigating the potential of catheter-assisted pulsed focused ultrasound ablation for atherosclerotic plaques. Med Phys 2024; 51:5181-5189. [PMID: 38873842 DOI: 10.1002/mp.17253] [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] [Received: 09/05/2023] [Revised: 05/17/2024] [Accepted: 05/18/2024] [Indexed: 06/15/2024] Open
Abstract
BACKGROUND Atherosclerosis is a condition in which an adhesive substance called plaque accumulates over time inside the arteries. Plaque buildup results in the constriction of arteries, causing a shortage of blood supply to tissues and organs. Removing atherosclerotic plaques controls the development of acute ischemic stroke and heart diseases. It remains imperative for positive patient outcomes. PURPOSE This study sought to develop a minimally invasive technique for removing arterial plaques by applying focused ultrasound (FUS) energy on the metal surface of a nitinol catheter wire to induce inertial cavitation. The induced cavitation can deplete plaque mechanically inside the arteries, leading towards improved recanalization of blood vessels. METHODS The enhanced cavitation effect induced by combining FUS with a metal catheter was first verified by exposing agar phantom gels with or without a 0.9-mm diameter nitinol wire to an acoustic field produced by a 0.5-MHz FUS transducer. The phenomenon was further confirmed in pork belly fat samples with or without a 3-mm diameter nitinol catheter wire. Cavitation was monitored by detecting the peaks of emitted ultrasound signals from the samples using a passive cavitation detector (PCD). Cavitation threshold values were determined by observing the jump in the peak amplitude of signals received by the PCD when the applied FUS peak negative pressure (PNP) increased. To simulate arterial plaque removal, FUS with or without a catheter was used to remove tissues from pork belly fat samples and the lipid cores of human atherosclerotic plaque samples using 2500-cycle FUS bursts at 10% duty cycle and a burst repetition rate of 20 Hz. Treatment outcomes were quantified by subtracting the weight of samples before treatment from the weight of samples after treatment. All measurements were repeated 5 times (n = 5) unless otherwise indicated, and paired t-tests were used to compare the means of two groups. A p-value of <0.05 will be considered significant. RESULTS Our results showed that with a nitinol wire, the cavitation threshold in agar phantoms was reduced to 2.6 MPa from 4.3 MPa PNP when there was no nitinol wire in the focal region of FUS. For pork belly fat samples, cavitation threshold values were 1.0 and 2.0 MPa PNP, with and without a catheter wire, respectively. Pork belly fat tissues and lipid cores of atherosclerotic plaques were depleted at the interface between a catheter and the samples at 2 and 4 MPa FUS PNP, respectively. The results showed that with a catheter wire in the focal region of a 3-min FUS treatment session, 24.7 and 25.6 mg of lipid tissues were removed from pork belly fat and human atherosclerotic samples, respectively. In contrast, the FUS-only group showed no reduction in sample weight. The differences between FUS-only and FUS-plus-catheter groups were statistically significant (p < 0.001 for the treatment on pork belly samples, and p < 0.01 for the treatment on human atherosclerotic samples). CONCLUSION This study demonstrated the feasibility of catheter-assisted FUS therapy for removing atherosclerotic plaques.
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Affiliation(s)
- Abhirup Samaddar
- Institute for Bioengineering Research and Department of Mechanical Engineering, University of Kansas, Lawrence, Kansas, USA
| | - Rohit Singh
- Institute for Bioengineering Research and Department of Mechanical Engineering, University of Kansas, Lawrence, Kansas, USA
| | - Xinmai Yang
- Institute for Bioengineering Research and Department of Mechanical Engineering, University of Kansas, Lawrence, Kansas, USA
| | - Koji C Ebersole
- Department of Neurosurgery, the University of Kansas Medical Center, Kansas City, Kansas, USA
| | - M Laird Forrest
- Department of Pharmaceutical Chemistry, the University of Kansas, Lawrence, Kansas, USA
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Martinez Bravo G, Annarapu G, Carmona E, Nawarskas J, Clark R, Novelli E, Mota Alvidrez RI. Platelets in Thrombosis and Atherosclerosis: A Double-Edged Sword. THE AMERICAN JOURNAL OF PATHOLOGY 2024:S0002-9440(24)00209-8. [PMID: 38885926 DOI: 10.1016/j.ajpath.2024.05.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/07/2024] [Revised: 04/16/2024] [Accepted: 05/16/2024] [Indexed: 06/20/2024]
Abstract
This review focuses on the dual role of platelets in atherosclerosis and thrombosis, exploring their involvement in inflammation, angiogenesis, and plaque formation, as well as their hemostatic and prothrombotic functions. Beyond their thrombotic functions, platelets engage in complex interactions with diverse cell types, influencing disease resolution and progression. The contribution of platelet degranulation helps in the formation of atheromatous plaque, whereas the reciprocal interaction with monocytes adds complexity. Alterations in platelet membrane receptors and signaling cascades contribute to advanced atherosclerosis, culminating in atherothrombotic events. Understanding these multifaceted roles of platelets will lead to the development of targeted antiplatelet strategies for effective cardiovascular disease prevention and treatment. Understanding platelet functions in atherosclerosis and atherothrombosis at different stages of disease will be critical for designing targeted treatments and medications to prevent or cure the disease Through this understanding, platelets can be targeted at specific times in the atherosclerosis process, possibly preventing the development of atherothrombosis.
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Affiliation(s)
| | - Gowtham Annarapu
- Vascular Medicine Institute, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Emely Carmona
- School of Medicine, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
| | - James Nawarskas
- Pharmaceutical Sciences-Pharmacy Practice, College of Pharmacy, University of New Mexico, Albuquerque, New Mexico
| | - Ross Clark
- Cell Biology and Physiology, University of New Mexico, Albuquerque, New Mexico; Clinical and Translational Science Center, University of New Mexico, Albuquerque, New Mexico
| | - Enrico Novelli
- Vascular Medicine Institute, University of Pittsburgh, Pittsburgh, Pennsylvania; School of Medicine, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
| | - Roberto Ivan Mota Alvidrez
- Biomedical Engineering Department, University of New Mexico, Albuquerque, New Mexico; Pharmaceutical Sciences-Pharmacy Practice, College of Pharmacy, University of New Mexico, Albuquerque, New Mexico; Clinical and Translational Science Center, University of New Mexico, Albuquerque, New Mexico.
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Pinontoan R, Purnomo JS, Avissa EB, Tanojo JP, Djuan M, Vidian V, Samantha A, Jo J, Steven E. In-vitro and in-silico analyses of the thrombolytic potential of green kiwifruit. Sci Rep 2024; 14:13799. [PMID: 38877048 PMCID: PMC11178772 DOI: 10.1038/s41598-024-64160-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2023] [Accepted: 06/05/2024] [Indexed: 06/16/2024] Open
Abstract
Cardiovascular diseases (CVDs), mainly caused by thrombosis complications, are the leading cause of mortality worldwide, making the development of alternative treatments highly desirable. In this study, the thrombolytic potential of green kiwifruit (Actinidia deliciosa cultivar Hayward) was assessed using in-vitro and in-silico approaches. The crude green kiwifruit extract demonstrated the ability to reduce blood clots significantly by 73.0 ± 1.12% (P < 0.01) within 6 h, with rapid degradation of Aα and Bβ fibrin chains followed by the γ chain in fibrinolytic assays. Molecular docking revealed six favorable conformations for the kiwifruit enzyme actinidin (ADHact) and fibrin chains, supported by spontaneous binding energies and distances. Moreover, molecular dynamics simulation confirmed the binding stability of the complexes of these conformations, as indicated by the stable binding affinity, high number of hydrogen bonds, and consistent distances between the catalytic residue Cys25 of ADHact and the peptide bond. The better overall binding affinity of ADHact to fibrin chains Aα and Bβ may contribute to their faster degradation, supporting the fibrinolytic results. In conclusion, this study demonstrated the thrombolytic potential of the green kiwifruit-derived enzyme and highlighted its potential role as a natural plant-based prophylactic and therapeutic agent for CVDs.
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Affiliation(s)
- Reinhard Pinontoan
- Department of Biology, Universitas Pelita Harapan, Tangerang, 15811, Indonesia.
| | | | - Elvina Bella Avissa
- Department of Biology, Universitas Pelita Harapan, Tangerang, 15811, Indonesia
| | - Jessica Pricilla Tanojo
- Center of Excellence Applied Science Academy, Sekolah Pelita Harapan Lippo Village, Tangerang, 15810, Indonesia
| | - Moses Djuan
- Department of Biology, Universitas Pelita Harapan, Tangerang, 15811, Indonesia
| | - Valerie Vidian
- Department of Biology, Universitas Pelita Harapan, Tangerang, 15811, Indonesia
| | - Ariela Samantha
- Department of Biology, Universitas Pelita Harapan, Tangerang, 15811, Indonesia
| | - Juandy Jo
- Department of Biology, Universitas Pelita Harapan, Tangerang, 15811, Indonesia
- Mochtar Riady Institute for Nanotechnology, Lippo Karawaci, Tangerang, 15810, Indonesia
| | - Eden Steven
- Center of Excellence Applied Science Academy, Sekolah Pelita Harapan Lippo Village, Tangerang, 15810, Indonesia
- Emmerich Research Center, Jakarta, 14450, Indonesia
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Xie H, Chen Y, Ge W, Xu X, Liu C, Lan Z, Yang Y. Can the combination of antiplatelet or alteplase thrombolytic therapy with argatroban benefit patients suffering from acute stroke? a systematic review, meta-analysis, and meta-regression. PLoS One 2024; 19:e0298226. [PMID: 38412157 PMCID: PMC10898750 DOI: 10.1371/journal.pone.0298226] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2023] [Accepted: 01/19/2024] [Indexed: 02/29/2024] Open
Abstract
BACKGROUND The effectiveness of administering argatroban as a treatment approach following antiplatelet therapy or alteplase thrombolytic therapy in patients with acute stroke is presently uncertain. However, it is important to highlight the potential benefits of combining this medication with known thrombolytics or antiplatelet therapy. One notable advantage of argatroban is its short half-life, which helps minimize excessive anticoagulation and risk of bleeding complications in inadvertent cases of hemorrhagic stroke. By conducting a meticulous review and meta-analysis, we aim to further explore the common use of argatroban and examine the plausible advantages of combining this medication with established thrombolytic and antiplatelet therapies. METHOD In this study, we performed a rigorous and methodical search for both randomized controlled trials and retrospective analyses. Our main objective was to analyze the impact of argatroban on the occurrence of hemorrhagic events and the mRS scores of 0-2. We utilized a meta-analysis to assess the relative risk (RR) associated with using argatroban versus not using it. RESULTS In this study, we analyzed data from 11 different studies, encompassing a total of 8,635 patients. Out of these patients, 3999(46.3%) received argatroban treatment while the remaining 4636(53.7%)did not. The primary outcome of 90-day functional independence (modified Rankin scale (mRS) score≤2) showed that the risk ratio (RR) for patients using argatroban after alteplase thrombolytic therapy compared to those not using argatroban was(RR, 1.00 ([95% CI, 0.92-1.09]; P = 0.97), indicating no statistical significance. However, for patients using argatroban after antiplatelet therapy, was (RR,1.09 [95% CI, 1.04-1.14]; P = 0.0001), which was statistically significant. In terms of hemorrhagic events, the RR for patients using argatroban compared to those not using argatroban was (RR,1.08 [95% CI, 0.88-1.33]; P = 0.46), indicating no statistical significance. CONCLUSION The results of this study suggest that further research into combination therapy with argatroban and antiplatelet agents may be warranted, however more rigorous RCTs are needed to definitively evaluate the effects of combination treatment.
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Affiliation(s)
- Haiyan Xie
- Department of Clinical Pharmacy, The Third Hospital of Quzhou, Quzhou, Zhejiang, 324003, China
| | - Ying Chen
- Hangzhou Fuyang District Hospital of Traditional Chinese Medicine, Zhejiang, 311499, China
| | - Wukun Ge
- Department of Clinical Pharmacy, Ninghai First Hospital, Zhejiang, 315600, China
| | - Xiuping Xu
- Department of Emergency Internal Medicine, The Third Hospital of Quzhou, Quzhou, Zhejiang, 324003,China
| | - Chengjiang Liu
- Department of General Medicine, Affiliated Anqing First People’s Hospital of Anhui Medical University, HeFei, 246000, China
| | - Zhiyong Lan
- Department of Psychiatry Department, The Third Hospital of Quzhou, Quzhou, Zhejiang, 324003, China
| | - Yina Yang
- Department of Neurology, Ninghai First Hospital, Zhejiang, 315600, China
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7
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Sheikh AM, Yano S, Tabassum S, Nagai A. The Role of the Vascular System in Degenerative Diseases: Mechanisms and Implications. Int J Mol Sci 2024; 25:2169. [PMID: 38396849 PMCID: PMC10889477 DOI: 10.3390/ijms25042169] [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] [Received: 01/12/2024] [Revised: 02/03/2024] [Accepted: 02/07/2024] [Indexed: 02/25/2024] Open
Abstract
Degenerative diseases, encompassing a wide range of conditions affecting various organ systems, pose significant challenges to global healthcare systems. This comprehensive review explores the intricate interplay between the vascular system and degenerative diseases, shedding light on the underlying mechanisms and profound implications for disease progression and management. The pivotal role of the vascular system in maintaining tissue homeostasis is highlighted, as it serves as the conduit for oxygen, nutrients, and immune cells to vital organs and tissues. Due to the vital role of the vascular system in maintaining homeostasis, its dysfunction, characterized by impaired blood flow, endothelial dysfunction, and vascular inflammation, emerges as a common denominator of degenerative diseases across multiple systems. In the nervous system, we explored the influence of vascular factors on neurodegenerative diseases such as Alzheimer's and Parkinson's, emphasizing the critical role of cerebral blood flow regulation and the blood-brain barrier. Within the kidney system, the intricate relationship between vascular health and chronic kidney disease is scrutinized, unraveling the mechanisms by which hypertension and other vascular factors contribute to renal dysfunction. Throughout this review, we emphasize the clinical significance of understanding vascular involvement in degenerative diseases and potential therapeutic interventions targeting vascular health, highlighting emerging treatments and prevention strategies. In conclusion, a profound appreciation of the role of the vascular system in degenerative diseases is essential for advancing our understanding of degenerative disease pathogenesis and developing innovative approaches for prevention and treatment. This review provides a comprehensive foundation for researchers, clinicians, and policymakers seeking to address the intricate relationship between vascular health and degenerative diseases in pursuit of improved patient outcomes and enhanced public health.
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Affiliation(s)
- Abdullah Md. Sheikh
- Department of Laboratory Medicine, Faculty of Medicine, Shimane University, 89-1 Enya Cho, Izumo 693-8501, Japan; (S.Y.); (S.T.); (A.N.)
| | - Shozo Yano
- Department of Laboratory Medicine, Faculty of Medicine, Shimane University, 89-1 Enya Cho, Izumo 693-8501, Japan; (S.Y.); (S.T.); (A.N.)
| | - Shatera Tabassum
- Department of Laboratory Medicine, Faculty of Medicine, Shimane University, 89-1 Enya Cho, Izumo 693-8501, Japan; (S.Y.); (S.T.); (A.N.)
| | - Atsushi Nagai
- Department of Laboratory Medicine, Faculty of Medicine, Shimane University, 89-1 Enya Cho, Izumo 693-8501, Japan; (S.Y.); (S.T.); (A.N.)
- Department of Neurology, Faculty of Medicine, Shimane University, 89-1 Enya Cho, Izumo 693-8501, Japan
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8
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Narkhede M, Pardeshi A, Bhagat R, Dharme G. Review on Emerging Therapeutic Strategies for Managing Cardiovascular Disease. Curr Cardiol Rev 2024; 20:86-100. [PMID: 38629366 PMCID: PMC11327830 DOI: 10.2174/011573403x299265240405080030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/18/2023] [Revised: 03/04/2024] [Accepted: 03/18/2024] [Indexed: 08/07/2024] Open
Abstract
Cardiovascular disease (CVD) remains a foremost global health concern, necessitating ongoing exploration of innovative therapeutic strategies. This review surveys the latest developments in cardiovascular therapeutics, offering a comprehensive overview of emerging approaches poised to transform disease management. The examination begins by elucidating the current epidemiological landscape of CVD and the economic challenges it poses to healthcare systems. It proceeds to scrutinize the limitations of traditional therapies, emphasizing the need for progressive interventions. The core focus is on novel pharmacological interventions, including advancements in drug development, targeted therapies, and repurposing existing medications. The burgeoning field of gene therapy and its potential in addressing genetic predispositions to cardiovascular disorders are explored, alongside the integration of artificial intelligence and machine learning in risk assessment and treatment optimization. Non-pharmacological interventions take center stage, with an exploration of digital health technologies, wearable devices, and telemedicine as transformative tools in CVD management. Regenerative medicine and stem cell therapies, offering promises of tissue repair and functional recovery, are investigated for their potential impact on cardiac health. This review also delves into the interplay of lifestyle modifications, diet, exercise, and behavioral changes, emphasizing their pivotal role in cardiovascular health and disease prevention. As precision medicine gains prominence, this synthesis of emerging therapeutic modalities aims to guide clinicians and researchers in navigating the dynamic landscape of cardiovascular disease management, fostering a collective effort to alleviate the global burden of CVD and promote a healthier future.
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Affiliation(s)
- Minal Narkhede
- SMBT College of Pharmacy, Nandi Hills Dhamangaon Taluka Igatpuri, Nashik 422403, India
| | - Avinash Pardeshi
- SMBT College of Pharmacy, Nandi Hills Dhamangaon Taluka Igatpuri, Nashik 422403, India
| | - Rahul Bhagat
- SMBT College of Pharmacy, Nandi Hills Dhamangaon Taluka Igatpuri, Nashik 422403, India
| | - Gajanan Dharme
- SMBT College of Pharmacy, Nandi Hills Dhamangaon Taluka Igatpuri, Nashik 422403, India
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9
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Winson T, Basu Roy P, Tejani VN, Dhillon SS, Damarlapally N, Usman NUB, Panjiyar BK. The Efficacy and Safety of Antiplatelet Therapy in Patients With Acute Coronary Syndrome: A Scoping Review. Cureus 2023; 15:e49631. [PMID: 38161809 PMCID: PMC10756026 DOI: 10.7759/cureus.49631] [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] [Accepted: 11/29/2023] [Indexed: 01/03/2024] Open
Abstract
Cardiovascular disease, predominantly acute coronary syndrome (ACS), is the leading cause of death for both men and women. For decades, this has been a global healthcare challenge. The main reason for thrombus formation in the coronary arteries is platelet accumulation as part of an inflammatory reaction. The efforts to combat this process of platelet aggregation have led researchers to discover antiplatelet drugs, which have been a keystone in treating cardiovascular diseases related to arterial thrombus formation. Antiplatelet drugs inhibit various platelet responses and help mitigate atherothrombosis, thereby playing a major role in both primary and secondary prevention of ACS. This study employs a scoping review approach to recapitulate the data in the existing literature regarding the efficacy and safety of antiplatelet therapy in patients with ACS. By searching a total of 14,882 journals that were published between 2013 and July 26, 2023, 10 papers were selected for in-depth analysis. We conducted this literature search by using PubMed and Google Scholar databases and adhered to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) and the corresponding PRISMA Extension for Scoping Reviews in performing this review. The review findings revealed that the current approach of using antiplatelet agents in ACS is safe and efficient, provided that bleeding risk assessment is conducted and any prior contraindications are recognized before administering the drugs. Ethical approval was not required for this review as it involved secondary data collection from published journals. The findings of this scoping review will be published in peer-reviewed journals and presented at conferences.
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Affiliation(s)
| | | | - Vitrag N Tejani
- Pharmacology, Dr. N. D. Desai Faculty of Medical Science and Research, Dharmsinh Desai University, Kheda, IND
- Internal Medicine, Parul Institute of Medical Sciences and Research, Parul Sevashram Hospital, Parul University, Vadodara, IND
| | - Sukhmeet S Dhillon
- Internal Medicine, Baba Farid University of Health Sciences, Patiala, IND
| | | | | | - Binay K Panjiyar
- Cardiology, Harvard Medical School, Boston, USA
- Internal Medicine, California Institute of Behavioral Neurosciences & Psychology, Fairfield, USA
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10
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Tan CK, Wu DBC, Joseph Tan SY, Imran SS, Wee XT, Tan SYD. Validating the Prognostic Utility of the ABCD-GENE Score in Asian Patients with Acute Coronary Syndrome Patients on Clopidogrel. Eur Cardiol 2023; 18:e60. [PMID: 38023338 PMCID: PMC10658354 DOI: 10.15420/ecr.2023.27] [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: 06/16/2023] [Accepted: 08/14/2023] [Indexed: 12/01/2023] Open
Abstract
Background The ABCD-GENE score, which links cytochrome P450 2C19 (CYP2C19) phenotype and high platelet reactivity (HPR) to the risk of major adverse cardiovascular events (MACE) in clopidogrel users, has been validated in white and Japanese populations. The prognostic implications of the score in other Asian cohorts, however, have been largely unchartered. The aim of this study was to validate the prognostic utility of the ABCD-GENE score in a heterogeneous Asian acute coronary syndrome (ACS) cohort. Methods and Results In this single-centre, retrospective cohort evaluation of 423 ACS patients, the objectives were to characterise the best cut-off score for MACE prognostication by comparing the adjusted 1-year risk of MACE between groups above and below the candidate cut-off scores using Cox regression; and for on-clopidogrel HPR prediction using receiver operating characteristic (ROC) analysis and Youden's index. In the adjusted Cox model, an ABCD-GENE score cut-off at 10 points significantly predicts the 1-year risk of MACE (adjusted HR 3.771; 95% CI [1.041-13.661]). Female sex, baseline LDL, history of ACS and angiotensin receptor blocker use were additional independent predictors of MACE. On ROC analysis the ideal cut-off for HPR prediction was 7 points. However, that did not independently predict the 1-year risk of MACE (adjusted HR 1.595; 95% CI [0.425-5.989]). Conclusion The original ABCD-GENE score 10-point cut-off moderately predicts MACE in a heterogeneous, Asian ACS population at 1 year. Additional predictors of MACE were also identified in the present cohort, and these findings should be prospectively validated in larger ACS cohorts.
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Affiliation(s)
| | - David Bin-Chia Wu
- Saw Swee Hock School of Public Health, National University of SingaporeSingapore
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11
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Enciu A, Loeschner D, Alhallak M, Kellner G, Meyer A, Lauten A, Steinbrecher A, Gerlach R. Management and risk of postoperative bleeding in patients with low-dose antiplatelet aspirin medication during endoscopic endonasal surgery for pituitary adenomas. Acta Neurochir (Wien) 2023; 165:2995-3001. [PMID: 37668789 DOI: 10.1007/s00701-023-05766-5] [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] [Received: 05/04/2023] [Accepted: 08/08/2023] [Indexed: 09/06/2023]
Abstract
BACKGROUND To analyze the risk of postoperative bleeding following endoscopic endonasal transsphenoidal surgery (EETS) for treatment of pituitary adenomas (PA) in patients with short-term discontinuation of low-dose aspirin, if required for prevention of artherothrombotic disease (ATD). METHODS Patients with preoperative aspirin medication were identified in this single-center retrospective analysis of consecutive patients with PA, who underwent EETS between December 2008 and June 2022. Aspirin was discontinued perioperatively less than 2 days, > 2 and < 4 days, and > 4 and < 7 days according to the assumed risk of perioperative ATD. For those patients, the rate of postoperative bleeding, which required surgery, was compared to patients without aspirin. RESULTS Forty-five (14.8%) out of 304 patients underwent EETS with short-term perioperative aspirin discontinuation. Thirty-six (80%) patients discontinued aspirin < 2 days, 6 (13.3%) patients > 2 and < 4 days, and 3 patients (6.7%) > 4 but < 7 days. Postoperative bleeding rate was not increased in patients with short-term perioperative aspirin discontinuation. One patient (0.3%) without perioperative aspirin medication underwent revision surgery for treatment of postoperative hemorrhage with suprasellar extension. Eight patients (2.6%) had postoperative epistaxis (1 patient (0.3%) with short-term discontinuation and 7 patients (2.3%) without aspirin). Patients with perioperative aspirin were significantly older (68.3 ± 8.6 vs. 57.9 ± 14.1; p < 0.01) and had a significantly lower rate of hormonally active tumors (11.1% vs. 25.1%; p < 0.05) compared to patients without aspirin. No differences were found for tumor characteristics (tumor extension, tumor volume, largest diameter) between both groups. CONCLUSION Short-term discontinuation of low-dose aspirin was not associated with increased rate of postoperative bleeding in patients, who underwent EETS for treatment of PA.
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Affiliation(s)
- Andrei Enciu
- Department of Neurosurgery, Helios Clinics Erfurt, Nordhaeuser Str. 74, 99089, Erfurt, Germany
| | - Denise Loeschner
- Department of Neurosurgery, Helios Clinics Erfurt, Nordhaeuser Str. 74, 99089, Erfurt, Germany
| | - Mahmoud Alhallak
- Department of Neurosurgery, Helios Clinics Erfurt, Nordhaeuser Str. 74, 99089, Erfurt, Germany
| | - Geralf Kellner
- Department of ENT Surgery, Helios Clinics Erfurt, Nordhaeuser Str. 74, 99089, Erfurt, Germany
| | - Almuth Meyer
- Department of Medicine, Endocrinology, Helios Clinics Erfurt, Nordhaeuser Str. 74, 99089, Erfurt, Germany
| | - Alexander Lauten
- Department of Cardiology, Helios Clinics Erfurt, Nordhaeuser Str. 74, 99089, Erfurt, Germany
| | - Andreas Steinbrecher
- Department of Neurology, Helios Clinics Erfurt, Nordhaeuser Str. 74, 99089, Erfurt, Germany
| | - Ruediger Gerlach
- Department of Neurosurgery, Helios Clinics Erfurt, Nordhaeuser Str. 74, 99089, Erfurt, Germany.
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12
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Saigal K, Patel AB, Lucke-Wold B. Artificial Intelligence and Neurosurgery: Tracking Antiplatelet Response Patterns for Endovascular Intervention. MEDICINA (KAUNAS, LITHUANIA) 2023; 59:1714. [PMID: 37893432 PMCID: PMC10608122 DOI: 10.3390/medicina59101714] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/14/2023] [Revised: 09/22/2023] [Accepted: 09/22/2023] [Indexed: 10/29/2023]
Abstract
Platelets play a critical role in blood clotting and the development of arterial blockages. Antiplatelet therapy is vital for preventing recurring events in conditions like coronary artery disease and strokes. However, there is a lack of comprehensive guidelines for using antiplatelet agents in elective neurosurgery. Continuing therapy during surgery poses a bleeding risk, while discontinuing it before surgery increases the risk of thrombosis. Discontinuation is recommended in neurosurgical settings but carries an elevated risk of ischemic events. Conversely, maintaining antithrombotic therapy may increase bleeding and the need for transfusions, leading to a poor prognosis. Artificial intelligence (AI) holds promise in making difficult decisions regarding antiplatelet therapy. This paper discusses current clinical guidelines and supported regimens for antiplatelet therapy in neurosurgery. It also explores methodologies like P2Y12 reaction units (PRU) monitoring and thromboelastography (TEG) mapping for monitoring the use of antiplatelet regimens as well as their limitations. The paper explores the potential of AI to overcome such limitations associated with PRU monitoring and TEG mapping. It highlights various studies in the field of cardiovascular and neuroendovascular surgery which use AI prediction models to forecast adverse outcomes such as ischemia and bleeding, offering assistance in decision-making for antiplatelet therapy. In addition, the use of AI to improve patient adherence to antiplatelet regimens is also considered. Overall, this research aims to provide insights into the use of antiplatelet therapy and the role of AI in optimizing treatment plans in neurosurgical settings.
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Affiliation(s)
- Khushi Saigal
- College of Medicine, University of Florida, Gainesville, FL 32610, USA
| | - Anmol Bharat Patel
- College of Medicine, University of Miami—Miller School of Medicine, Miami, FL 33136, USA;
| | - Brandon Lucke-Wold
- Department of Neurosurgery, University of Florida, Gainesville, FL 32608, USA
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13
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Ravera S, Signorello MG, Panfoli I. Platelet Metabolic Flexibility: A Matter of Substrate and Location. Cells 2023; 12:1802. [PMID: 37443836 PMCID: PMC10340290 DOI: 10.3390/cells12131802] [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] [Received: 05/17/2023] [Revised: 07/04/2023] [Accepted: 07/05/2023] [Indexed: 07/15/2023] Open
Abstract
Platelets are cellular elements that are physiologically involved in hemostasis, inflammation, thrombotic events, and various human diseases. There is a link between the activation of platelets and their metabolism. Platelets possess considerable metabolic versatility. Although the role of platelets in hemostasis and inflammation is known, our current understanding of platelet metabolism in terms of substrate preference is limited. Platelet activation triggers an oxidative metabolism increase to sustain energy requirements better than aerobic glycolysis alone. In addition, platelets possess extra-mitochondrial oxidative phosphorylation, which could be one of the sources of chemical energy required for platelet activation. This review aims to provide an overview of flexible platelet metabolism, focusing on the role of metabolic compartmentalization in substrate preference, since the metabolic flexibility of stimulated platelets could depend on subcellular localization and functional timing. Thus, developing a detailed understanding of the link between platelet activation and metabolic changes is crucial for improving human health.
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Affiliation(s)
- Silvia Ravera
- Department of Experimental Medicine, University of Genoa, 16132 Genoa, Italy;
| | | | - Isabella Panfoli
- Department of Pharmacy (DIFAR), University of Genoa, 16132 Genoa, Italy;
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14
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Betti M, Bernardi M, Niccoli G, Biondi-Zoccai G, Spadafora L. Ginsenoside Re: Are we Close to a Safer Antiplatelet Therapy? J Cardiovasc Pharmacol 2023; 82:37-39. [PMID: 37070829 DOI: 10.1097/fjc.0000000000001431] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/19/2023]
Affiliation(s)
- Matteo Betti
- Centro Cardiologico Monzino, IRCCS, Milan, Italy
- Università degli Studi di Milano
| | - Marco Bernardi
- Department of Clinical, Internal Medicine, Anesthesiology and Cardiovascular Sciences, Sapienza University of Rome, Rome, Italy
| | - Giampaolo Niccoli
- Department of Medicine and Surgery, University of Parma, Parma, Italy
- Cardiology Unit, University Hospital of Parma, Parma, Italy
| | - Giuseppe Biondi-Zoccai
- Department of Medical-Surgical Sciences and Biotechnologies, Sapienza University of Rome, Latina, Italy; and
- Mediterranea Cardiocentro, Naples, Italy
| | - Luigi Spadafora
- Department of Clinical, Internal Medicine, Anesthesiology and Cardiovascular Sciences, Sapienza University of Rome, Rome, Italy
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15
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Yu L, Wang Z, Xu C, Liu A, Li T, Wang Y, Lu X, Xu H. Integrated Chinese and Western medicine for stable angina pectoris of coronary heart disease: a real-world study including 690 patients. Front Cardiovasc Med 2023; 10:1194082. [PMID: 37273882 PMCID: PMC10235782 DOI: 10.3389/fcvm.2023.1194082] [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: 03/26/2023] [Accepted: 05/05/2023] [Indexed: 06/06/2023] Open
Abstract
Objective We aimed to evaluate the effects of integrated Chinese and Western medical therapeutic modalities on clinical prognosis in a population with stable angina pectoris (SAP) of coronary heart disease (CHD). Methods In a prospective cohort study, 732 patients with SAP of CHD hospitalized in the Integrated Cardiology Unit of the China-Japan Friendship Hospital From October 2020 to October 2021 were included. The patients were divided into integrated treatment and conventional treatment groups according to whether they had been taking Chinese medicine for more than 6 months per year. The occurrence of composite cardiovascular events (CVEs), including cardiac death, non-fatal myocardial infarction, revascularization, stroke, all-cause death, and readmission due to angina attack, heart failure, or malignant arrhythmia, was recorded during follow-up. The effects of different treatment modalities on prognosis were evaluated using univariate and multifactorial logistic regression. Logistic regression models were evaluated using receiver operating characteristic (ROC) curves. In sensitivity analysis, the correlation between treatment modality and outcome events was corrected by rematching the two groups of patients using the propensity score matching (PSM) method. Results The data from 690 patients were included in the analysis, with 327 patients in the integrated treatment group and 363 patients in the conventional treatment group. CVEs occurred in 19 patients (5.8%) in the integrated treatment group and 37 patients (10.2%) in the conventional treatment group. The proportion of outcome events was significantly lower in the combination treatment group than in the conventional treatment group (P = 0.037). Covariate correction by multimodal multifactorial logistic regression revealed a lower risk of CVEs in patients receiving integrated therapy compared with conventional therapy (OR = 0.246, 95% CI = 0.097-0.622, P = 0.003). Moreover, a history of renal insufficiency (OR = 3.991, 95% CI = 1.164-13.684, P = 0.028) and a higher Gensini score (OR = 1.039, 95% CI = 1.028-1.050, P < 0.001) were risk factors for the development of CVEs. Model evaluation showed that C-statistic = 0.955 and area under the ROC curve (AUC) = 0.955. After PSM correction, the results still showed that integrated Chinese and Western medical treatment reduced the occurrence of CVEs in patients compared with Western treatment alone (OR = 0.339, 95% CI = 0.131-0.874, P = 0.025). Conclusion Integrated treatment based on Chinese and Western medicine might improve the prognosis and reduce the risk of CVEs in this disease population. Trial registration China Clinical Trials Registry, ChiCTR1800017891, Registered 20 August 2018, http://www.chictr.org.cn/showproj.aspx?proj = 30170.
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Affiliation(s)
- Linghua Yu
- Graduate School, Beijing University of Chinese Medicine, Beijing, China
| | - Zihan Wang
- Graduate School, Beijing University of Chinese Medicine, Beijing, China
| | - Chenxi Xu
- Graduate School, Beijing University of Chinese Medicine, Beijing, China
| | - Anxiang Liu
- Graduate School, Beijing University of Chinese Medicine, Beijing, China
| | - Tong Li
- Graduate School, Beijing University of Chinese Medicine, Beijing, China
| | - Yubi Wang
- Graduate School, Beijing University of Chinese Medicine, Beijing, China
| | - Xiaoyan Lu
- Department of Integrative Cardiology, China-Japan Friendship Hospital, Beijing, China
| | - Hao Xu
- Xiyuan Hospital, China Academy of Chinese Medical Sciences, Beijing, China
- National Clinical Research Center for Chinese Medicine Cardiology, Xiyuan Hospital, China Academy of Chinese Medical Sciences, Beijing, China
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Ahmed SHH, Gonda T, Agbadua OG, Girst G, Berkecz R, Kúsz N, Tsai MC, Wu CC, Balogh GT, Hunyadi A. Preparation and Evaluation of 6-Gingerol Derivatives as Novel Antioxidants and Antiplatelet Agents. Antioxidants (Basel) 2023; 12:antiox12030744. [PMID: 36978992 PMCID: PMC10045534 DOI: 10.3390/antiox12030744] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2023] [Revised: 03/10/2023] [Accepted: 03/13/2023] [Indexed: 03/30/2023] Open
Abstract
Ginger (Zingiber officinale) is widely used as a spice and a traditional medicine. Many bioactivities have been reported for its extracts and the isolated compounds, including cardiovascular protective effects. Different pathways were suggested to contribute to these effects, like the inhibition of platelet aggregation. In this study, we synthesised fourteen 6-gingerol derivatives, including eight new compounds, and studied their antiplatelet, COX-1 inhibitor, and antioxidant activities. In silico docking of selected compounds to h-COX-1 enzyme revealed favourable interactions. The investigated 6-gingerol derivatives were also characterised by in silico and experimental physicochemical and blood-brain barrier-related parameters for lead and preclinical candidate selection. 6-Shogaol (2) was identified as the best overall antiplatelet lead, along with compounds 3 and 11 and the new compound 17, which require formulation to optimize their water solubility. Compound 5 was identified as the most potent antioxidant that is also promising for use in the central nervous system (CNS).
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Affiliation(s)
- Sara H H Ahmed
- Institute of Pharmacognosy, University of Szeged, H-6720 Szeged, Hungary
| | - Tímea Gonda
- Institute of Pharmacognosy, University of Szeged, H-6720 Szeged, Hungary
| | - Orinamhe G Agbadua
- Institute of Pharmacognosy, University of Szeged, H-6720 Szeged, Hungary
| | - Gábor Girst
- Institute of Pharmacognosy, University of Szeged, H-6720 Szeged, Hungary
| | - Róbert Berkecz
- Institute of Pharmaceutical Analysis, University of Szeged, H-6720 Szeged, Hungary
| | - Norbert Kúsz
- Institute of Pharmacognosy, University of Szeged, H-6720 Szeged, Hungary
| | - Meng-Chun Tsai
- Graduate Institute of Natural Products, Kaohsiung Medical University, Kaohsiung 807, Taiwan
| | - Chin-Chung Wu
- Graduate Institute of Natural Products, Kaohsiung Medical University, Kaohsiung 807, Taiwan
| | - György T Balogh
- Institute of Pharmacodynamics and Biopharmacy, University of Szeged, H-6720 Szeged, Hungary
- Department of Chemical and Environmental Process Engineering, Budapest University of Technology and Economics, H-1111 Budapest, Hungary
| | - Attila Hunyadi
- Institute of Pharmacognosy, University of Szeged, H-6720 Szeged, Hungary
- Interdisciplinary Centre of Natural Products, University of Szeged, H-6720 Szeged, Hungary
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17
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Lee DH, Kwak HJ, Shin Y, Kim SJ, Lee GH, Park IH, Kim SH, Kang KS. Elucidation of Phytochemicals Affecting Platelet Responsiveness in Dangguisu-san: Active Ingredient Prediction and Experimental Research Using Network Pharmacology. PLANTS (BASEL, SWITZERLAND) 2023; 12:1120. [PMID: 36903980 PMCID: PMC10005453 DOI: 10.3390/plants12051120] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 12/28/2022] [Revised: 02/13/2023] [Accepted: 02/28/2023] [Indexed: 06/18/2023]
Abstract
Plant-derived phytochemicals are emerging as novel agents for protection against chronic disorders. Dangguisu-san is a herbal prescription to invigorate the blood and relieve pain. Among the numerous active constituents of Dangguisu-san, those expected to be effective at inhibiting platelet aggregation were predicted using a network pharmacological method, and their efficacy was experimentally demonstrated. All four identified chemical components, namely chrysoeriol, apigenin, luteolin, and sappanchalcone, suppressed the aggregation of platelets to a certain extent. However, we report, for the first time, that chrysoeriol acts as a strong inhibitor of platelet aggregation. Although additional in vivo studies are needed, among the complex constituents of herbal medicines, the components that exert an inhibitory effect on platelet aggregation were predicted using a network pharmacological method and experimentally confirmed with human platelets.
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Affiliation(s)
- Dong-Ha Lee
- Department of Biomedical Laboratory Science, Namseoul University, Cheonan 31020, Republic of Korea
| | - Hee Jae Kwak
- College of Pharmacy, Yonsei Institute of Pharmaceutical Science, Yonsei University, Incheon 21983, Republic of Korea
| | - Yonghee Shin
- College of Korean Medicine, Gachon University, Seongnam 13120, Republic of Korea
| | - Sung Jin Kim
- College of Korean Medicine, Gachon University, Seongnam 13120, Republic of Korea
| | - Ga Hee Lee
- Department of Biomedical Laboratory Science, Namseoul University, Cheonan 31020, Republic of Korea
| | - Il-Ho Park
- College of Pharmacy, Sahmyook University, Seoul 01795, Republic of Korea
| | - Seung Hyun Kim
- College of Pharmacy, Yonsei Institute of Pharmaceutical Science, Yonsei University, Incheon 21983, Republic of Korea
| | - Ki Sung Kang
- College of Korean Medicine, Gachon University, Seongnam 13120, Republic of Korea
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18
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Pan Y, Feng X, Zhou S, Yang S, Qiu P, Gong S, Chu Q, Chen P. Hydroxyls on the B ring and gallic acyl are essential for catechins to restrain ADP-induced thrombosis. Food Funct 2023; 14:1037-1047. [PMID: 36562296 DOI: 10.1039/d2fo01232d] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Platelet hyperactivation could lead to various cardiovascular and cerebrovascular diseases, while epidemiological analyses have found that long-term tea drinking could prevent and restrain cardiovascular diseases. Existing studies have shown that catechins, especially epigallocatechin gallate (EGCG), are the main functional factors of tea in alleviating thrombosis, which could inhibit arterial thrombosis and platelet aggregation induced by a variety of agonists. However, their structure-activity relationship and the underlying mechanisms are still unclear. Based on the above background, this study took six typical catechins as research objects, constructed platelet activation models with different inducers, and explored the inhibitory effects and potential mechanisms of catechins with different structures on platelet aggregation through flow cytometry, immunoblotting, cell spreading, and other experiments. It was found that ester catechins could inhibit platelet aggregation induced by adenosine diphosphate (ADP), while epigallocatechin (EGC) with three hydroxyls on the B ring in non-ester catechins was also able to effectively inhibit platelet aggregation. Our data suggested that gallic acyl on the C ring and three hydroxyls on the B ring were the main functional groups affecting the antithrombotic effect of catechins, and the effect of gallic acyl on platelets was significantly stronger than that of the hydroxyl.
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Affiliation(s)
- Yani Pan
- Tea Research Institute, Zhejiang University, Hangzhou 310058, China.
| | - Xinyu Feng
- Tea Research Institute, Zhejiang University, Hangzhou 310058, China. .,Department of Food Science and Nutrition, Zhejiang University, Hangzhou 310058, China
| | - Su Zhou
- Tea Research Institute, Zhejiang University, Hangzhou 310058, China. .,Department of Food Science and Nutrition, Zhejiang University, Hangzhou 310058, China
| | - Shiyan Yang
- Tea Research Institute, Zhejiang University, Hangzhou 310058, China.
| | - Pei Qiu
- Tea Research Institute, Zhejiang University, Hangzhou 310058, China.
| | - Shuying Gong
- Tea Research Institute, Zhejiang University, Hangzhou 310058, China.
| | - Qiang Chu
- Tea Research Institute, Zhejiang University, Hangzhou 310058, China.
| | - Ping Chen
- Tea Research Institute, Zhejiang University, Hangzhou 310058, China.
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19
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Pennings GJ, Reddel CJ, Chen VM, Gnanenthiran SR, Kritharides L. Perspective: Collagen induced platelet activation via the GPVI receptor as a primary target of colchicine in cardiovascular disease. Front Cardiovasc Med 2023; 9:1104744. [PMID: 36741844 PMCID: PMC9892722 DOI: 10.3389/fcvm.2022.1104744] [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: 11/22/2022] [Accepted: 12/30/2022] [Indexed: 01/20/2023] Open
Abstract
Colchicine has been demonstrated to reduce cardiovascular death, myocardial infarction (MI), ischemic stroke, and ischemia-driven coronary revascularization in people with coronary artery disease (CAD). These reductions were observed even in patients already taking antiplatelet therapy. As well as having anti-inflammatory effects, colchicine demonstrates antiplatelet effects. We propose that colchicine's antiplatelet effects primarily target collagen-induced platelet activation via the collagen receptor, glycoprotein (GP)VI, which is critical for arterial thrombosis formation. In settings such as stroke and MI, GPVI signaling is upregulated. We have demonstrated in vitro that therapeutic concentrations of colchicine lead to a decrease in collagen-induced platelet aggregation and alter GPVI signaling. Clinical studies of colchicine given for 6 months lead to a significant reduction in serum GPVI levels in CAD patients, which may ameliorate thrombotic risk. Future evaluation of the effects of colchicine in clinical trials should include assessment of its effects on collagen-mediated platelet activation, and consideration be given to quantifying the contribution of such antiplatelet effects additional to the known anti-inflammatory effects of colchicine.
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Affiliation(s)
- Gabrielle J. Pennings
- Vascular Biology Group, ANZAC Research Institute, The University of Sydney, Concord, NSW, Australia,Department of Cardiology, Concord Repatriation General Hospital, Concord, NSW, Australia
| | - Caroline J. Reddel
- Vascular Biology Group, ANZAC Research Institute, The University of Sydney, Concord, NSW, Australia
| | - Vivien M. Chen
- Department of Haematology, Concord Repatriation General Hospital, Concord, NSW, Australia,Platelet, Thrombosis Research Laboratory, ANZAC Research Institute, The University of Sydney, Concord, NSW, Australia
| | - Sonali R. Gnanenthiran
- Vascular Biology Group, ANZAC Research Institute, The University of Sydney, Concord, NSW, Australia,Department of Cardiology, Concord Repatriation General Hospital, Concord, NSW, Australia,The George Institute for Global Health, University of New South Wales, Newtown, NSW, Australia
| | - Leonard Kritharides
- Vascular Biology Group, ANZAC Research Institute, The University of Sydney, Concord, NSW, Australia,Department of Cardiology, Concord Repatriation General Hospital, Concord, NSW, Australia,*Correspondence: Leonard Kritharides ✉
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20
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Aspirin and Primary Cancer Risk Reduction in Ischemic Cardiac or Cerebrovascular Disease Survivors: A Nationwide Population-Based Propensity-Matched Cohort Study. Cancers (Basel) 2022; 15:cancers15010097. [PMID: 36612095 PMCID: PMC9817941 DOI: 10.3390/cancers15010097] [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: 09/12/2022] [Revised: 12/06/2022] [Accepted: 12/20/2022] [Indexed: 12/28/2022] Open
Abstract
Ischemic cardiac or cerebrovascular disease (ICCD) survivors represent a subpopulation with a high cancer risk. Antiplatelet medications, such as aspirin, remain a fundamental therapy for the secondary prevention of ischemic attack in these patients. We conducted a population-based cohort study to investigate the association of long-term low-dose aspirin use with the risk of primary cancer in ICCD survivors. Patients aged ≥20 years with newly diagnosed ICCD (n = 98,519) between January 2000 and December 2013 were identified from the Taiwan National Health Insurance Research Database. The aspirin user and nonuser groups (each n = 24,030) were propensity-matched (1:1) for age, sex, comorbidities, prior medications, ICCD diagnosis year, and year of index dates. The incidence rate of primary cancer was significantly lower in the user group (6.49/1000 person-years) than in the nonuser group (14.04/1000 person-years). Multivariate Cox regression analysis indicated that aspirin use was an independent factor associated with a reduced risk of primary cancer (aHR (95% confidence interval) = 0.42 (0.38−0.45)) after adjustment. Kaplan−Meier curve analysis revealed that the cumulative incidence rate of primary cancer was significantly lower (p < 0.0001) in the user group than in the nonuser group over the 14-year follow-up period. Subgroup analyses demonstrated that this anticancer effect increased with duration of treatment and with similar estimates in women and men. In addition, aspirin use was associated with a reduced risk for seven out of the ten most common cancers in Taiwan. These findings suggest the anticancer effect of aspirin in ICCD survivors and provide information for assessing the benefit-to-risk profile of aspirin as an antiplatelet medication in these patients.
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21
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Hu W, Luo Y, Yang X. Inappropriate Use of Proton Pump Inhibitors Increases Cardiovascular Events in Patients with Coronary Heart Disease. Int J Gen Med 2022; 15:8685-8691. [PMID: 36578351 PMCID: PMC9792105 DOI: 10.2147/ijgm.s392767] [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: 10/09/2022] [Accepted: 12/13/2022] [Indexed: 12/24/2022] Open
Abstract
Antiplatelet drugs, as the cornerstone of the treatment of coronary heart disease, control the progression of the disease, but bring a higher risk of gastrointestinal bleeding. Relevant guidelines recommend the use of proton pump inhibitors (PPIs) to minimize the risk of gastrointestinal bleeding in patients receiving dual antiplatelet therapy. But for people at low risk of gastrointestinal bleeding, the harms associated with routine use of PPIs may far outweigh the benefits. PPIs increase the risk of lower gastrointestinal bleeding, inhibit the effect of antiplatelet drugs, impair vascular endothelial function, meanwhile induce hypomagnesemia, iron deficiency, vitamins D and K deficiency, etc. Eventually, PPIs may lead to an increase in cardiovascular events. However, the situation is that PPIs are often overused. This review elucidates the mechanisms by which PPIs increase cardiovascular events, thereby reminding clinicians to rationally prescribe PPIs.
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Affiliation(s)
- Wen Hu
- Department of Cardiology, Chengdu Seventh People’s Hospital, Chengdu, People’s Republic of China
| | - Yunhao Luo
- Department of Critical Care Medicine, Chengdu First People’s Hospital, Chengdu, People’s Republic of China
| | - Xiujuan Yang
- Department of Cardiology, Chengdu Seventh People’s Hospital, Chengdu, People’s Republic of China,Correspondence: Xiujuan Yang, Email
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22
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Tam CC, Tse HF. Antiplatelet Therapy Aims and Strategies in Asian Patients with Acute Coronary Syndrome or Stable Coronary Artery Disease. J Clin Med 2022; 11:jcm11247440. [PMID: 36556067 PMCID: PMC9784545 DOI: 10.3390/jcm11247440] [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: 11/12/2022] [Revised: 11/30/2022] [Accepted: 12/13/2022] [Indexed: 12/23/2022] Open
Abstract
Dual antiplatelet therapy (DAPT) has been the mainstay treatment to reduce ischemic events, such as myocardial infarction or stroke, in patients with coronary artery disease (CAD). The development of potent P2Y12 inhibitors (ticagrelor and prasugrel) has helped to further reduce ischemic events, particularly among high-risk patients. Meanwhile, the evolution of newer generations of drug-eluting stents are also improving outcomes of percutaneous coronary intervention. Research studies on antiplatelet therapy in recent years have focused on balancing ischemic and bleeding risks through different strategies, which include P2Y12 inhibitor monotherapy, escalation and de-escalation, and extended DAPT. Because results from the large number of clinical studies may sometimes appear conflicting, this review aims to summarize recent advances, and demonstrate that they are aligned by a general principle, namely, strategies may be adopted based on treatment aims for specific patients at several time points. Another aim of this review is to outline the important considerations for using antiplatelet therapy in Asian patients, in whom there is a greater prevalence of CYP2C19 loss-of-function mutations, and a common increased risk of bleeding, despite high platelet reactivity (the so-called "East Asian Paradox").
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Affiliation(s)
- Chor-Cheung Tam
- Division of Cardiology, Queen Mary Hospital, The University of Hong Kong, Hong Kong, China
- Correspondence:
| | - Hung-Fat Tse
- Cardiology Division, Department of Medicine, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong, China
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23
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[Cardiovascular risk factors, haemostasis and antithrombotic treatment in retinal vessel occlusion]. DIE OPHTHALMOLOGIE 2022; 119:1129-1139. [PMID: 36344732 DOI: 10.1007/s00347-022-01751-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 10/13/2022] [Indexed: 11/09/2022]
Abstract
Venous and arterial retinal vascular occlusions are age-related disorders, generally associated with classical cardiovascular risk factors, rather than an isolated ocular disease. As affected patients often also have an increased general risk for other vascular diseases, such as ischemic stroke, an interdisciplinary clarification of cardiovascular risk factors and systemic comorbidities is essential for all patients. Extended hemostaseological investigations may be recommended in those patients who do not match the typical risk profile. Patients at a young age by the time of manifestation, without conventional risk factors as well as patients with an increased risk of developing antiphospholipid syndrome may require a selective clinical investigation including testing for thrombophilic risk factors. Recent studies have clearly demonstrated an association between coagulation and lipid metabolism disorders and the development of both retinal vein and artery occlusions in specific subgroups of patients. Therapeutic approaches to treat retinal vascular occlusions or reduce the long-term risk of recurrences with anticoagulant or antiplatelet drugs have not gained widespread acceptance. However, intravenous thrombolysis may be a valuable treatment option for central retinal artery occlusions within a short time to treatment therapeutic window. For defined disorders of the coagulation system, the administration of antithrombotic drugs to reduce the general vascular risk can be a reasonable approach. This article provides an overview of cardiovascular risk factors, the general vascular risk and the current state of knowledge on ophthalmologically relevant disorders of coagulation and lipid metabolism in patients with venous and arterial retinal vascular occlusions.
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24
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Tao Q, Xiao G, Wang T, Zhang L, Yu M, Peng L, Han L, Du X, Han W, He S, Lyu M, Zhu Y. Identification of linoleic acid as an antithrombotic component of Wenxin Keli via selective inhibition of p-selectin-mediated platelet activation. Biomed Pharmacother 2022; 153:113453. [DOI: 10.1016/j.biopha.2022.113453] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2022] [Revised: 07/10/2022] [Accepted: 07/18/2022] [Indexed: 11/27/2022] Open
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25
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Polysaccharide-protein complex from coelomic fluid of Dendrobaena veneta earthworm exerts a multi-pathway antiplatelet effect without coagulopathy and cytotoxicity. Biomed Pharmacother 2022; 151:113205. [PMID: 35644114 DOI: 10.1016/j.biopha.2022.113205] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2022] [Revised: 05/19/2022] [Accepted: 05/24/2022] [Indexed: 11/21/2022] Open
Abstract
There is a pressing need to identify novel antiplatelet agents, an alternative to acetylsalicylic acid and thienopyridines, to broaden the prevention of cardiovascular events, the leading cause of global morbidity and mortality. Invertebrate coelomocytes structurally and functionally resemble the thrombocyte-like cells of vertebrates; therefore, the coelomic fluid in which they are suspended may contain agents controlling their clumping abilities. However, whether coelomocytes-free coelomic fluid may also affect human platelet activities was not a subject of any study. This study aimed to screen the in vitro antiplatelet and anticoagulant activities of the polysaccharide-protein complex from Dendrobaena veneta coelomic fluid (25-100 µg/mL) (PPC-DV). All tested fluid concentrations induced significant (42.4-52.5%) inhibition of adenosine-5'-diphosphate (ADP)-induced aggregation of human platelets at a level comparable to that of 140 µmol/L acetylsalicylic acid. Its relevant antiplatelet effect (27.2-45.9%) was also evidenced in the thrombin receptor-activating peptide-6 (TRAP-6) assay. Moreover, 50 and 100 µg/mL of PPC-DV inhibited arachidonic acid-inducible aggregation. No coagulopathic or cytotoxic effects of PPC-DV were observed. The study indicates that PPC-DV, at a concentration of at least 50 µg/mL, exerts a favorable antiplatelet effect by targeting at least three pathways (P2Y12 receptor, cyclooxygenase-1, and protease-activated receptor-1), justifying further experimental and clinical investigations on its use in cardiovascular disease prevention.
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