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Circulation. Cardiovascular... Apr 2024Dual antiplatelet therapy-the combination of aspirin and a P2Y12 inhibitor-remains the standard antiplatelet regimen recommended to prevent ischemic complications... (Review)
Review
Dual antiplatelet therapy-the combination of aspirin and a P2Y12 inhibitor-remains the standard antiplatelet regimen recommended to prevent ischemic complications immediately after percutaneous coronary intervention. Nonetheless, recent advances in stent technologies, percutaneous coronary intervention techniques, adjunctive pharmacotherapy for secondary prevention, and the rising awareness of the prognostic impact of bleeding, which are inevitably associated with dual antiplatelet therapy, led to the investigation of alternative antiplatelet regimens related to fewer bleeding and a preserved ischemic protection. Thrombotic complications occur mostly in the first months after percutaneous coronary intervention, while the risk of bleeding remains stable over time; this observation laid the foundation of the concept of antiplatelet de-escalation, consisting of a more intense antiplatelet regimen early after percutaneous coronary intervention, followed by a less potent antiplatelet therapy thereafter. According to new definitions proposed by the Academic Research Consortium, de-escalation can be achieved by discontinuation of 1 antiplatelet agent, switching from a potent P2Y12 inhibitor to clopidogrel, or by reducing the dose of antiplatelet agents. This review discusses the rationale and the evidence supporting antiplatelet de-escalation, provides practical guidance to use these new regimens, and gives insights into future developments in the field.
Topics: Humans; Platelet Aggregation Inhibitors; Acute Coronary Syndrome; Treatment Outcome; Clopidogrel; Hemorrhage; Percutaneous Coronary Intervention
PubMed: 38626078
DOI: 10.1161/CIRCINTERVENTIONS.123.013263 -
International Journal of Molecular... Mar 2022Platelets are at the forefront of human health and disease following the advances in their research presented in past decades. Platelet activation, their most crucial... (Review)
Review
Platelets are at the forefront of human health and disease following the advances in their research presented in past decades. Platelet activation, their most crucial function, although beneficial in the case of vascular injury, may represent the initial step for thrombotic complications characterizing various pathologic states, primarily atherosclerotic cardiovascular diseases. In this review, we initially summarize the structural and functional characteristics of platelets. Next, we focus on the process of platelet activation and its associated factors, indicating the potential molecular mechanisms involving inflammation, endothelial dysfunction, and miRs. Finally, an overview of the available antiplatelet agents is being portrayed, together with agents possessing off-set platelet-inhibitory actions, while an extensive presentation of drugs under investigation is being given.
Topics: Blood Platelets; Humans; Pharmaceutical Preparations; Platelet Activation; Platelet Aggregation Inhibitors; Thrombosis
PubMed: 35328719
DOI: 10.3390/ijms23063301 -
Urologic Oncology Oct 2021Bladder cancer is a disease of the older adult, and management of comorbid conditions requiring anticoagulation (AC) or antiplatelet agents (APA) around the time of... (Review)
Review
BACKGROUND
Bladder cancer is a disease of the older adult, and management of comorbid conditions requiring anticoagulation (AC) or antiplatelet agents (APA) around the time of radical cystectomy (RC) is a frequent clinical challenge. It is estimated that 10% of adult surgical patients are on chronic anticoagulation medications, and considerations surrounding the perioperative disruption, resumption, and modification or substitution of AC and APA in patients undergoing radical cystectomy are critical for the practicing urologist.
METHODS
In our report, we performed a comprehensive literature review using PubMed to evaluate all available studies from 1950 to present. Additionally, we reviewed current multidisciplinary guideline papers from the American College of Surgeons, American College of Cardiology, and CHEST Society regarding perioperative management of anticoagulation and antiplatelet agents.
RESULTS
Our keyword search yielded 35 articles from 1950 to 2019. We identified 16 studies pertaining specifically to evaluation and perioperative management of anticoagulation in patient undergoing RC. Many of the recommendations in this realm are informed by trial data outside the RC population in the general surgical population or general adult population. Current guidelines from the American College of Surgeons, American College of Cardiology/American Heart Association, and CHEST Society inform our recommendations heavily and are summarized in Table 1.
CONCLUSIONS
Radical cystectomy remains both a mainstay of therapy for patients with muscle-invasive bladder cancer and a morbid procedure. Competing risks of perioperative hemorrhage and thromboembolic events make management of anticoagulation and antiplatelet agents an important and modifiable risk factor. Our review of the current literature highlights the knowledge gap that exists in management of these agents in the radical cystectomy patient. A multi-disciplinary approach to management of this clinical challenge remains a mainstay of treatment.
Topics: Anticoagulants; Cystectomy; Female; Humans; Male; Platelet Aggregation Inhibitors; Urinary Bladder Neoplasms
PubMed: 31928866
DOI: 10.1016/j.urolonc.2019.12.011 -
European Heart Journal. Cardiovascular... May 2024
Topics: Humans; Platelet Aggregation Inhibitors; Anticoagulants; Administration, Oral; Treatment Outcome; Hemorrhage; Risk Factors; Risk Assessment
PubMed: 38563454
DOI: 10.1093/ehjcvp/pvae021 -
Journal of Thrombosis and Haemostasis :... Oct 2022Antithrombotic agents reduce risk of thromboembolism in severely ill patients. Patients with coronavirus disease 2019 (COVID-19) may realize additional benefits from...
Antithrombotic agents reduce risk of thromboembolism in severely ill patients. Patients with coronavirus disease 2019 (COVID-19) may realize additional benefits from heparins. Optimal dosing and timing of these treatments and benefits of other antithrombotic agents remain unclear. In October 2021, ISTH assembled an international panel of content experts, patient representatives, and a methodologist to develop recommendations on anticoagulants and antiplatelet agents for patients with COVID-19 in different clinical settings. We used the American College of Cardiology Foundation/American Heart Association methodology to assess level of evidence (LOE) and class of recommendation (COR). Only recommendations with LOE A or B were included. Panelists agreed on 12 recommendations: three for non-hospitalized, five for non-critically ill hospitalized, three for critically ill hospitalized, and one for post-discharge patients. Two recommendations were based on high-quality evidence, the remainder on moderate-quality evidence. Among non-critically ill patients hospitalized for COVID-19, the panel gave a strong recommendation (a) for use of prophylactic dose of low molecular weight heparin or unfractionated heparin (LMWH/UFH) (COR 1); (b) for select patients in this group, use of therapeutic dose LMWH/UFH in preference to prophylactic dose (COR 1); but (c) against the addition of an antiplatelet agent (COR 3). Weak recommendations favored (a) sulodexide in non-hospitalized patients, (b) adding an antiplatelet agent to prophylactic LMWH/UFH in select critically ill, and (c) prophylactic rivaroxaban for select patients after discharge (all COR 2b). Recommendations in this guideline are based on high-/moderate-quality evidence available through March 2022. Focused updates will incorporate future evidence supporting changes to these recommendations.
Topics: Aftercare; Anticoagulants; COVID-19; Fibrinolytic Agents; Heparin; Heparin, Low-Molecular-Weight; Humans; Patient Discharge; Platelet Aggregation Inhibitors; Rivaroxaban
PubMed: 35906716
DOI: 10.1111/jth.15808 -
Methods in Molecular Biology (Clifton,... 2022Platelet activation and aggregation is implicated in all stages of inflammation-related atherosclerosis from the initial steps of endothelial dysfunction and plaque...
Platelet activation and aggregation is implicated in all stages of inflammation-related atherosclerosis from the initial steps of endothelial dysfunction and plaque formation, to plaque rupture and atherothrombotic events, such as acute coronary syndrome, myocardial infarction, and ischemic incidences. Platelet aggregometry assays are the mainstream for evaluating and monitoring platelet reactivity in such conditions and for the investigation of prophylactic and therapeutic approaches. The most established methodology is light transmittance aggregometry (LTA). Here we describe the appropriate preparation of platelet suspensions from human blood and the methodology of LTA-based assays that is used for basic and clinical research for monitoring and evaluating the activities of several thrombotic mediators, as well as determining the dose efficacy and safety of several pharmaceutical and nutraceutical compounds intended for therapeutic and prophylactic interventions for atherosclerosis.
Topics: Atherosclerosis; Blood Platelets; Humans; Platelet Activation; Platelet Aggregation; Platelet Aggregation Inhibitors; Platelet Function Tests
PubMed: 35237975
DOI: 10.1007/978-1-0716-1924-7_21 -
Journal of Intensive Care Medicine Jan 2021Patients with intracranial hemorrhage (including intracerebral hemorrhage, subarachnoid hemorrhage, and traumatic hemorrhage) are commonly admitted to the intensive care...
INTRODUCTION
Patients with intracranial hemorrhage (including intracerebral hemorrhage, subarachnoid hemorrhage, and traumatic hemorrhage) are commonly admitted to the intensive care unit (ICU). Although indications for oral antiplatelet agents are increasing, the impact of preadmission use on outcomes in patients with intracranial hemorrhage admitted to the ICU is unknown. We sought to evaluate the association between preadmission oral antiplatelet use, in-hospital mortality, resource utilization, and costs among ICU patients with intracranial hemorrhage.
METHODS
We retrospectively analyzed a prospectively collected registry (2011-2016) and included consecutive adult patients from 2 hospitals admitted to ICU with intracranial hemorrhage. Patients were categorized on the basis of preadmission oral antiplatelet use. We excluded patients with preadmission anticoagulant use. The primary outcome was in-hospital mortality and was analyzed using a multivariable logistic regression model. Contributors to total hospital cost were analyzed using a generalized linear model with log link and gamma distribution.
RESULTS
Of 720 included patients with intracranial hemorrhage, 107 (14.9%) had been using an oral antiplatelet agent at the time of ICU admission. Oral antiplatelet use was not associated with in-hospital mortality (adjusted odds ratio: 1.31 [95% confidence interval [CI]: 0.93-2.22]). Evaluation of total costs also revealed no association with oral antiplatelet use (adjusted ratio of means [aROM]: 0.92 [95% CI: 0.82-1.02, = .10]). Total cost among patients with intracranial hemorrhage was driven by illness severity (aROM: 1.96 [95% CI: 1.94-1.98], < .001), increasing ICU length of stay (aROM: 1.05 [95% CI: 1.05-1.06], < .001), and use of invasive mechanical ventilation (aROM: 1.76 [95% CI: 1.68-1.86], < .001).
CONCLUSIONS
Among ICU patients admitted with intracranial hemorrhage, preadmission oral antiplatelet use was not associated with increased in-hospital mortality or hospital costs. These findings have important prognostic implications for clinicians who care for patients with intracranial hemorrhage.
Topics: Adult; Health Care Costs; Hospital Mortality; Hospitalization; Humans; Intensive Care Units; Intracranial Hemorrhages; Length of Stay; Platelet Aggregation Inhibitors; Retrospective Studies
PubMed: 31741418
DOI: 10.1177/0885066619885347 -
Clinical Biochemistry Nov 2020Acetylsalicylic acid (ASA) or brand name Aspirin is a widely available medication used to relieve inflammation, fever and pain. It has also been frequently prescribed as... (Review)
Review
Acetylsalicylic acid (ASA) or brand name Aspirin is a widely available medication used to relieve inflammation, fever and pain. It has also been frequently prescribed as prevention for cardiovascular disease due to its anti-thrombotic qualities. However, ASA is also connected to increased internal bleeding, leading to concerns that this harmful side effect may outweigh its cardioprotective properties in some populations. In this review, we summarize data from several recent, large-scale clinical trials that put into the question the long-standing recommendations about prescribing ASA for primary cardiovascular disease. We also provide a detailed overview of the role of ASA in cancer, surgery and female reproductive health. Finally, we discuss the ASA prescription guidelines of several major medical organizations and suggest that this new evidence may lead to updates to these influential and longstanding recommendations.
Topics: Aspirin; Cardiovascular Diseases; Clinical Trials as Topic; Female; Hemorrhage; Humans; Male; Platelet Aggregation Inhibitors; Practice Guidelines as Topic; Treatment Outcome
PubMed: 32721423
DOI: 10.1016/j.clinbiochem.2020.07.003 -
Pharmacological Reports : PR Dec 2022Immuno-thrombosis of COVID-19 results in the activation of platelets and coagulopathy. Antiplatelet therapy has been widely used in COVID-19 patients to prevent... (Review)
Review
Immuno-thrombosis of COVID-19 results in the activation of platelets and coagulopathy. Antiplatelet therapy has been widely used in COVID-19 patients to prevent thrombotic events. However, recent analysis of clinical trials does not support the major effects of antiplatelet therapy on mortality in hospitalized COVID-19 patients, despite the indisputable evidence for an increased risk of thrombotic complications in COVID-19 disease. This apparent paradox calls for an explanation. Platelets have an important role in sensing and orchestrating host response to infection, and several platelet functions related to host defense response not directly related to their well-known hemostatic function are emerging. In this paper, we aim to review the evidence supporting the notion that platelets have protective properties in maintaining endothelial barrier integrity in the course of an inflammatory response, and this role seems to be of particular importance in the lung. It might, thus, well be that the inhibition of platelet function, if affecting the protective aspect of platelet activity, might diminish clinical benefits resulting from the inhibition of the pro-thrombotic phenotype of platelets in immuno-thrombosis of COVID-19. A better understanding of the platelet-dependent mechanisms involved in the preservation of the endothelial barrier is necessary to design the antiplatelet therapeutic strategies that inhibit the pro-thrombotic activity of platelets without effects on the vaso-protective function of platelets safeguarding the pulmonary endothelial barrier during multicellular host defense in pulmonary circulation.
Topics: Humans; COVID-19; Platelet Aggregation Inhibitors
PubMed: 36463349
DOI: 10.1007/s43440-022-00438-0 -
Blood Reviews Jan 2020Antiplatelet medications have long been the mainstay for secondary prevention in cardiovascular disorders. More recently, with the advent of coronary stents, there has... (Review)
Review
Antiplatelet medications have long been the mainstay for secondary prevention in cardiovascular disorders. More recently, with the advent of coronary stents, there has been an increased use of more potent antiplatelet agents to prevent stent occlusion. Since these drugs are antithrombotic, it is not unusual for them to be associated with serious bleeding, particularly intracranial and gastrointestinal haemorrhage. There are no robust guidelines on how to manage these clinical situations, although there have been some important studies published recently in this area. Similarly, there is very limited evidence on how to manage urgent surgery in patients receiving these medications. In this review, we provide updated guidance on the management of bleeding and surgery on antiplatelet drugs while stressing the need for further studies to provide evidence-based guidelines.
Topics: Hemorrhage; Humans; Platelet Aggregation Inhibitors
PubMed: 31648803
DOI: 10.1016/j.blre.2019.100619