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Cardiology 2021Gastrointestinal bleeding after percutaneous coronary intervention (PCI) is a not too uncommon clinical situation and is associated with high morbidity and mortality.... (Review)
Review
Gastrointestinal bleeding after percutaneous coronary intervention (PCI) is a not too uncommon clinical situation and is associated with high morbidity and mortality. After initial treatment, a number of clinical decisions must be made weighing the risks of ischemic events and future bleeding. In particular, healthcare providers must carefully balance the effectiveness of antiplatelet therapy in the secondary prevention of coronary events, primarily future spontaneous myocardial infarction and stent thrombosis, against the risk of major, most commonly gastrointestinal bleeding. The first question is whether a dual antiplatelet therapy strategy is required or if a single antiplatelet agent will suffice. Then, if a single antiplatelet agent is adequate, which agent should be continued. Although there is some guidance to answer some of these questions, there are inadequate evidence-based data for others. Below, we review the various considerations and summarize our approach and rationale to manage patients who had gastrointestinal bleeding after PCI.
Topics: Coronary Artery Disease; Gastrointestinal Hemorrhage; Humans; Percutaneous Coronary Intervention; Platelet Aggregation Inhibitors; Thrombosis
PubMed: 34521081
DOI: 10.1159/000517051 -
Journal of the American College of... Jul 2023
Topics: Humans; Platelet Aggregation Inhibitors; Coronary Artery Disease; Secondary Prevention; Aspirin; Myocardial Infarction; Purinergic P2Y Receptor Antagonists; Drug Therapy, Combination; Treatment Outcome; Percutaneous Coronary Intervention
PubMed: 37407109
DOI: 10.1016/j.jacc.2023.05.022 -
Brain and Nerve = Shinkei Kenkyu No... May 2023Ischemic stroke therapy consists of acute phase and preventive treatment strategies. Acute-phase ischemic stroke treatment includes systemic thrombolysis (rt-PA) and...
Ischemic stroke therapy consists of acute phase and preventive treatment strategies. Acute-phase ischemic stroke treatment includes systemic thrombolysis (rt-PA) and mechanical thrombectomy (endovascular therapy). Rt-PA is a very potent thrombolytic agent but its effectiveness is time-dependent. For the prevention of stroke recurrence (secondary stroke prevention) according to the TOAST classification, antiplatelet therapy (aspirin, clopidogrel, and cilostazol) is used for atherothrombotic and lacuna strokes, while anti-coagulant therapy (warfarin and direct oral anticoagulants [DOACs]) are used for cardiogenic cerebral embolism. Additionally, neuroprotective therapy using edaravone, a free radical scavenger, has recently been introduced to minimize brain tissue damage. Recently, neuronal regenerative therapies using stem cells have also been developed.
Topics: Humans; Ischemic Stroke; Thrombolytic Therapy; Stroke; Tissue Plasminogen Activator; Fibrinolytic Agents; Platelet Aggregation Inhibitors; Brain Ischemia; Anticoagulants
PubMed: 37194512
DOI: 10.11477/mf.1416202358 -
Anesthesia and Analgesia Feb 2022Sevoflurane was first synthesized independently by Richard Wallin and Bernard Regan at Travenol Laboratories Incorporated and Ross Terrell and Louise Croix at Airco, Inc... (Review)
Review
Sevoflurane was first synthesized independently by Richard Wallin and Bernard Regan at Travenol Laboratories Incorporated and Ross Terrell and Louise Croix at Airco, Inc in the late 1960s, and subsequent animal studies and a phase-1 human trial of the agent published in 1981 showed promising results. Further research in the United States was halted, however, because of concerns regarding potential nephrotoxicity and the introduction of less degradable alternatives. Interest in sevoflurane resumed in Japan when Maruishi Pharmaceutical Company, Limited (Ltd) (Maruishi) decided to continue its development in 1982. They secured approval by the Japanese Ministry of Health, Labor and Welfare for its clinical use in January 1990. Because of its low blood:gas partition coefficient and resulting rapid action, sevoflurane quickly became the anesthetic of choice of Japanese anesthesiologists. In 1992 Abbott Laboratories, now AbbVie, Inc (Abbott, North Chicago, IL) finalized a licensing agreement with Maruishi to seek the US Food and Drug Administration approval for sevoflurane sales in the United States. Approved in June 1995, sevoflurane is now marketed by Abbott in 120 countries and has been administered >120 million times. This report details the Japanese contribution to the development of sevoflurane.
Topics: Animals; Clinical Trials as Topic; Drug Compounding; Drug Development; Humans; Japan; Platelet Aggregation Inhibitors; Sevoflurane
PubMed: 33650992
DOI: 10.1213/ANE.0000000000005384 -
Zhonghua Jie He He Hu Xi Za Zhi =... Oct 2022Platelets-related pathophysiological mechanism and clinical research is one of the research hot topics in chronic obstructive pulmonary disease (COPD) at home and... (Review)
Review
Platelets-related pathophysiological mechanism and clinical research is one of the research hot topics in chronic obstructive pulmonary disease (COPD) at home and abroad. Increasing evidence has proved the association between thrombocytosis and COPD. Platelets activation interacts with COPD. Antiplatelet therapy has been shown to have significant effects on both short-term and long-term outcomes in COPD. Platelets inhibition may be an emerging therapeutic target for COPD, and antiplatelet therapy is expected to become an inexpensive and effective treatment for COPD. This article reviewed the research progress in platelets and COPD.
Topics: Blood Platelets; Humans; Platelet Aggregation Inhibitors; Pulmonary Disease, Chronic Obstructive
PubMed: 36207962
DOI: 10.3760/cma.j.cn112147-20220425-00349 -
Analytical and Bioanalytical Chemistry Jan 2022Antiplatelet and anticoagulant drugs are classified antithrombotic agents with the purpose to reduce blood clot formation. For a successful treatment of many known...
Antiplatelet and anticoagulant drugs are classified antithrombotic agents with the purpose to reduce blood clot formation. For a successful treatment of many known complex cardiovascular diseases driven by platelet and/or coagulation activity, the need of more than one antithrombotic agent is inevitable. However, combining drugs with different mechanisms of action enhances risk of bleeding. Dual anticoagulant and antiplatelet (APAC), a novel semisynthetic antithrombotic molecule, provides both anticoagulant and antiplatelet properties in preclinical studies. APAC is entering clinical studies with this new exciting approach to manage cardiovascular diseases. For a better understanding of the biological function of APAC, comprehensive knowledge of its structure is essential. In this study, atomic force microscopy (AFM) was used to characterize APAC according to its structure and to investigate the molecular interaction of APAC with von Willebrand factor (VWF), since specific binding of APAC to VWF could reduce platelet accumulation at vascular injury sites. By the optimization of drop-casting experiments, we were able to determine the volume of an individual APAC molecule at around 600 nm, and confirm that APAC forms multimers, especially dimers and trimers under the experimental conditions. By studying the drop-casting behavior of APAC and VWF individually, we depictured their interaction by using an indirect approach. Moreover, in vitro and in vivo conducted experiments in pigs supported the AFM results further. Finally, the successful adsorption of APAC to a flat gold surface was confirmed by using photothermal-induced resonance, whereby attenuated total reflection-Fourier transform infrared spectroscopy (ATR-FTIR) served as a reference method.
Topics: Anticoagulants; Heparin; Humans; Microscopy, Atomic Force; Platelet Aggregation Inhibitors; Proteoglycans; Spectroscopy, Fourier Transform Infrared
PubMed: 34773471
DOI: 10.1007/s00216-021-03765-y -
Pharmacology Research & Perspectives Dec 2020Clopidogrel is the most common and widely used antiplatelet agent for patients with coronary artery disease following confirmation by electrocardiographic studies. The... (Review)
Review
Clopidogrel is the most common and widely used antiplatelet agent for patients with coronary artery disease following confirmation by electrocardiographic studies. The nonresponsiveness of patients to clopidogrel and the possibility of testing for clopidogrel resistance by platelet function assays (PFA) are contentious issues. Light transmission aggregometry (LTA) is considered as the gold standard test among all PFA. In this review, the most commonly used PFA used for monitoring the effect of clopidogrel, LTA, vasodilator-stimulated phosphoprotein assay phosphorylation, rotational thromboelastometry (ROTEM) delta and ROTEM platelet, thromboelastography, PFA-100, VerifyNow P2Y12 assay, Multiplate analyzer, Plateletworks assay and pharmacogenetic studies, are comparatively discussed including their principles of action, advantages, and disadvantages. VerifyNow P2Y12 assay can be accepted as the ideal point of care test out of the discussed assays. However, modified assays are required which could overcome the limitations associated with currently available assays.
Topics: Animals; Clopidogrel; Drug Monitoring; Humans; Pharmacogenetics; Pharmacogenomic Testing; Platelet Aggregation Inhibitors; Platelet Function Tests; Point-of-Care Systems; Thrombelastography
PubMed: 33200888
DOI: 10.1002/prp2.686 -
The Senior Care Pharmacist Jan 2022This case study reviews appropriate antiplatelet treatment options for an older patient post-myocardial infarction and stent placement. This case investigates the...
This case study reviews appropriate antiplatelet treatment options for an older patient post-myocardial infarction and stent placement. This case investigates the benefits and risks associated with antiplatelet agents in older people and what patient- and drug-specific factors, such as adverse effects and drug interactions, to consider when choosing treatment.
Topics: Aged; Humans; Myocardial Infarction; Platelet Aggregation Inhibitors
PubMed: 34953509
DOI: 10.4140/TCP.n.2022.17 -
Open Heart Jun 2021Although primarily affecting the respiratory system, COVID-19 causes multiple organ damage. One of its grave consequences is a prothrombotic state that manifests as... (Review)
Review
Although primarily affecting the respiratory system, COVID-19 causes multiple organ damage. One of its grave consequences is a prothrombotic state that manifests as thrombotic, microthrombotic and thromboembolic events. Therefore, understanding the effect of antiplatelet and anticoagulation therapy in the context of COVID-19 treatment is important. The aim of this rapid review was to highlight the role of thrombosis in COVID-19 and to provide new insights on the use of antithrombotic therapy in its management. A rapid systematic review was performed using preferred reporting items for systematic reviews. Papers published in English on antithrombotic agent use and COVID-19 complications were eligible. Results showed that the use of anticoagulants increased survival and reduced thromboembolic events in patients. However, despite the use of anticoagulants, patients still suffered thrombotic events likely due to heparin resistance. Data on antiplatelet use in combination with anticoagulants in the setting of COVID-19 are quite scarce. Current side effects of anticoagulation therapy emphasise the need to update treatment guidelines. In this rapid review, we address a possible modulatory role of antiplatelet and anticoagulant combination against COVID-19 pathogenesis. This combination may be an effective form of adjuvant therapy against COVID-19 infection. However, further studies are needed to elucidate potential risks and benefits associated with this combination.
Topics: Anticoagulants; COVID-19; Drug Therapy, Combination; Humans; Platelet Aggregation Inhibitors; SARS-CoV-2; Thromboembolism; Treatment Outcome; COVID-19 Drug Treatment
PubMed: 34099529
DOI: 10.1136/openhrt-2021-001628 -
Phytotherapy Research : PTR May 2023This study was designed to evaluate antiplatelet effect and therapeutic effect of ginkgo diterpene lactone meglumine injection (GDLI) in acute ischemic stroke (AIS)... (Randomized Controlled Trial)
Randomized Controlled Trial
This study was designed to evaluate antiplatelet effect and therapeutic effect of ginkgo diterpene lactone meglumine injection (GDLI) in acute ischemic stroke (AIS) patients. In this randomized, double-blind, placebo-controlled trial, we randomly assigned 70 inpatients within 48 hr after the onset of AIS to combination therapy with GDLI and aspirin (GDLI at a dose of 25 mg/d for 14 days plus aspirin at a dose of 100 mg/d for 90 days) or to placebo plus aspirin in a ratio of 1:1. Platelet function, the National Institute of Health Stroke Scale (NIHSS), and the modified Rankin Scale (mRS) were evaluated. A good outcome was defined as NIHSS scores decrease ≥5 or mRS scores decrease ≥2. Results showed that arachidonic acid induced maximum platelet aggregation rate (AA-MAR) and mean platelet volume (MPV) of the GDLI-aspirin group were much lower than that of the aspirin group (p = 0.013 and p = 0.034, respectively) after the 14-day therapy. The combination of GDLI and aspirin was superior to aspirin alone, and had significant impact on the good outcome at day 90 (ORadj 7.21 [95%CI, 1.03-50.68], p = 0.047). In summary, GDLI has antiplatelet effect and can improve the prognosis of AIS patients.
Topics: Humans; Platelet Aggregation Inhibitors; Stroke; Ischemic Stroke; Ginkgo biloba; Aspirin
PubMed: 36609866
DOI: 10.1002/ptr.7720