- Three, six, or twelve months of dual antiplatelet therapy after DES implantation in patients with or without acute coronary syndromes: an individual patient data pairwise and network meta-analysis of six randomized trials and 11 473 patients. [Journal Article]
- EHEur Heart J 2017 Jan 21
- CONCLUSIONS: Optimal DAPT duration after DES differs according to clinical presentation. In the present meta-analysis, despite the fact that most enrolled ACS patients were relatively low risk, 3-month DAPT was associated with increased ischaemic risk, whereas 3-month DAPT appeared safe in stable CAD. Prolonged DAPT increases bleeding regardless of clinical presentation. Further study is required to identify the optimal duration of DAPT after DES in individual patients based on their relative ischaemic and bleeding risks.
- Randomized Comparison of Oral P2Y12-Receptor Inhibitor Loading Strategies for Transitioning From Cangrelor: The ExcelsiorLOAD2 Trial. [Journal Article]
- JCJACC Cardiovasc Interv 2017 Jan 23; 10(2):121-129
- CONCLUSIONS: Prasugrel 60 mg given at the start of a 2-h infusion of cangrelor can provide a sufficient platelet inhibition post-cangrelor. This approach prevents the transient gap in platelet inhibition seen with oral loading after discontinuation of cangrelor. (Impact of Extent of Clopidogrel-Induced Platelet Inhibition during Elective Stent Implantation on Clinical Event Rate - Advanced Loading Strategies [ExcelsiorLOAD2]; DRKS00009739).
- The use of indomethacin in the prevention of postoperative radioulnar synostosis after distal biceps repair. [Journal Article]
- JSJ Shoulder Elbow Surg 2017; 26(2):295-298
- CONCLUSIONS: Indomethacin use after distal biceps repair was associated with a statistically significant reduction in the rate of symptomatic radioulnar synostosis and did not have any associated adverse effects, including gastrointestinal bleeding or rerupture, despite prolonged use of up to 6 weeks. This study represents the largest study to report the outcomes of patients undergoing distal biceps repair with concomitant synostosis prophylaxis using indomethacin.
- Use of Proton-Pump Inhibitors Predicts Heart Failure and Death in Patients with Coronary Artery Disease. [Journal Article]
- PlosPLoS One 2017; 12(1):e0169826
- CONCLUSIONS: In patients with CAD, PPI use is independently associated with an increased incidence of HF and death but not with a high rate of acute ischaemic events. Further studies are needed to confirm these findings.
- Risk of bleeding and repeated bleeding events in prasugrel-treated patients: a review of data from the Japanese PRASFIT studies. [Review]
- CICardiovasc Interv Ther 2017 Jan 17
- Prasugrel is a third-generation thienopyridine that achieves potent platelet inhibition with less pharmacological variability than other thienopyridines. However, clinical experience suggests that pr...
Prasugrel is a third-generation thienopyridine that achieves potent platelet inhibition with less pharmacological variability than other thienopyridines. However, clinical experience suggests that prasugrel may be associated with a higher risk of de novo and recurrent bleeding events compared with clopidogrel in Japanese patients undergoing percutaneous coronary intervention (PCI). In this review, we evaluate the risk of bleeding in Japanese patients treated with prasugrel at the doses (loading/maintenance doses: 20/3.75 mg) adjusted for Japanese patients, evaluate the risk factors for bleeding in Japanese patients, and examine whether patients with a bleeding event are at increased risk of recurrent bleeding. This review covers published data and new analyses of the PRASFIT (PRASugrel compared with clopidogrel For Japanese patIenTs) trials of patients undergoing PCI for acute coronary syndrome or elective reasons. The bleeding risk with prasugrel was similar to that observed with the standard dose of clopidogrel (300/75 mg), including when bleeding events were re-classified using the Bleeding Academic Research Consortium criteria. The pharmacodynamics of prasugrel was not associated with the risk of bleeding events. The main risk factors for bleeding events were female sex, low body weight, advanced age, and presence of diabetes mellitus. Use of a radial puncture site was associated with a lower risk of bleeding during PCI than a femoral puncture site. Finally, the frequency and severity of recurrent bleeding events during continued treatment were similar between prasugrel and clopidogrel. In summary, this review provides important insights into the risk and types of bleeding events in prasugrel-treated patients.Trial registration numbers: JapicCTI-101339 and JapicCTI-111550.
- Additive antithrombotic effect of ASP6537, a selective cyclooxygenase (COX)-1 inhibitor, in combination with clopidogrel in guinea pigs. [Journal Article]
- EJEur J Pharmacol 2017 Jan 14
- Clopidogrel (Plavix(®), Sanofi-Aventis), the adenosine diphosphate P2Y12 receptor antagonist, is reported to be effective in the prevention of cardiovascular events and is often used in combination w...
Clopidogrel (Plavix(®), Sanofi-Aventis), the adenosine diphosphate P2Y12 receptor antagonist, is reported to be effective in the prevention of cardiovascular events and is often used in combination with aspirin, particularly in high-risk patients. ASP6537 is a reversible cyclooxygenase (COX)-1 inhibitor that is under investigation as an anti-platelet agent. First, we investigated the reversibility of the antiplatelet effect of ASP6537 and its interaction with ibuprofen to compare the usability of ASP6537 with that of aspirin. We then evaluated the antithrombotic effect of ASP6537 in combination with clopidogrel using a FeCl3-induced thrombosis model in guinea pigs. ASP6537 exerted reversible antiplatelet activity, and no pharmacodynamic interaction with ibuprofen was noted. When administered as monotherapy, ASP6537 exerted a significant antithrombotic effect at ≥3mg/kg, while aspirin inhibited thrombosis at 100mg/kg. ASP6537 exerted significant additive effects in combination with clopidogrel, and the minimum antithrombotic dose was reduced by concomitant administration of clopidogrel. Our study showed that ASP6537 did not interact with ibuprofen and has clear additive effects in combination with clopidogrel. ASP6537 may therefore represent a promising antiplatelet agent for use in clinical settings in combination with clopidogrel.
- Effect of Clopidogrel by Smoking Status on Secondary Stroke Prevention. [Letter]
- CircCirculation 2017 Jan 17; 135(3):315-316
- Platelet receptor Gene (P2Y12, P2Y1) and platelet glycoprotein Gene (GPIIIa) polymorphisms are associated with antiplatelet drug responsiveness and clinical outcomes after acute minor ischemic stroke. [Journal Article]
- EJEur J Clin Pharmacol 2017 Jan 13
- CONCLUSIONS: Responsiveness to antiplatelet drugs and the risks for adverse clinical events in this MIS cohort appear to be multifactorial since the outcomes were not mediated by single gene polymorphisms.
- A comparison of cangrelor, prasugrel, ticagrelor, and clopidogrel in patients undergoing percutaneous coronary intervention: A network meta-analysis. [Journal Article]
- CRCardiovasc Revasc Med 2016 Oct 21
- CONCLUSIONS: Despite rapid platelet inhibition provided by cangrelor, newer oral P2Y12 inhibitors such as ticagrelor and prasugrel have comparable clinical outcomes.
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- Characterization of Three CYP2C19 Gene Variants by MassARRAY and Point of Care Techniques: Experience from a Czech Centre. [Journal Article]
- AIArch Immunol Ther Exp (Warsz) 2017 Jan 12
- Distribution of cytochrome P450 2C19 enzyme gene (CYP2C19) variants affecting metabolism of clopidogrel was determined in 526 Czech patients after percutaneous coronary intervention using MassARRAY g...
Distribution of cytochrome P450 2C19 enzyme gene (CYP2C19) variants affecting metabolism of clopidogrel was determined in 526 Czech patients after percutaneous coronary intervention using MassARRAY genotyping and compared to distribution in other populations of European descent. Fifty-three (10%) patients underwent parallel determination of CYP2C19 genotypes from buccal swabs by a point of care technique with 100% concordance to the main genotyping platform. Observed CYP2C19 genotypes were related to clopidogrel metabolism phenotypes and discussed in population context. Hereby, presented methodologies provide accurate CYP2C19 genotyping results in a relatively short time of one up to 12 h and may, therefore, find the relevant place in the field of genotype-guided antiplatelet therapy.