Optimal duration of antiplatelet therapy after pci in high-risk patients with diabetes mellitus: Current evidence and ongoing issues regarding long-term atherothrombotic ischemic events

2021 ◽  
Vol 331 ◽  
pp. e243
Author(s):  
H. Wang ◽  
K. Dou
Keyword(s):  
Diabetes Mellitus ◽  
High Risk ◽  
Antiplatelet Therapy ◽  
Current Evidence ◽  
High Risk Patients ◽  
Optimal Duration ◽  
Patients With Diabetes ◽  
Risk Patients ◽  
Ischemic Events

scholarly journals The Impact of Pharmacist-delivered Motivational Interviewing on Chronic Kidney Disease Identification and Management in Patients with Diabetes Mellitus and Low Socioeconomic Status

2019 ◽  
Vol 10 (4) ◽  
pp. 8
Author(s):  
Keri Lillian DePatis ◽  
Catherine Harrington
Keyword(s):  
Diabetes Mellitus ◽  
Chronic Kidney Disease ◽  
High Risk ◽  
Kidney Disease ◽  
Motivational Interviewing ◽  
Urinary Albumin ◽  
Secondary Outcome ◽  
High Risk Patients ◽  
Patients With Diabetes ◽  
Risk Patients

Purpose: Chronic kidney disease (CKD) is a common complication among patients with diabetes mellitus; however, noncompliance with the recommended annual screening is common. Increased screening among high-risk patients is important to identify the early stages CKD, potentially resulting in earlier treatment, slower progression, fewer complications, and decreased healthcare expenditures. Motivational interviewing (MI) has previously been shown to be effective for various behaviors, such as smoking cessation and cholesterol level control. The objective of this study is to evaluate the effectiveness of pharmacist-delivered MI compared to typical education (TE) methods in increasing CKD screening and subsequent angiotensin-converting enzyme inhibitor (ACE-I) or angiotensin II receptor blocker (ARB) initiation in high-risk patient populations. Methods: Pharmacists screened diabetic patients within their chronic disease management clinic to identify patients that are at high-risk for CKD, indicated by a score of 4 or greater on the validated SCORED screening tool. High-risk patients were randomized to one of four groups to receive either one or two face-to-face education sessions from a pharmacist or student pharmacist using either MI or TE methods. Patients were then given the option to have their urine tested with a dipstick to detect albumin and creatinine, provided at no cost. The primary outcome was to determine the rate of urinary albumin testing, and the secondary outcome was to determine the rate of ACE-I or ARB initiation in patients found to have albuminuria. Results: There were no significant differences in the rates of urinary albumin screening (87% in TE vs. 100% in MI, P = 0.4828) or subsequent ACE-I/ARB initiation (100% in TE and 50% in MI, P = 1.000) between education groups. Of the high-risk patients who underwent urinary albumin screening, 54% (n=15) were found to have proteinuria Conclusions: While it appears that MI does not impact patient acceptance rates of microalbuminuria screening and ACE-I/ARB initiation, this study demonstrates the feasibility of pharmacist-delivered microalbuminuria screening in patients at high-risk for CKD in the outpatient setting.   Article Type: Practice-Based Research

scholarly journals The impact of discontinuation of aspirin within 24 months among the high risk patients who are receiving prolonged dual antiplatelet therapy after implantation of second-generation drug-eluting stents

2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
S.W Cho ◽  
D.Y Kim ◽  
T.K Park ◽  
J.M Lee ◽  
J.H Yang ◽  
...  
Keyword(s):  
High Risk ◽  
Antiplatelet Therapy ◽  
Second Generation ◽  
Dual Antiplatelet Therapy ◽  
High Risk Patients ◽  
Cerebrovascular Events ◽  
Risk Patients ◽  
Drug Eluting ◽  
The Impact

Abstract Background The clinical impact of discontinuation of aspirin within 24 months after PCI for high risk patients who are receiving prolonged dual antiplatelet therapy (DAPT) is not known. We investigated the long-term outcomes prolonged DAPT among high risk patients after second-generation drug-eluting stent (DES) implantation. Methods and results Of 2082 consecutive patients undergoing PCI using 2nd generation DES, we studied 637 patients at high risk either angiographically or clinically who received clopidogrel longer than 24 months and were event-free at 12 months after index PCI. Patients were divided into 2 groups: the clopidogrel monotherapy group (aspirin discontinued within 24 months) and the prolonged DAPT group. The primary outcome was major adverse cardiac and cerebrovascular events (a composite of all-cause death, non-fatal myocardial infarction, or stroke) between 12 and 36 months after the index procedure. In propensity score-matched population, the risk of major adverse cardiac and cerebrovascular events (4.7%, 12/256 versus 4.3%, 11/256, hazard ratio (HR) 0.95, 95% confidence interval (CI) 0.42–2.16, p=0.91), all-cause mortality (3.1%, 8/256 versus 2.0%, 5/256, HR 0.70, CI 0.23–2.14), cardiovascular death (0.4%, 1/256 versus 0.8%, 2/256, HR 2.34, CI 0.21–25.80, p=0.49), non-fatal myocardial infarct (0.8%, 2/256 versus 0.4%, 1/256, HR 0.57, CI 0.05–6,32, p=0.65), stroke (0.8%, 2/256 versus 0.8%, 2/256, HR 1.09, CI 0.15–7.76, p=0.93) were not significantly different between patients receiving clopidogrel monotherapy and prolonged DAPT. Conclusion Compared to prolonged DAPT, aspirin discontinuation 12–24 months after PCI for high risk patients who received DAPT has similar long-term risk of major adverse cardiac and cerebrovascular events in patients after second-generation DES implantation. Funding Acknowledgement Type of funding source: None

Abstract 297: Dual Antiplatelet Therapy versus Triple Therapy with Anticoagulant Following Percutaneous Coronary Intervention in High Risk Patients Requiring Long-Term Anticoagulation: A Meta-Analysis

2012 ◽  
Vol 5 (suppl_1) ◽  
Author(s):  
Hemang B Panchal ◽  
Tejaskumar Shah ◽  
Mukesh Singh ◽  
Sandeep Khosla ◽  
Vijay Ramu ◽  
...  
Keyword(s):  
Ischemic Stroke ◽  
High Risk ◽  
Triple Therapy ◽  
Antiplatelet Therapy ◽  
Dual Antiplatelet Therapy ◽  
Meta Analysis ◽  
Bleeding Events ◽  
High Risk Patients ◽  
Risk Patients

Background: Dual antiplatelet therapy with aspirin and clopidogrel is the cornerstone of treatment to prevent major adverse cardiovascular events (MACE) in patients following percutaneous coronary intervention (PCI). In high-risk patients requiring long-term anticoagulant, the current literatures have controversial results in preventing MACE and bleeding events with the use of triple therapy with aspirin, clopidogrel and warfarin compared to dual antiplatelet therapy following PCI. The purpose of this meta-analysis was to compare the safety and efficacy of triple therapy with dual therapy following PCI in high-risk patients requiring long term anticoagulation. Methods: A literature search identified 4 prospective and 4 retrospective studies with total of 2439 patients requiring long term anticoagulation undergoing PCI. End points measured were bleeding events, deaths, ischemic stroke, myocardial infarction, stent thrombosis and MACE. The odds ratios (OR) with 95% confidence intervals (CI) were computed and two sided alpha error <0.05 considered as a level of significance. Results: In contrast to dual antiplatelet therapy, patients on triple therapy with anticoagulant had significantly lower stent thrombosis (OR: 0.45, CI: 0.21-0.94, p=0.03) and ischemic stroke (OR: 0.30, CI: 0.16-0.56, p<0.001) (Fig 1 - Zone A is dual therapy group, zone B is triple therapy group). No significant difference was found between two groups in overall bleeding events (OR: 1.57, CI: 0.87-2.85, p=0.14), major bleeding events(OR:1.21, CI: 0.57-2.59, p=0.62), deaths (OR:0.89, CI: 0.5-1.58, p=0.69), myocardial infarction (OR:1.31, CI: 0.85-2.02, p=0.22) and MACE (OR:0.61, CI:0.20-1.82, p=0.37). Conclusions: Our meta-analysis suggests that the triple therapy with anticoagulant does not increase bleeding compared to dual antiplatelet therapy. Moreover, triple therapy decreases stent thrombosis and ischemic stroke following PCI in patients requiring long-term anticoagulants. Our study did not show any difference in mortality between two groups. Triple therapy may be a favorable strategy following PCI in high-risk patients requiring long-term anticoagulation. The randomized control clinical trials are needed for further evaluation of long-term outcomes.

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