Towards a Post-Discharge Bleeding Risk Equation for Acute Coronary Syndromes

2013 ◽  
Vol 22 (7) ◽  
pp. 581-582
Author(s):  
T. Suk ◽  
M. Lee ◽  
I. Ternouth ◽  
G. Devlin ◽  
A.J. Kerr
Keyword(s):  
Acute Coronary Syndromes ◽  
Bleeding Risk ◽  
Post Discharge ◽  
Risk Equation ◽  
Coronary Syndromes

Is there Sex-related Outcome Difference According to oral P2Y12 Inhibitors in Patients with Acute Coronary Syndromes? A Systematic Review and Meta-Analysis of 107,126 Patients

2019 ◽  
Vol 17 (2) ◽  
pp. 191-203
Author(s):  
Oliver Brown ◽  
Jennifer Rossington ◽  
Gill Louise Buchanan ◽  
Giuseppe Patti ◽  
Angela Hoye
Keyword(s):  
Systematic Review ◽  
Acute Coronary Syndromes ◽  
Meta Analysis ◽  
Indirect Comparison ◽  
Bleeding Risk ◽  
Cardiovascular Death ◽  
P2y12 Inhibitors ◽  
Significant Difference ◽  
Coronary Syndromes ◽  
Randomised Controlled

Background and Objectives: The majority of patients included in trials of anti-platelet therapy are male. This systematic review and meta-analysis aimed to determine whether, in addition to aspirin, P2Y12 blockade is beneficial in both women and men with acute coronary syndromes. </P><P> Methods: Electronic databases were searched and nine eligible randomised controlled studies were identified that had sex-specific clinical outcomes (n=107,126 patients). Risk Ratios (RR) and 95% Confidence Intervals (CI) were calculated for a composite of cardiovascular death, myocardial infarction or stroke (MACE), and a safety endpoint of major bleeding for each sex. Indirect comparison analysis was performed to statistically compare ticagrelor against prasugrel. </P><P> Results: Compared to aspirin alone, clopidogrel reduced MACE in men (RR, 0.79; 95% CI, 0.68 to 0.92; p=0.003), but was not statistically significant in women (RR, 0.88; 95% CI, 0.75 to 1.02, p=0.08). Clopidogrel therapy significantly increased bleeding in women but not men. Compared to clopidogrel, prasugrel was beneficial in men (RR, 0.84; 95% CI, 0.73 to 0.97; p=0.02) but not statistically significant in women (RR, 0.94; 95% CI, 0.83 to 1.06; p=0.30); ticagrelor reduced MACE in both men (RR, 0.85; 95% CI, 0.77 to 0.94; p=0.001) and women (RR, 0.84; 95% CI, 0.73 to 0.97; p=0.02). Indirect comparison demonstrated no significant difference between ticagrelor and prasugrel in either sex. Compared to clopidogrel, ticagrelor and prasugrel increased bleeding risk in both women and men. </P><P> Conclusion: In summary, in comparison to monotherapy with aspirin, P2Y12 inhibitors reduce MACE in women and men. Ticagrelor was shown to be superior to clopidogrel in both sexes. Prasugrel showed a statistically significant benefit only in men; however indirect comparison did not demonstrate superiority of ticagrelor over prasugrel in women.

scholarly journals Bleeding risk assessment and comorbidities in elderly patients with acute coronary syndromes

2016 ◽  
Vol 35 (4) ◽  
pp. 247-248
Author(s):  
Albert Ariza-Solé ◽  
Francesc Formiga ◽  
Eva Bernal ◽  
Alberto Garay
Keyword(s):  
Risk Assessment ◽  
Elderly Patients ◽  
Acute Coronary Syndromes ◽  
Bleeding Risk ◽  
Coronary Syndromes

Abstract 15408: Long-term Antithrombotic Management Patterns After Acute Coronary Syndromes: 2-[[Unsupported Character - Codename ­]]years Follow-up in the EPICOR Asia Study

Circulation ◽  
2015 ◽  
Vol 132 (suppl_3) ◽  
Author(s):  
Yong Huo ◽  
Stephen W Lee ◽  
Jitendra P Sawhney ◽  
Hyo-Soo Kim ◽  
Rungroj Krittayaphong ◽  
...  
Keyword(s):  
Antiplatelet Therapy ◽  
Hospital Discharge ◽  
Acute Coronary Syndromes ◽  
Single Agent ◽  
Real Life ◽  
Post Discharge ◽  
Index Event ◽  
Coronary Syndromes ◽  
Antithrombotic Management

Introduction: Guidelines recommend dual-antiplatelet therapy (DAPT) for 12 months in patients with acute coronary syndromes (ACS). Information on patterns and duration of DAPT use after hospital discharge in ACS patients in Asia is sparse. Objective: We describe changes in real-life antithrombotic management patterns (AMPs) up to 2-y post discharge based on data from the EPICOR Asia study (NCT01361386). Methods: This observational study enrolled 12 922 hospital survivors post ACS from 218 hospitals in 8 countries/regions in Asia. Data were collected from symptom onset for the index event (ST-segment elevation myocardial infarction [STEMI] 51.2%, non-STEMI (NSTEMI) 19.9%, or unstable angina [UA] 28.9%), during hospitalization, at discharge and over 2 y follow-up. Results: Overall, 90.6% of patients were on DAPT at hospital discharge which declined to 79.6%, 71.8%, 53.7%, and 45.6% at 6, 12, 18, and 23 months post discharge (Fig). At discharge, most patients (87.6%) received aspirin + clopidogrel, with 79.5%, 71.8%, 53.6%, and 45.4% on this combination at 6, 12, 18, and 23 months. At discharge only 3.0% of patients received aspirin + prasugrel and 1.7% of patients received aspirin + cilostazol. Only 8.3% of patients were on single antiplatelet therapy (SAPT) at discharge with 12.2%, 15.6%, 28.1%, and 30.3% on SAPT at 6, 12, 18, and 23 months post discharge; aspirin being the most commonly used single agent. No notable differences were seen among index event groups. Of the patients on DAPT at discharge, STEMI 93.4%; NSTEMI 90.2%; UA 85.9%, comparable proportions across groups remained on DAPT at 23 months follow up; STEMI 51.0%; NSTEMI 51.9%; UA 47.6%. Conclusions: Most ACS patients remain on DAPT at 12 months and around half remain at 23 months post-discharge. Further study should assess between-country differences, the benefit/risk balance from prolonged DAPT, why DAPT is discontinued before 12 months, and impact on clinical outcomes.

Is it possible to separate ischemic and bleeding risk in patients with non-ST segment elevation acute coronary syndromes?

2014 ◽  
Vol 171 (3) ◽  
pp. 448-450 ◽  
Author(s):  
Albert Ariza-Solé ◽  
José C. Sánchez-Salado ◽  
Victoria Lorente ◽  
Guillermo Sánchez-Elvira ◽  
Guillem Muntané ◽  
...  
Keyword(s):  
Acute Coronary Syndromes ◽  
Bleeding Risk ◽  
St Segment Elevation ◽  
St Segment ◽  
Coronary Syndromes

Cardiogenic shock in patients with acute coronary syndromes

2015 ◽  
Author(s):  
Holger Thiele ◽  
Uwe Zeymer
Keyword(s):  
Intensive Care ◽  
Cardiogenic Shock ◽  
Acute Coronary Syndromes ◽  
Artery Bypass ◽  
Left Ventricular ◽  
Circulatory Support ◽  
Intensive Care Treatment ◽  
Post Discharge ◽  
Coronary Syndrome ◽  
Coronary Syndromes

Cardiogenic shock complicating an acute coronary syndrome is observed in up to 10% of patients and is associated with high mortality still approaching 50%. The extent of ischaemic myocardium has a profound impact on the initial, in-hospital, and post-discharge management and prognosis of the cardiogenic shock patient. Careful risk assessment for each patient, based on clinical criteria, is mandatory, to decide appropriately regarding revascularization by primary percutaneous coronary intervention or coronary artery bypass grafting, drug treatment by inotropes and vasopressors, mechanical left ventricular support, additional intensive care treatment, triage among alternative hospital care levels, and allocation of clinical resources. This chapter will outline the underlying causes and diagnostic criteria, pathophysiology, and treatment of cardiogenic shock complicating acute coronary syndromes, including mechanical complications and shock from right heart failure. There will be a major focus on potential therapeutic issues from an interventional cardiologist’s and an intensive care physician’s perspective on the advancement of new therapeutical arsenals, both mechanical percutaneous circulatory support and pharmacological support. Since studying the cardiogenic shock population in randomized trials remains challenging, this chapter will also touch upon the specific challenges encountered in previous clinical trials and the implications for future perspectives in cardiogenic shock.

scholarly journals Chinese Herb and Formulas for Promoting Blood Circulation and Removing Blood Stasis and Antiplatelet Therapies

2012 ◽  
Vol 2012 ◽  
pp. 1-8 ◽  
Author(s):  
Yue Liu ◽  
Hui-Jun Yin ◽  
Da-zhuo Shi ◽  
Ke-ji Chen
Keyword(s):  
Acute Coronary Syndromes ◽  
Blood Circulation ◽  
Adverse Reactions ◽  
Chinese Herb ◽  
Blood Stasis ◽  
Bleeding Risk ◽  
Blood Stasis Syndrome ◽  
The World ◽  
Close Relationship ◽  
Coronary Syndromes

Atherothrombosis, which directly threatens people's health and lives, is the main cause of morbidity and mortality all over the world. Platelets play a key role in the development of acute coronary syndromes (ACSs) and contribute to cardiovascular events. Oral antiplatelet drugs are a milestone in the therapy of cardiovascular atherothrombotic diseases. In recent years, many reports have shown the possibility that “resistance” to oral anti-platelet drugs and many adverse reactions, such as serious bleeding risk, which provides an impetus for developing new anti-platelet drugs possesses highly efficiency and fewer adverse effects. Study on the blood stasis syndrome and promoting blood circulation and removing blood stasis is the most active field of research of integration of traditional and western medicine in China. Blood-stasis syndrome and platelet activation have close relationship, many Chinese herb and formulas for promoting blood circulation and removing blood stasis possess definite anti-platelet effect. This paper covers the progress of anti-platelet mechanism of Chinese herb and formulas for promoting blood circulation and removing blood stasis and is to be deeply discussed in further research.

scholarly journals Does anemia affect the predictive ability of bleeding risk scores in patients with acute coronary syndromes?

2016 ◽  
Vol 35 (12) ◽  
pp. 637-644
Author(s):  
Alberto Garay ◽  
Albert Ariza-Solé ◽  
Francesc Formiga ◽  
Victoria Lorente ◽  
José C. Sánchez-Salado ◽  
...  
Keyword(s):  
Acute Coronary Syndromes ◽  
Predictive Ability ◽  
Bleeding Risk ◽  
Risk Scores ◽  
Coronary Syndromes
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