scholarly journals New oral anticoagulants in addition to single or dual antiplatelet therapy after an acute coronary syndrome: a systematic review and meta-analysis

2013 ◽  
Vol 34 (22) ◽  
pp. 1670-1680 ◽  
Author(s):  
J. Oldgren ◽  
L. Wallentin ◽  
J. H. Alexander ◽  
S. James ◽  
B. Jonelid ◽  
...  
Keyword(s):  
Systematic Review ◽  
Acute Coronary Syndrome ◽  
Antiplatelet Therapy ◽  
Dual Antiplatelet Therapy ◽  
Meta Analysis ◽  
Oral Anticoagulants ◽  
New Oral Anticoagulants ◽  
Coronary Syndrome

Insights into the role of thrombin in the pathogenesis of recurrent ischaemia after acute coronary syndrome

2014 ◽  
Vol 112 (11) ◽  
pp. 924-931 ◽  
Author(s):  
Jeffrey Weitz
Keyword(s):  
Acute Coronary Syndrome ◽  
Antiplatelet Therapy ◽  
Recurrent Events ◽  
Dual Antiplatelet Therapy ◽  
Thrombus Formation ◽  
Oral Anticoagulants ◽  
Composite Endpoint ◽  
Medical Emergency ◽  
Recurrent Ischaemia ◽  
Coronary Syndrome

SummaryAcute coronary syndrome (ACS) is a medical emergency. Patients who survive the initial event remain at risk of recurrent cardiovascular events. In most cases, ACS is triggered by thrombosis after rupture of an atherosclerotic plaque. Key to thrombus formation at this site is the generation of thrombin, which not only converts fibrinogen to fibrin but also serves as a potent platelet agonist and induces platelet aggregation at the site of vascular injury. Although dual antiplatelet therapy is more effective for the prevention of recurrent events than aspirin alone after ACS, there remains an approximately 10 % risk of recurrent ischaemic events at one year. Recent studies have evaluated whether the addition of an anticoagulant to antiplatelet therapy reduces the risk of recurrent ischaemia after an ACS event. Rivaroxaban, an oral factor Xa inhibitor, attenuates thrombin generation. When used in conjunction with dual antiplatelet therapy in patients with stabilised ACS, rivaroxaban 2.5 mg twice daily significantly reduced the risk of the composite endpoint of cardiovascular death, myocardial infarction and stroke compared with placebo. Although it increased the risk of bleeding, rivaroxaban was associated with a reduction in mortality; a finding that supports the use of a dual-pathway approach that combines anticoagulant and antiplatelet therapy. This review explores the pathophysiology of ACS to provide perspective on the results of recent clinical trials with novel oral anticoagulants for ACS and to identify their potential role in this setting.

scholarly journals Impact of known or new-onset atrial fibrillation on 2-year cardiovascular event rate in patients with acute coronary syndromes: results from the prospective EPICOR Registry

2018 ◽  
Vol 8 (2) ◽  
pp. 121-129 ◽  
Author(s):  
Uwe Zeymer ◽  
Lieven Annemans ◽  
Nicolas Danchin ◽  
Stuart Pocock ◽  
Simon Newsome ◽  
...  
Keyword(s):  
Acute Coronary Syndrome ◽  
Antiplatelet Therapy ◽  
Dual Antiplatelet Therapy ◽  
Oral Anticoagulants ◽  
Composite Endpoint ◽  
Coronary Syndrome ◽  
Long Term Follow Up ◽  
New Onset

Background: Atrial fibrillation (AF) is associated with increased morbidity in acute coronary syndrome patients, but impact on outcomes beyond 1 year is unclear. Methods: This was a post-hoc analysis from the long-tErm follow-uP of antithrombotic management patterns In acute CORonary syndrome patients (EPICOR) registry (NCT01171404), a prospective, observational study conducted in Europe and Latin America, which enrolled acute coronary syndrome survivors at discharge. Antithrombotic management patterns, mortality, a composite endpoint of death/new non-fatal myocardial infarction/stroke and bleeding events were assessed after 2 years of follow-up in patients with or without AF. Results: Of 10,568 patients enrolled, 397 (4.7%) had prior AF and 382 (3.6%) new-onset AF during index hospitalisation. Fewer patients with AF underwent percutaneous coronary intervention (52.1% vs. 66.6%; P<0.0001). At discharge, fewer AF patients received dual antiplatelet therapy (71.6% vs. 89.5%; P<0.0001); oral anticoagulant use was higher in AF patients but was still infrequent (35.0% vs. 2.5%; P<0.0001). Use of dual antiplatelet therapy and oral anticoagulants declined over follow-up with over 50% of all AF/no AF patients remaining on dual antiplatelet therapy (55.6% vs. 60.6%), and 23.3% (new-onset AF) to 42.1% (prior AF) on oral anticoagulants at 2 years. At 2 years, mortality, composite endpoint and bleeding rates were higher in AF patients (all P<0.0001) compared to patients without AF. On multivariable analysis, the risk of mortality or the composite endpoint was significant for prior AF ( P=0.003, P=0.001) but not new-onset AF ( P=0.88, P=0.92). Conclusions: Acute coronary syndrome patients with AF represent a high-risk group with increased event rates during long-term follow-up. Prior AF is an independent predictor of mortality and/or ischaemic events at 2 years. Use of anticoagulants in AF after acute coronary syndrome is still suboptimal.

scholarly journals SINGLE VS. DUAL ANTIPLATELET THERAPY IN PATIENTS WITH ACUTE CORONARY SYNDROME - A META-ANALYSIS

2021 ◽  
Vol 77 (18) ◽  
pp. 18
Author(s):  
Waqas Ullah ◽  
Mohammed Faisal Uddin ◽  
Harigopal Sandhyavenu ◽  
Yasar Sattar ◽  
Mohamed Zghouzi ◽  
...  
Keyword(s):  
Acute Coronary Syndrome ◽  
Antiplatelet Therapy ◽  
Dual Antiplatelet Therapy ◽  
Meta Analysis ◽  
Coronary Syndrome

scholarly journals New oral anticoagulants combined with antiplatelet therapy in the treatment of coronary heart disease: an updated meta-analysis

2020 ◽  
Author(s):  
Leiling Liu ◽  
Jiahui Hu ◽  
Yating Wang ◽  
Hao Lei ◽  
Danyan Xu
Keyword(s):  
Ischemic Stroke ◽  
Combination Therapy ◽  
Antiplatelet Therapy ◽  
Meta Analysis ◽  
Oral Anticoagulants ◽  
New Oral Anticoagulants ◽  
Phase Iii ◽  
Cochrane Library ◽  
Coronary Syndrome ◽  
Stable Cad

Abstract Objective New oral anticoagulants (NOACs) combined with antiplatelet therapy for acute coronary syndrome (ACS) may reduce ischemic events, but there is no consensus on bleeding risk. Moreover, the effect of NOACs on stable coronary artery disease (CAD) needs to be elucidated. We conducted a meta-analysis, to summarize the efficacy and safety of NOACs combined with antiplatelet therapy in the treatment of stable CAD and ACS.Methods We searched PubMed, Web of Science, and the Cochrane Library, then performed a systematic review of all 17 randomized controlled trials.Results For patients with stable CAD, rivaroxaban combined with antiplatelet therapy significantly reduced the rate of major adverse cardiovascular events (MACEs) (risk ratio; 95% confidence interval: 0.88; 0.81–0.95) and ischemic stroke (0.62; 0.50–0.77), with a relatively low risk of major bleeding (1.72; 1.42–2.07). For patients with ACS, the combination of NOACs could reduce the risk of MACEs (0.91; 0.85–0.97), myocardial infarction (MI) (0.90; 0.83–0.98) and ischemic stroke (0.75; 0.58–0.97), accompanied by increased non–fatal bleeding events and intracranial hemorrhage (3.42; 1.76–6.65). Results were similar when restricting the analysis to phase III studies except for the rate of stroke in patients with ACS.Conclusions Combination therapy can reduce the incidence of MI in ACS patients, but the risk of bleeding from intracranial hemorrhaging outweighs the benefit of MACEs driven by MI. That is due to combination therapy having no positive impact on mortality, thus the benefit-risk balance may be more favorable with patients with stable CAD.

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