Patient perspectives of nuisance bleeding and adherence to dual antiplatelet therapy: a qualitative study

ObjectiveTo understand the experiences of patients with dual antiplatelet therapy (DAPT) and nuisance bleeding, and their perspectives of the impact of nuisance bleeding on medication adherence and information seeking.MethodsWe conducted focus groups with patients who had undergone percutaneous coronary intervention, coronary artery bypass graft and conservatively managed acute coronary syndrome patients. Two focus groups were with patients at the early stages of treatment (0–3 months), and two with patients coming to the end of treatment (9–12 months). Group discussions were audio recorded, and recordings were transcribed verbatim, anonymised and analysed using framework analysis.FindingsNine patients taking DAPT for up to 3 months, and 12 taking DAPT between 9 and 12 months participated in the focus groups. We found that: (1) participants adhered to treatment when they believed DAPT was important to health outcomes; (2) those who experienced nuisance bleeding reported symptoms to be mild and manageable; (3) participants’ and their family’s understanding of DAPT risks and benefits, and their ability to manage symptoms, influenced perspectives of and experiences with adherence. Factors influencing DAPT knowledge included access to medication counselling, engaging with information communicated during medication counselling, and access to timely, relevant and expert information and advice after discharge from hospital.ConclusionsPositive attitudes towards adherence were facilitated by knowledge and understanding of DAPT and confidence in dealing with symptoms caused by DAPT, but hindered by lack of opportunities to access relevant, timely and appropriate medication counselling. Education interventions should aim to support medication literacy through family-centred approaches and involve patients and families at all stages of intervention design and evaluation.

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Optimal Medical Therapy on Top of Dual-Antiplatelet Therapy: 1-Year Clinical Outcome in Patients With Acute Coronary Syndrome: The START Antiplatelet Registry

Angiology ◽

10.1177/0003319719895171 ◽

2019 ◽

Vol 71 (3) ◽

pp. 235-241 ◽

Cited By ~ 1

Author(s):

Plinio Cirillo ◽

Luigi Di Serafino ◽

Vittorio Taglialatela ◽

Paolo Calabrò ◽

Emilia Antonucci ◽

...

Keyword(s):

Acute Coronary Syndrome ◽

Clinical Outcome ◽

Antiplatelet Therapy ◽

Medical Therapy ◽

Real World ◽

Dual Antiplatelet Therapy ◽

Optimal Medical Therapy ◽

Cerebrovascular Event ◽

Coronary Syndrome ◽

The Impact

Optimal medical therapy (OMT) at discharge is recommended after acute coronary syndrome (ACS). Few studies report the impact of OMT on long-term clinical outcome in a real-world scenario. We evaluated the impact of discharge OMT on top of dual-antiplatelet therapy (DAPT) on clinical outcome in the real-world ACS population of the Survey on anTicoagulated pAtients RegisTer ANTIPLATELET registry. The primary end point was major adverse cardiac and cerebrovascular event (MACCE), a composite of death, myocardial infarction, stroke, or target vessel revascularization. The co-primary end point was net adverse cardiac and cerebrovascular event (NACE), based on MACCE plus major bleeding. Consecutive patients with ACS with 1-year follow-up were enrolled. They were evaluated at discharge for the use of a β-blocker, angiotensin-converting enzyme inhibitor/angiotensin II receptor blockers and statins. Optimal medical therapy was defined as the use of ≥2 of 3 medications. At multivariate analysis, both MACCE and NACE were significantly higher in non-OMT patients than in OMT patients (MACCE 18 [19] vs 59 [9], hazard ratio [HR] = 0.44 [0.26-0.75], P = .002, NACE 19 [20] vs 67 [10], HR = 0.47 [0.28-0.79], P = .004). In this real-world scenario, OMT at discharge on top of DAPT seems associated with a better clinical outcome compared with patients discharged on non-OMT.

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Differential effects of dual antiplatelet therapy in patients presented with acute coronary syndrome vs. stable ischaemic heart disease after coronary artery bypass grafting

European Heart Journal - Cardiovascular Pharmacotherapy ◽

10.1093/ehjcvp/pvaa080 ◽

2020 ◽

Author(s):

Ki Hong Choi ◽

Young Bin Song ◽

Dong Seop Jeong ◽

Yong Ho Jang ◽

David Hong ◽

...

Keyword(s):

Acute Coronary Syndrome ◽

Heart Disease ◽

Coronary Artery ◽

Antiplatelet Therapy ◽

Lower Risk ◽

Dual Antiplatelet Therapy ◽

Artery Bypass ◽

Cardiovascular Death ◽

Bypass Grafting ◽

Coronary Syndrome

Abstract Aims The current study sought to evaluate whether long-term clinical outcomes according to the use of dual antiplatelet therapy (DAPT) or single antiplatelet therapy (SAPT) differed between acute coronary syndrome (ACS) and stable ischaemic heart disease (SIHD) patients who underwent coronary artery bypass grafting surgery (CABG). Methods and results Between January 2001 and December 2017, 3199 patients with ACS (55.3%) and 2583 with SIHD (44.7%) who underwent isolated CABG were enrolled. The study population was stratified using DAPT or SAPT in ACS patients and SIHD patients. The primary outcome was a cardiovascular death or myocardial infarction (MI) at 5 years. After CABG, DAPT was more frequently used in patients with ACS than in those with SIHD [n = 1960 (61.3%) vs. n = 1313 (50.8%), P < 0.001]. Among patients with ACS, the DAPT group showed a significantly lower risk of cardiovascular death or MI at 5 years than the SAPT group [DAPT vs. SAPT, 4.0% vs. 7.8%, hazard ratio (HR) 0.521, 95% confidence interval (CI) 0.339–0.799; P = 0.003]. In contrast, among patients with SIHD, there was no significant difference in the rate of cardiovascular death or MI at 5 years between the use of DAPT and SAPT (4.0% vs. 4.0%, HR 0.991, 95% CI 0.604–1.626; P = 0.971). These findings were robust to multiple sensitivity analyses and competing risk analysis. In the subgroup analysis, the use of DAPT was associated with a significantly lower risk of cardiovascular death or MI among SIHD patients with a previous percutaneous coronary intervention (PCI), with a significant interaction between the use of DAPT and PCI history (interaction P = 0.011). Conclusion Among ACS patients who underwent CABG, the use of DAPT was associated with lower cardiovascular death or MI than the use of SAPT, but this was not the case in SIHD patients. Trial registration ClinicalTrials.gov, NCT03870815.

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Impact of bleeding during dual antiplatelet therapy in patients with coronary artery disease

Scientific Reports ◽

10.1038/s41598-020-78400-4 ◽

2020 ◽

Vol 10 (1) ◽

Author(s):

Ying-Chang Tung ◽

Lai-Chu See ◽

Shu-Hao Chang ◽

Jia-Rou Liu ◽

Chi-Tai Kuo ◽

...

Keyword(s):

Antiplatelet Therapy ◽

Dual Antiplatelet Therapy ◽

East Asian ◽

Asian Population ◽

Adverse Outcomes ◽

Research Database ◽

Coronary Syndrome ◽

Asian Patients ◽

Increased Risk ◽

The Impact

AbstractThis nationwide retrospective cohort study used the National Health Insurance Research Database of Taiwan to compare the impact of bleeding on clinical outcomes in patients with acute myocardial infarction (AMI) versus chronic coronary syndrome (CCS). Between July 2007 and December 2010, patients with AMI (n = 15,391) and CCS (n = 19,724) who received dual antiplatelet therapy after coronary stenting were identified from the database. AMI was associated with increased risks of MI (AMI vs. CCS: 0.38 vs. 0.16 per 100 patient-months; p < 0.01), all-cause death (0.49 vs. 0.32 per 100 patient-months; p < 0.01), and BARC type 3 bleeding (0.22 vs. 0.13 per 100 patient-months; p < 0.01) at 1 year compared with CCS, while the risk of BARC type 2 bleeding was marginally higher in the CCS patients than in the AMI patients (1.32 vs. 1.4 per 100 person-months; p = 0.06). Bleeding was an independent predictor of MI, stroke, and all-cause death in this East Asian population, regardless of the initial presentation. Among the patients with bleeding, AMI was associated with a higher risk of ischemic events at 1 year after bleeding compared with CCS (MI: 0.34 vs. 0.25 per 100 patient-months; p = 0.06; ischemic stroke: 0.22 vs. 0.13 per 100 patient-months; p = 0.02). The 1-year mortality after bleeding was comparable between the two groups after propensity score weighting. In conclusion, bleeding conferred an increased risk of adverse outcomes in East Asian patients with AMI and CCS.

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Dual Antiplatelet Therapy After Coronary Artery Bypass Grafting in the Setting of Acute Coronary Syndrome

The American Journal of Cardiology ◽

10.1016/j.amjcard.2015.03.050 ◽

2015 ◽

Vol 116 (1) ◽

pp. 148-154 ◽

Cited By ~ 13

Author(s):

Ritin Bomb ◽

Carrie S. Oliphant ◽

Rami N. Khouzam

Keyword(s):

Acute Coronary Syndrome ◽

Coronary Artery ◽

Coronary Artery Bypass Grafting ◽

Antiplatelet Therapy ◽

Coronary Artery Bypass ◽

Dual Antiplatelet Therapy ◽

Artery Bypass ◽

Bypass Grafting ◽

Artery Bypass Grafting ◽

Coronary Syndrome

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Hydroxyurea Regressed Atherosclerosis Plaques in ApoE-/- Mice: A Discovery Based on Clinic

10.21203/rs.3.rs-32322/v1 ◽

2020 ◽

Author(s):

Qian Tong ◽

Xinyu Yang ◽

Shu-Rong Ma ◽

Xian-Feng Zhang ◽

Yan Wang ◽

...

Keyword(s):

Antiplatelet Therapy ◽

Dual Antiplatelet Therapy ◽

Therapy Group ◽

Artery Bypass ◽

Control Group ◽

High Dose ◽

Atorvastatin Calcium ◽

Coronary Syndrome ◽

Clopidogrel Bisulfate ◽

Oil Red O

Abstract Background: A 58-year-old lady was introduced to the clinic because of acute coronary syndrome combined with essential thrombocythemia. After coronary artery bypass grafting. After treating her with aspirin, statins and hydroxyurea (HU), the plaques in her coronary arteries showed improvement dramatically. Here, we aim to investigate that HU might regress atherosclerosis plaques in ApoE−/− mice and the potential mechanism.Methods: Wild-type (C57BL/6, n = 8) and Apolipoprotein E knockout (ApoE-/-, n = 40) mice were used in atherosclerosis model and medication groups. The mice were separated into 7 groups, including the normal control group, the atherosclerosis model group, the dual antiplatelet therapy group (aspirin, and clopidogrel bisulfate), the low-dose and high-dose HU therapy groups [aspirin, clopidogrel bisulfate, and HU (10 or 20 mg/kg/day)], the positive medicine group (aspirin, clopidogrel bisulfate, and atorvastatin calcium), and the combined medicine treatment group [aspirin, clopidogrel bisulfate, atorvastatin calcium, and HU (10 mg/kg/day)]. Fasting serum and aortic vessels were obtained after experiment. The aortic oil red O, Hematoxylin-eosin, and full-length oil red O staining was performed to evaluate the HU’s efficacy of anti- atherosclerosis, and the investigation of HU mechanisms was carried out in HepG2 cells for proprotein convertase subtilisin/kexin type 9 (PCSK9) level.Results: The oil red O and H&E staining results came out that HU therapy with antiplatelet showed an obvious effect in decreasing atherosclerosis plaques and the effect of HU therapy (10 or 20 mg/kg) was stronger than dual antiplatelet therapy plus statin, without liver and kidney toxicity observed. Furthermore, the combined drugs with HU (10 mg/kg/day), statin and antiplatelet nearly eliminated the plaques. One of the possible mechanisms of HU might be related with the inhibition of PCSK9.Conclusions: A discovery based on clinic reveals that HU regressed atherosclerosis plaques in ApoE-/- mice, which provides us a new insight into anti-atherosclerosis drugs strategy. PCSK9 could be one of the possible mechanisms and further mechanisms need to be explored.

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Timing of dual antiplatelet therapy in acute coronary syndrome: a problem of coronary artery bypass grafting accessibility for patients

Russian Journal of Cardiology ◽

10.15829/1560-4071-2020-3812 ◽

2020 ◽

Vol 25 (8) ◽

pp. 3812

Author(s):

T. S. Golovina ◽

Yu. N. Neverova ◽

R. S. Tarasov

Keyword(s):

Acute Coronary Syndrome ◽

Coronary Artery ◽

Antiplatelet Therapy ◽

Coronary Artery Bypass ◽

Dual Antiplatelet Therapy ◽

Artery Bypass ◽

St Segment Elevation ◽

Coronary Syndrome ◽

St Segment ◽

Elevation Acute Coronary Syndrome

The feasibility of dual antiplatelet therapy as early as possible in patients with ST-segment elevation acute coronary syndrome, where percutaneous coronary intervention is recommended, has been proven: it improves treatment outcomes by reducing the risk of adverse ischemic events, including stent thrombosis and myocardial infarction.This article provides a detailed analysis of the evidence data and current recommendations on the validity and timing of dual antiplatelet therapy for acute coronary syndrome. The emphasis is made on the controversy regarding the early dual antiplatelet therapy in non-ST-segment elevation acute coronary syndrome. The rationale for using dual antiplatelet therapy only after coronary angiography and determining the revascularization strategy is described, which should increase the accessibility of coronary artery bypass graft surgery for patients.

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Does Dual Antiplatelet Therapy Affect Blood Loss and Transfusion Requirements in Robotic-Assisted Coronary Artery Surgery?

Innovations Technology and Techniques in Cardiothoracic and Vascular Surgery ◽

10.1177/155698451200700605 ◽

2012 ◽

Vol 7 (6) ◽

pp. 399-402 ◽

Cited By ~ 11

Author(s):

Jonathan M. Hemli ◽

Lincoln S. Darla ◽

Christopher R. Panetta ◽

Joan Jennings ◽

Valavanur A. Subramanian ◽

...

Keyword(s):

Coronary Artery ◽

Antiplatelet Therapy ◽

Dual Antiplatelet Therapy ◽

Antiplatelet Agents ◽

Coronary Surgery ◽

Robotic Assisted ◽

Coronary Syndrome ◽

Perioperative Bleeding ◽

Transfusion Requirements ◽

The Impact

Objective Patients who present for coronary surgery often receive preoperative dual antiplatelet therapy with aspirin and a thienopyridine derivative (clopidogrel or prasugrel), especially after a recent acute coronary syndrome. Studies have shown that patients on aspirin and clopidogrel are at increased risk for perioperative bleeding and related events. We sought to examine the impact of dual antiplatelet therapy on bleeding and transfusion requirements in patients undergoing robotic-assisted minimally invasive coronary artery bypass grafting. Methods From January 2010 to November 2011, a total of 110 patients underwent robotic-assisted off-pump coronary surgery at our institution. All patients underwent robotic-assisted harvest of the left internal mammary artery from the chest wall. Some patients then underwent direct coronary anastomosis to the left anterior descending coronary artery via a left minithoracotomy, whereas others had a complete robotic endoscopic procedure within the closed chest. The patients were divided into two groups for outcome analysis on the basis of preoperative antiplatelet therapy: group 1 (either aspirin alone or no antiplatelet agents at all; n = 53) and group 2 (aspirin plus clopidogrel or prasugrel; n = 57). Results Perioperative chest tube drainage was not significantly different between the patient groups, irrespective of the preoperative antiplatelet agents used. Transfusion requirements and other morbidities were also similar in both groups of patients. Conclusions Preoperative dual antiplatelet therapy does not result in significantly increased bleeding or perioperative transfusion requirements. If clinically indicated, it is reasonable to continue preoperative combination antiplatelet therapy in patients undergoing robotic-assisted coronary surgery.

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