Response to Dual Antiplatelet Therapy Does Not Impact Bleeding Risks in Patients Undergoing Oral Surgery after Acute Coronary Syndromes

Introduction: Oral surgery (OS) in patients on antecedent dual antiplatelet therapy (DAPT) may be associated with extra bleeding risks. Monitoring platelet activity in such patients may be beneficial for safety when performing OS. Objectives: The aim of this study was to assess whether platelet function during DAPT impacted the risk of bleeding following OS in patients with acute coronary syndromes (ACS). Patients and Methods: Patients who required OS on top of DAPT with aspirin and clopidogrel (n = 55) for invasively treated ACS were included. The control group (n = 33) consisted of patients who underwent OS with no antiplatelet agent. Platelet aggregation before OS was assessed with a Multiplate® analyzer. Bleeding during OS and at days 1, 3, 7 and 10 after surgery was serially evaluated. Results: All 88 patients completed the study. An incomplete response to aspirin or clopidogrel was observed in 43.6% of the patients. In 11% of the cases, an excessive response to clopidogrel was demonstrated. No excessive bleeding upon OS was exhibited in either group during the entire follow-up. Platelet aggregation values and the use of DAPT did not impact the performance of OS. Conclusion: Therapy with clopidogrel and aspirin after ACS does not seem to increase the risk of real-life bleeding following OS, regardless of the platelet activity response to DAPT.

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High post-treatment platelet reactivity is associated with a high incidence of myonecrosis after stenting for non-ST elevation acute coronary syndromes

Thrombosis and Haemostasis ◽

10.1160/th06-07-0362 ◽

2007 ◽

Vol 97 (02) ◽

pp. 282-287 ◽

Cited By ~ 40

Author(s):

Corinne Frere ◽

Jacques Quilici ◽

Pierre-Emmanuel Morange ◽

Lyassine Nait-Saidi ◽

Christopher Mielot ◽

...

Keyword(s):

Platelet Aggregation ◽

Antiplatelet Therapy ◽

Acute Coronary Syndromes ◽

Troponin I ◽

Dual Antiplatelet Therapy ◽

Platelet Reactivity ◽

Post Treatment ◽

Increased Risk ◽

Coronary Syndromes ◽

St Elevation

SummaryHigh post-treatment platelet reactivity (HPPR= adenosine diphosphate [ADP] 10 µM-induced platelet aggregation > 70%) identifies low responders to dual antiplatelet therapy with increased risk of recurrent cardiovascular (CV) events after stenting for non-ST elevation acute coronary syndromes (NSTEACS). This study was designed to compare the incidence of periprocedural myocardial infarction (MI) after stenting for NSTEACS patients between non-responders to dual antiplatelet therapy defined by HPPR and normo-responders. One hundred ninety NSTE-ACS consecutive patients undergoing coronary stenting were included in this prospective study. They received 250 mg aspirin and a 600 mg loading dose of clopidogrel at least 12 hours (h) before percutaneous coronary intervention (PCI). A single post-treatment blood sample was obtained before PCI to analyze maximal intensity of ADP-induced platelet aggregation, and troponin levels were analyzed before PCI, and 12 and 24 h after PCI. Troponin I was considered elevated if > 0.4 ng/ ml. HPPR was present in 22% of patients (n=42). Periprocedural MI occurred significantly more frequently in patients with HPPR than in the normo-responders (43% vs. 24%, p=0.014). After being correlated with recurrent ischemic events after stenting for NSTE-ACS, the HPPR seems to be also a marker of increased risk of periprocedural MI for NSTE-ACS patients.

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Temporal Trends in the Use of Antiplatelet Therapy in Patients With Acute Coronary Syndromes

Journal of Cardiovascular Pharmacology and Therapeutics ◽

10.1177/1074248417724869 ◽

2017 ◽

Vol 23 (1) ◽

pp. 57-65 ◽

Cited By ~ 11

Author(s):

María Asunción Esteve-Pastor ◽

Juan Miguel Ruíz-Nodar ◽

Esteban Orenes-Piñero ◽

José Miguel Rivera-Caravaca ◽

Miriam Quintana-Giner ◽

...

Keyword(s):

Antiplatelet Therapy ◽

Clinical Guidelines ◽

Acute Coronary Syndromes ◽

Temporal Trends ◽

Antiplatelet Agent ◽

Real Life ◽

Antiplatelet Agents ◽

High Rate ◽

St Segment Elevation ◽

Coronary Syndromes

Background: Current clinical guidelines of acute coronary syndromes (ACS) recommend the use of potent antiplatelet therapy, prasugrel or ticagrelor, because both drugs consistently reduce cardiovascular events. Purpose: The aim of this study was to examine temporal changes in the use of optimal antiplatelet therapy in patients with ACS. Methods: A total of 1717 consecutive patients admitted for ACS in 3 tertiary hospitals from February 2014 to December 2015 were enrolled. We divided these 23 months into 4 semesters: period I (0-5 months), period II (6-11 months), period III (12-17 months), and period IV (17-23 months). Demographic, clinical, and treatment data were collected both at admission and at discharge. Results: Treatment with clopidogrel remained constant throughout the periods (52%, 50%, 44%, and 50% for periods I, II, III, and IV, respectively), whereas a progressive increase in ticagrelor treatment was observed (15%, 25%, 26%, and 28%; P = .001). Indeed, new P2Y12 agents showed an increase from 47% at the first semester to 65% in patients with ST-segment elevation myocardial infarction (STEMI), and in patients younger than 75 years from 36% to 53%. However, for patients older than 75 years, diabetic, and patients with end-stage kidney disease, clopidogrel was the second most commonly used antiplatelet agent. Conclusion: In this real-life registry of patients with ACS, we observed there is still a high rate of use of clopidogrel, despite guidelines recommendations, and our analyses also showed a trend toward the use of ticagrelor. Patients who received new antiplatelet agents were patients with STEMI, younger than 75 years, and with less comorbidities. However, the use of ticagrelor and prasugrel remains low, highlighting a therapeutic inertia with considerable gap between evidence-based clinical guidelines and daily clinical practice.

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Adherence to dual antiplatelet therapy with ticagrelor in patients with acute coronary syndromes treated with percutaneous coronary intervention in real life. Results of the REAL-TICA registry

European Heart Journal - Cardiovascular Pharmacotherapy ◽

10.1093/ehjcvp/pvy018 ◽

2018 ◽

Vol 4 (4) ◽

pp. 205-210 ◽

Cited By ~ 7

Author(s):

Uwe Zeymer ◽

Martin Cully ◽

Mathias Hochadel

Keyword(s):

Percutaneous Coronary Intervention ◽

Antiplatelet Therapy ◽

Acute Coronary Syndromes ◽

Dual Antiplatelet Therapy ◽

Real Life ◽

Coronary Intervention ◽

The Real ◽

Percutaneous Coronary ◽

Coronary Syndromes

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

Circulation ◽

10.1161/circ.132.suppl_3.15408 ◽

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.

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