How I treat unexplained arterial thrombosis

Abstract Most arterial thrombotic events have a clear atherosclerotic or cardioembolic etiology, but hematologists are frequently asked to assist in the diagnosis and management of a patient with a nonatherosclerotic and noncardioembolic arterial event, referred to here as an unexplained arterial thrombosis. Because there is an assorted list of factors that can precipitate an arterial event, we present a systematic diagnostic approach to ensure consideration of not only primary hypercoagulable disorders, but also pro-thrombotic medications or substances, vascular and anatomic abnormalities, and undiagnosed systemic disorders, such as malignancy and autoimmune diseases. We also review existing literature of the role of hypercoagulable disorders in arterial thrombosis and discuss our approach to thrombophilia workup in patients after an unexplained arterial event. We conclude with 3 representative cases to both illustrate the application of the outlined diagnostic schema and discuss common management considerations, specifically the selection of anticoagulation vs antiplatelet therapy for secondary prevention.

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Role of oral anticoagulant therapy for secondary prevention in patients with stable atherothrombotic disease manifestations

Therapeutic Advances in Hematology ◽

10.1177/2040620719861475 ◽

2019 ◽

Vol 10 ◽

pp. 204062071986147 ◽

Cited By ~ 2

Author(s):

Sung Won Cho ◽

Francesco Franchi ◽

Dominick J. Angiolillo

Keyword(s):

Secondary Prevention ◽

Antiplatelet Therapy ◽

Anticoagulant Therapy ◽

Oral Anticoagulant ◽

Oral Anticoagulant Therapy ◽

Arterial Disease ◽

Vascular Protection ◽

Treatment Regimens ◽

Peripheral Arterial

Coronary artery disease and peripheral arterial disease are strong predictors of risk for a future ischemic event. Despite the utilization of effective secondary prevention strategies, the prevalence of ischemic recurrences remains high, underscoring the need for effective secondary prevention antithrombotic treatment regimens. To date, most of the tested approaches have been with the use of antiplatelet therapies, used either individually or in combination. However, most recent findings support the potential role of oral anticoagulant therapy in addition to antiplatelet therapy to reduce the risk of ischemic recurrences. This approach has been tested in both acute and stable settings of patients with cardiovascular disease manifestations. The present manuscript provides an overview on the rationale and clinical trial updates on the role of oral anticoagulant therapy, in particular rivaroxaban used at the so-called vascular protection dose, in adjunct to antiplatelet therapy (i.e. aspirin), a strategy known as dual pathway inhibition, for secondary prevention of ischemic recurrences in patients with stable atherosclerotic disease manifestations.

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ТHE ROLE OF GENETIC TESTING FOR OPTIMAL ANTIPLATELET THERAPY SELECTION IN THE TREATMENT OF CORONARY ARTERY DISEASE PATIENTS

CARDIOVASCULAR THERAPY AND PREVENTION ◽

10.15829/1728-8800-2014-2-71-75 ◽

2014 ◽

Vol 13 (2) ◽

pp. 71-75

Author(s):

S. T. Matskeplishvili ◽

Y. E. Arutyunova

Keyword(s):

Coronary Artery Disease ◽

Genetic Testing ◽

Coronary Artery ◽

Antiplatelet Therapy ◽

Life Quality ◽

Evidence Base ◽

Artery Disease ◽

Improved Methods ◽

Selection Of

The studies of coronary heart disease as a cause of reduced life quality and disability in population led to improved methods of diagnosis and treatment of this disease. To date, accumulated large evidence base supports the use of DAT (dual antiplatelet therapy) in patients with coronary artery disease after PCI. According to the same data some patients still develop severe complications, i. e. stent thrombosis. In this regard, recent years there is increasing importance of the genetic testing for selection of the optimal antiplatelet therapy in patients with coronary artery disease.

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The role of antiplatelet therapy in acute coronary syndromes and for secondary prevention following a myocardial infarction

Progress in Cardiovascular Diseases ◽

10.1016/0033-0620(93)90023-7 ◽

1993 ◽

Vol 36 (1) ◽

pp. 75-83 ◽

Cited By ~ 13

Author(s):

Syed M. Jafri ◽

Barbara Zarowitz ◽

Sidney Goldstein ◽

Michael Lesch

Keyword(s):

Myocardial Infarction ◽

Secondary Prevention ◽

Antiplatelet Therapy ◽

Acute Coronary Syndromes ◽

Coronary Syndromes

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The role of antiplatelet therapy in the secondary prevention of coronary artery disease

Current Opinion in Cardiology ◽

10.1097/hco.0b013e328338f7b5 ◽

2010 ◽

Vol 25 (4) ◽

pp. 321-328 ◽

Cited By ~ 11

Author(s):

Miles W Behan ◽

Derek P Chew ◽

Philip E Aylward

Keyword(s):

Coronary Artery Disease ◽

Coronary Artery ◽

Secondary Prevention ◽

Antiplatelet Therapy ◽

Artery Disease

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The Role of Clopidogrel in 2020: A Reappraisal

Cardiovascular Therapeutics ◽

10.1155/2020/8703627 ◽

2020 ◽

Vol 2020 ◽

pp. 1-12 ◽

Cited By ~ 2

Author(s):

Giuseppe Patti ◽

Giuseppe Micieli ◽

Claudio Cimminiello ◽

Leonardo Bolognese

Keyword(s):

Secondary Prevention ◽

Antiplatelet Therapy ◽

Minor Stroke ◽

Clinical Settings ◽

Coronary Syndrome ◽

Increased Risk ◽

Integral Role ◽

Artery Disease ◽

Ischemic Attack

Antiplatelet therapy is the mainstay of treatment and secondary prevention of cardiovascular disease (CVD), including acute coronary syndrome (ACS), transient ischemic attack (TIA) or minor stroke, and peripheral artery disease (PAD). The P2Y12 inhibitors, of which clopidogrel was the first, play an integral role in antiplatelet therapy and therefore in the treatment and secondary prevention of CVD. This review discusses the available evidence concerning antiplatelet therapy in patients with CVD, with a focus on the role of clopidogrel. In combination with aspirin, clopidogrel is often used as part of dual antiplatelet therapy (DAPT) for the secondary prevention of ACS. Although newer, more potent P2Y12 inhibitors (prasugrel and ticagrelor) show a greater reduction in ischemic risk compared with clopidogrel in randomized trials of ACS patients, these newer P2Y12 inhibitors are often associated with an increased risk of bleeding. Deescalation of DAPT by switching from prasugrel or ticagrelor to clopidogrel may be required in some patients with ACS. Furthermore, real-world studies of ACS patients have not confirmed the benefits of the newer P2Y12 inhibitors over clopidogrel. In patients with very high-risk TIA or stroke, short-term DAPT with clopidogrel plus aspirin for 21–28 days, followed by clopidogrel monotherapy for up to 90 days, is recommended. Clopidogrel monotherapy may also be used in patients with symptomatic PAD. In conclusion, there is strong evidence supporting the use of clopidogrel antiplatelet therapy in several clinical settings, which emphasizes the importance of this medication in clinical practice.

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