scholarly journals Oral Antithrombotic Use Among Myocardial Infarction Patients

2003 ◽  
Vol 37 (1) ◽  
pp. 143-146 ◽  
Author(s):  
Menno E van der Elst ◽  
Nelly Cisneros-Gonzalez ◽  
Cornelis J de Blaey ◽  
Henk Buurma ◽  
Anthonius de Boer
Keyword(s):  
Myocardial Infarction ◽  
Record Linkage ◽  
Antithrombotic Therapy ◽  
Past History ◽  
Oral Anticoagulants ◽  
Antiplatelet Agents ◽  
Antithrombotic Treatment ◽  
History Of ◽  
Using Data

OBJECTIVE To examine the use of oral antithrombotics (i.e., antiplatelet agents, oral anticoagulants) after myocardial infarction (MI) in the Netherlands from 1988 to 1998. METHODS Retrospective follow-up of 3800 patients with MI, using data from the PHARMO Record Linkage System. RESULTS From 1988 to 1998, oral antithrombotic treatment increased significantly from 54.0% to 88.9%. In 1998, only 75.8% of patients who experienced a MI in the late 1980s received oral antithrombotic treatment compared with 94.4% of those who experienced a recent MI. CONCLUSIONS Oral antithrombotics were considerably underused in patients with a past history of MI. Therefore, these patients should be reviewed for antithrombotic therapy to assess whether their failure to use oral antithrombotics was right or wrong, and whether treatment should be initiated if possible.

scholarly journals Oral anticoagulant treatment after bioprosthetic valvular intervention or valvuloplasty in patients with atrial fibrillation—A SWEDEHEART study

PLoS ONE ◽  
2022 ◽  
Vol 17 (1) ◽  
pp. e0262580
Author(s):  
Christina Christersson ◽  
Claes Held ◽  
Angelo Modica ◽  
Johan Westerbergh ◽  
Gorav Batra
Keyword(s):  
Atrial Fibrillation ◽  
Oral Anticoagulants ◽  
Valve Prosthesis ◽  
Antithrombotic Treatment ◽  
Oral Anticoagulant Treatment ◽  
Biological Prosthesis ◽  
National Patient ◽  
History Of ◽  
New Onset

Aims To describe the prevalence of atrial fibrillation (AF), use of oral anticoagulants (OAC) and change in antithrombotic treatment patterns during follow-up after valve intervention with a biological prosthesis or valvuloplasty. Methods and results All patients with history of AF or new-onset AF discharged alive after valvular intervention (biological prosthesis or valvuloplasty) between 2010–2016 in Sweden were included (n = 7,362). Information about comorbidities was collected from national patient registers. Exposure to OAC was based on pharmacy dispensation data. In total 4,800 (65.2%) patients had a history of AF, and 2,562 (34.8%) patients developed new-onset AF, with 999 (39.0%) developing new-onset AF within 3 months after intervention. The proportion of patients with biological valve prosthesis was higher in patients with new-onset AF compared to history of AF (p<0.001). CHA2DS2-VASc score ≥2 was observed in 83.1% and 75.5% patients with history of AF and new-onset AF, respectively. Warfarin was more frequently dispensed than NOAC at discharge in patients with history of AF (43.9% vs 7.3%), and in patients with new-onset AF (36.6% vs 17.1%). Almost half of the AF population was not dispensed on any OAC at discharge (48.8% in patients with history of AF and 46.3% in patients with new-onset AF). Conclusion In this real world study of patients with AF and recent valvular intervention, risk of new-onset AF after valvular intervention is high emphasizing need for frequent rhythm monitoring after intervention. A considerable undertreatment with OAC was observed despite being indicated for the majority of the patients. Warfarin was the OAC most frequently dispensed.

Prothrombin Activation Fragment 1 + 2 and Thrombin Antithrombin III Complexes in Patients with Angina Pectoris: Relation to the Presence and Severity of Coronary Atherosclerosis

1993 ◽  
Vol 70 (04) ◽  
pp. 550-553 ◽  
Author(s):  
J Kienast ◽  
S G Thompson ◽  
C Raskino ◽  
H Pelzer ◽  
C Fechtrup ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Angina Pectoris ◽  
Coronary Atherosclerosis ◽  
Antithrombin Iii ◽  
Past History ◽  
Oral Anticoagulant Therapy ◽  
Oral Anticoagulants ◽  
Positive Association ◽  
History Of ◽  
Prothrombin Activation

SummaryPlasma levels of the prothrombin activation fragment 1 + 2 (F 1 + 2) and of thrombin antithrombin III complexes (TAT) were determined in 225 patients with angina pectoris undergoing coronary angiography. Oral anticoagulant therapy was associated with a marked reduction in mean Fl + 2 (0.63 vs 1.62 nmol/l, p <0.0001) and TAT levels (1.65 vs 2.23 μg/1, p <0.0001). Omitting patients on oral anticoagulants, TAT values showed a positive association with patients’ age (r = 0.18; p = 0.01) and were slightly higher in patients with a history of myocardial infarction than in those without (2.47 vs 2.11 <g/l; p = 0.06). Both Fl + 2 and TAT levels were increased in patients with angiographically verified coronary atherosclerosis as compared to patients with angina and angiographically normal coronaries (Fl + 2: 1.76 vs 1.36 nmol/1, TAT: 2.35 vs 2.00 μg/1; p-values after adjusting for age, sex and past history of myocardial infarction 0.06 and 0.11 respectively). However, no graded relationship between Fl + 2 or TAT values and severity of atherosclerosis was observed. This study provides suggestive evidence that a procoagulant state exists in patients with angina pectoris and coronary atherosclerosis. Its relevance in predicting coronary ischaemic events needs to be studied prospectively.

scholarly journals Antiphospholipid Syndrome in a Pregnant Female Presenting with Severe Thrombocytopenia and Bleeding

2015 ◽  
Vol 2015 ◽  
pp. 1-3
Author(s):  
Kunal Mahajan ◽  
Virender Katyal ◽  
Suvrat Arya ◽  
Meha Shrama
Keyword(s):  
Antithrombotic Therapy ◽  
Antiphospholipid Antibody ◽  
Antiphospholipid Antibody Syndrome ◽  
Severe Thrombocytopenia ◽  
Antithrombotic Treatment ◽  
Thrombotic Risk ◽  
Pregnancy Morbidity ◽  
Recurrent Pregnancy Losses ◽  
History Of

The antiphospholipid antibody syndrome (APS) is defined by the persistent presence of antiphospholipid antibodies in patients with recurrent venous or arterial thromboembolism or pregnancy morbidity. Antithrombotic therapy is the mainstay of treatment given the high risk of recurrent thromboembolism that characterizes this condition. Despite the prothrombotic nature of APS, thrombocytopenia is present in a proportion of patients, which can complicate management and limit the use of antithrombotic therapy. The mechanism of APS-associated thrombocytopenia is multifactorial and its relation to thrombotic risk is poorly characterized. The presence of thrombocytopenia does not appear to reduce thrombotic risk in patients with APS, who can develop thromboembolic complications necessitating antithrombotic treatment. In these cases, treatment of the thrombocytopenia may be necessary to facilitate administration of antithrombotic agents. We present such a pregnant lady with history of recurrent pregnancy losses who presented with severe thrombocytopenia and bleeding manifestations, who was subsequently diagnosed to have antiphospholipid antibody syndrome. She was initially managed with steroids and when her platelet counts improved, antithrombotic therapy was started. She delivered an uneventful and successful pregnancy outcome without any complications during follow-up.

Abstract 183: Antithrombotic Therapy and Bleeding Risk in a Prospective Cohort Study of Patients with Cerebral Cavernous Malformations (CCM)

Stroke ◽  
2013 ◽  
Vol 44 (suppl_1) ◽  
Author(s):  
C Stapf ◽  
D Hervé ◽  
J P Guichard ◽  
D Bresson ◽  
A Soumaré ◽  
...  
Keyword(s):  
Antithrombotic Therapy ◽  
Vascular Malformations ◽  
Oral Anticoagulants ◽  
Bleeding Risk ◽  
Antithrombotic Treatment ◽  
Cavernous Malformations ◽  
Retrospective Data Collection ◽  
Risk Of Hemorrhage

BACKGROUND: Cerebral cavernous malformation (CCM) are the most frequently diagnosed vascular malformations in the brain and are often asymptomatic. The potential risk of hemorrhage often precludes antithrombotic treatment in patients with cardiovascular disease, but no systematic study has been undertaken to evaluate the effect of blood-thinning therapy on the risk of CCM hemorrhage. PATIENTS AND METHODS: We prospectively followed consecutive patients with a diagnosis of one or more CCMs in a prospective database since 2008. Retrospective data collection was used for patients with a diagnostic event or imaging studies done prior to first assessment. Symptomatic hemorrhage and other focal neurological events during prospective follow-up were defined according to the current guidelines of the Angioma Alliance Scientific Advisory board RESULTS: A total of 87 patients were prospectively enrolled in our cohort (50 women (57%), mean age 44.8 years (SD +/- 17.6), mean follow up 3.9 years) harboring a total of 738 CCMs. N=55 patients (63%) had a single CCM, and 32 patients (37%) had multiple CCMs. Longitudinal follow-up included 16 (18%) patients receiving long-term antithrombotic therapy by antiplatelet treatment (n=11) or oral anticoagulants (n=5). During 5536 lesion-years of observation, none of the patients under antithrombotic therapy experienced CCM hemorrhage on follow up. CONCLUSION: Our observational data suggest long-term antithrombotic treatment by antiplatelet drugs or warfarin does not increase the frequency of CCM-related hemorrhage. Patients harboring single or multiple CCMs suffering ischemic stroke or heart disease should not be withheld antithrombotic therapy.

scholarly journals Cardiovascular family history increases the risk of disease recurrence after a first myocardial infarction

2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
A Wahrenberg ◽  
P Magnusson ◽  
R Kuja-Halkola ◽  
H Habel ◽  
K Hambraeus ◽  
...  
Keyword(s):  
Risk Factors ◽  
Myocardial Infarction ◽  
Family History ◽  
Cardiovascular Events ◽  
Cardiovascular Death ◽  
Funding Source ◽  
History Of ◽  
First Time ◽  
Early Family

Abstract Background Despite recent advances in secondary prevention, recurrent cardiovascular events are common after a myocardial infarction (MI). It has been reported that genetic risk scores may predict the risk of recurrent cardiovascular events. Although patient-derived family history is a composite of both genetic and environmental heritability of atherosclerotic cardiovascular disease (ASCVD), it is an easily accessible information compared to genetically based risk models but the association with recurrent events is unknown. Purpose To evaluate whether a register-verified family history of ASCVD is associated with recurrent cardiovascular events (rASCVD) in patients after a first-time MI. Methods We included patients with a first-time MI during 2005 – 2014, registered in the SWEDEHEART SEPHIA registry and without prior ASCVD. Follow-up was available until Dec 31st, 2018. Data on relatives, diagnoses and prescriptions were extracted from national registers. A family history of ASCVD was defined as a register-verified hospitalisation due to MI, angina with coronary revascularization procedures, stroke or cardiovascular death in any parent. Early history was defined as such an event before the age of 55 years in fathers and 65 years in mothers. The association between family history and a composite outcome including recurrent MI, angina requiring acute revascularization, ischaemic stroke and cardiovascular death during follow-up was studied with Cox proportional hazard regression with time from SEPHIA registry completion as underlying time-scale, adjusted for age with splines, gender and year of SEPHIA registry. Regression models were then further adjusted for hypertension, diabetes, smoking and for a subset of patients, LDL-cholesterol (LDL_C) at time of first event. Results Of 25,615 patients, 2.5% and 32.1% had an early and ever-occurring family history of ASCVD, respectively. Patients with early family history were significantly younger than other patients and were more likely to be current smokers and have a higher LDL-C (Median (IQR) 3.5 (1.1) vs 3.3 (1.1) mmol/L). In total, 3,971 (15.5%) patients experienced the outcome. Early family history of ASCVD was significantly associated with rASCVD (Hazard ratio (HR) 1.52, 95% confidence interval (CI) 1.23–1.87), and the effect was sustained when adjusted for cardiovascular risk factors (HR 1.48, 95% CI 1.20–1.83) and LDL-C (HR 1.35, 95% CI 1.04–1.74). Ever-occurring family history was weakly associated with ASCVD (HR 1.09, 95% CI 1.02 – 1.17) and the association remained unchanged with adjustments for risk factors. Conclusions Early family history of cardiovascular disease is a potent risk factor for recurrent cardiovascular events in a secondary prevention setting, independent of traditional risk factors including LDL-C. This is a novel finding and these patients may potentially benefit from intensified secondary preventive measures after a first-time MI. Funding Acknowledgement Type of funding source: Private grant(s) and/or Sponsorship. Main funding source(s): This work was funded by grants from The Swedish Heart and Lung Association

scholarly journals Long term dual antiplatelet therapy after myocardial infarction: retrospective analysis in an outpatient population

2021 ◽  
Author(s):  
Gennaro Ratti ◽  
Antonio Maglione ◽  
Emilia Biglietto ◽  
Cinzia Monda ◽  
Ciro Elettrico ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Term Treatment ◽  
Multivessel Disease ◽  
Coronary Syndrome ◽  
Anticoagulant Drugs ◽  
Long Term Treatment ◽  
Risk Condition ◽  
History Of

Long term treatment with ticagrelor 60 mg and low-dose aspirin are indicated after acute coronary syndrome (ACS). We retrospectively reviewed aggregate data of 187 patients (155 M and 38 F) (mean age 63.8±9 years) in follow up after ACS with at least one high risk condition (Multivessel disease, diabetes, GFR<60 mL/min, history of prior myocardial infarction, age >65 years) treated with ticagrelor 60 mg twice daily (after 90 mg twice daily for 12 months). The results were compared with findings (characteristics of the patients at baseline, outcomes, bleeding) of PEGASUS-TIMI 54 trial and Eu Label. The highrisk groups were represented as follows: multivessel disease 105 pts (82%), diabetes 63 pts (33%), GFR< 60 mL/min 27 pts (14%), history of prior MI 33 pts (17%), >65 year aged 85 pts (45%). Treatment was withdrawn in 7 patients: 3 cases showed atrial fibrillation and were placed on oral anticoagulant drugs, one developed intracranial bleeding, in three patients a temporary withdrawal was due to surgery (1 colon polyposis and 2 cases of bladder papilloma). Chest pain without myocardial infarction occurred in 16 patients (revascularization was required in 9 patients). Dyspnea was present in 15 patients, but was not a cause for discontinuation of therapy. Long term treatment with ticagrelor 60 mg twice daily plus aspirin 100 mg/day showed a favourable benefit/risk profile after ACS.  In this study all patients had been given ticagrelor 90 mg twice daily for 12 months and the 60 mg twice daily dosage was started immediately thereafter, unlike PEGASUS-TIMI 54 trial in which it was prescribed within a period ranging from 1 day to 1 year after discontinuation of the 90 mg dose. This makes our results more consistent with current clinical practice. However, a careful outpatient follow-up and constant counseling are mandatory to check out compliance to therapy and adverse side effects.

scholarly journals Cerebrovascular fibromuscular dysplasia

2017 ◽  
Vol 7 (3) ◽  
pp. 225-236 ◽  
Author(s):  
Andrea M. Harriott ◽  
Eli Zimmerman ◽  
Aneesh B. Singhal ◽  
Michael R. Jaff ◽  
Mark E. Lindsay ◽  
...  
Keyword(s):  
Disease Progression ◽  
Fibromuscular Dysplasia ◽  
Massachusetts General Hospital ◽  
Case Series ◽  
Antiplatelet Agents ◽  
Cerebrovascular Event ◽  
Symptomatic Disease ◽  
Surveillance Imaging ◽  
History Of

AbstractBackground:Fibromuscular dysplasia (FMD) is a rare noninflammatory, nonatherosclerotic arteriopathy of medium-sized arteries affecting up to 7% of the population. The disease can affect any artery but commonly affects renal, extracranial carotid, and vertebral arteries. The epidemiology and natural course of cerebrovascular FMD is unknown and requires further investigation.Methods:We present demographic and outcomes data on a case series of 81 patients with cerebrovascular FMD from Massachusetts General Hospital presenting between 2011 and 2015 followed by a review of the peer-reviewed literature.Results:Patients were a median age of 53 years (±12 SD) and the majority were women. Approximately 50% had a history of tobacco use and more than two-thirds had hypertension. Most patients were on monoplatelet therapy with aspirin; during follow-up, 7 of 67 had progressive disease or additional symptoms. One of 67 patients had a cerebrovascular event: TIA. There were 5 of 67 who had noncerebrovascular events or disease progression and 1 death of unclear cause.Conclusions:Cerebrovascular FMD may present with myriad symptoms. Our data support that patients with FMD with symptomatic disease have a low rate of recurrent symptoms or disease progression and can be managed conservatively with stroke risk modification, antiplatelet agents, surveillance imaging, and counseling.

Abstract W P339: Anticoagulation Remains Underutilized in the Management of Atrial Fibrillation: Results From the Edmonton Registry of Atrial Fibrillation and StrokE (ERASE) Study

Stroke ◽  
2014 ◽  
Vol 45 (suppl_1) ◽  
Author(s):  
Ghazala Basir ◽  
Ashfaq Shuaib ◽  
Affan Tahir ◽  
Kasim Qureshi ◽  
Hasnain Zeeshan ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Antithrombotic Therapy ◽  
Oral Anticoagulants ◽  
Antiplatelet Agents ◽  
Tertiary Hospital ◽  
Stroke Patients ◽  
Single Centre ◽  
Chads2 Score ◽  
Similar Frequency ◽  
Prior Stroke

Background: Since 2010, three novel oral anticoagulants (NOAC) have been approved and included in the guidelines as alternatives to warfarin for the prevention of stroke in patients with non-valvular atrial fibrillation (NVAF). Prior to the introduction of NOACs, studies showed that anticoagulation with warfarin in stroke patients with NVAF is suboptimal with as few as 40% anticoagulated and most subtherapeutic. The goal of this study is to examine anticoagulation usage in a contemporary prospective registry of TIA/stroke patients with NVAF and determine whether the introduction of NOACs has increased anticoagulation usage. Methods: This is an ongoing single centre observational study. Consecutive TIA/ischemic stroke admissions (2012-13) to a tertiary hospital in Edmonton, Canada with NVAF were enrolled. Data regarding demographic, clinical, antithrombotic treatment and laboratory parameters were collected in a prospectively maintained database. Those with previously diagnosed NVAF were included in the present analysis (149/181). Clinical characteristics were compared between patients on anticoagulants and those on other/no antithrombotic therapy. Results: The 149 included patients had a mean (SD) age of 78.7 (10.0) years. Male were 52.3% and 86.6% (129) had a preadmission CHADS2 score ≥2. At the time of TIA/stroke, 51% (76/149) were on an anticoagulant, 24.2% (36/149) on antiplatelet agents and 28.4% (37/149) were on no antithrombotic therapy. Of the 76 patients on anticoagulants, 81.6% were on warfarin and the remaining (18.4%) were on a NOAC. Only 31% of patients on warfarin had a therapeutic INR at the time of stroke. Patients not anticoagulated had a similar frequency of prior stroke (21% vs. 23%; p=0.80) but tended to have a lower CHADS2 score (p=0.082) than those anticoagulated. In patients with CHADS≥2, 47% were not on an anticoagulant. Conclusions: Despite therapeutic advances in the treatment of NVAF, anticoagulation usage in TIA/stroke patients with preexisting NVAF remains suboptimal. In this study, only 53% of patients with NVAF and a CHADS≥2 were treated with anticoagulants. This study emphasizes the need for increased efforts to encourage prescribing of oral anticoagulants in high-risk individuals.

Abstract WP226: The Association of Green Tea and Coffee Consumption With Mortality From Cardiovascular Disease and All Causes Among Persons With and Without History of Stroke or Myocardial Infarction: The JACC Study

Stroke ◽  
2020 ◽  
Vol 51 (Suppl_1) ◽  
Author(s):  
Masayuki Teramoto ◽  
Isao Muraki ◽  
Kokoro Shirai ◽  
Akiko Tamakoshi ◽  
Hiroyasu Iso
Keyword(s):  
Myocardial Infarction ◽  
Cardiovascular Disease ◽  
General Population ◽  
Green Tea ◽  
Coffee Consumption ◽  
Tea Consumption ◽  
Food Frequency ◽  
All Cause Mortality ◽  
History Of

Background: Both green tea and coffee consumption have been associated with lower risks of mortality from cardiovascular disease (CVD) and all causes in general population, but little is known about those impact on persons with history of CVD. We examined the association of those consumption with these mortalities among persons with and without history of stroke or myocardial infarction in general population. Methods: The study subjects were 60,664 participants (896 stroke and 1751 myocardial infarction survivors and 58,017 persons with no history of stroke or myocardial infarction), aged 40-79 years at the baseline (1988-1990), who completed a lifestyle and medical history questionnaire including self-administered food frequency under the Japan Collaborative Cohort Study for Evaluation of Cancer Risk (JACC Study). Results: During the median follow-up of 18.5 years, a total of 12,745 (7,458 men and 5,287 women) deaths including 3,737 CVD deaths were documented. Green tea and coffee consumption were inversely associated with CVD and all-cause mortality among myocardial infarction survivors as well as persons without history of stroke or myocardial infarction. After adjustment for known cardiovascular risk factors, the lower risks of mortality from CVD and all-causes associated with frequent green tea consumption (5-6 and ≥7 cups/day) or coffee consumption (≥2 cups/day) remained statistical. Conclusions: Both green tea and coffee consumption were inversely associated with risks of CVD and all-cause mortality among myocardial infarction survivors and persons without history of stroke or myocardial infarction.

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