scholarly journals Discontinuation of Oral Antiplatelet Agents before Dental Extraction - Necessity or Myth?

Folia Medica ◽  
2017 ◽  
Vol 59 (3) ◽  
pp. 336-343 ◽  
Author(s):  
Atanaska S. Dinkova ◽  
Dimitar T. Atanasov ◽  
Ludmila G. Vladimirova-Kitova
Keyword(s):  
Acetylsalicylic Acid ◽  
Antiplatelet Therapy ◽  
Local Anaesthesia ◽  
Antiplatelet Agents ◽  
Bleeding Risk ◽  
Major Haemorrhage ◽  
Excessive Bleeding ◽  
Significant Difference ◽  
Patients At Risk ◽  
Experimental Group

AbstractBackground:The risk of excessive bleeding often prompts physicians to interrupt the antiplatelet agents as acetylsalicilyc acid and clopidogrel before dental extractions which puts patients at risk of adverse thrombotic events.Aim:To assess the bleeding risk during dental extractions in patients with continued antiplatelet therapy.Materials and methods:The study included 130 patients (64 men and 66 women) aged between 18 and 99 years old. Sixty-eight of the patients received 100 mg acetilsalicilic acid (ASA); these were divided into two groups: 34 patients continued taking ASA and 34 patients stopped it 72 hours before extraction. Sixty-two of the patients were treated with 75 mg clopidogrel; these were also divided into two groups: 31 continued taking clopidogrel and 31 patients stopped it 72 hours before extractions. Extraction was performed under local anaesthesia as no more than 3 teeth per visit were extracted. Local haemostasis with gelatine sponge and/or suturing was used to control bleeding.Results:Mild bleeding was observed most frequently in the first 30 minutes, successfully managed by local haemostasis. Only 1 patient in the control and 1 in the experimental group receiving ASA reported mild bleeding in the first 24 hours, controlled by compression with gauze. No major haemorrhage requiring emergency or more than local haemostasis occurred. No statistically significant difference in bleeding between two groups was found.Conclusion:Single and multiple dental extractions in patients receiving acetylsalicylic acid or clopidogrel can be safely performed without discontinuation of the therapy with provided appropriate local haemostasis.

Mechanisms of platelet activation: Need for new strategies to protect against platelet-mediated atherothrombosis

2009 ◽  
Vol 102 (08) ◽  
pp. 248-257 ◽  
Author(s):  
Lisa Jennings
Keyword(s):  
Antiplatelet Therapy ◽  
Platelet Activation ◽  
Platelet Reactivity ◽  
Thrombus Formation ◽  
Antiplatelet Agents ◽  
Bleeding Risk ◽  
Adenosine Diphosphate ◽  
Adp Receptor ◽  
Activation Pathways ◽  
New Strategies

SummaryPlatelets are central mediators of haemostasis at sites of vascular injury, but they also mediate pathologic thrombosis. Activated platelets stimulate thrombus formation in response to rupture of an atherosclerotic plaque or endothelial cell erosion, promoting atherothrombotic disease. They also interact with endothelial cells and leukocytes to promote inflammation, which contributes to atherosclerosis. Multiple pathways contribute to platelet activation, and current oral antiplatelet therapy with aspirin and a P2Y12 adenosine diphosphate (ADP) receptor antagonist target the thromboxane A2 and ADP pathways, respectively. Both can diminish activation by other factors, but the extent of their effects depends upon the agonist, agonist strength, and platelet reactivity status. Although these agents have demonstrated significant clinical benefit, residual morbidity and mortality remain high. Neither agent is effective in inhibiting thrombin, the most potent platelet activator. This lack of comprehensive inhibition of platelet function allows continued thrombus formation and exposes patients to risk for recurrent thrombotic events. Moreover, bleeding risk is a substantial limitation of antiplatelet therapy, because these agents target platelet activation pathways critical for both protective haemostasis and pathologic thrombosis. Novel antiplatelet therapies that provide more complete inhibition of platelet activation without increasing bleeding risk could considerably decrease residual risk for ischemic events. Inhibition of the protease-activated receptor (PAR)-1 platelet activation pathway stimulated by thrombin is a novel, emerging approach to achieve more comprehensive inhibition of platelet activation when used in combination with current oral antiplatelet agents. PAR-1 inhibition is not expected to increase bleeding risk, as this pathway does not interfere with haemostasis.

Dabigatran etexilate and concomitant use of non-steroidal anti-inflammatory drugs or acetylsalicylic acid in patients undergoing total hip and total knee arthroplasty: No increased risk of bleeding

2012 ◽  
Vol 108 (07) ◽  
pp. 183-190 ◽  
Author(s):  
Andreas Kurth ◽  
Andreas Clemens ◽  
Herbert Noack ◽  
Bengt Eriksson ◽  
Joseph Caprini ◽  
...  
Keyword(s):  
Acetylsalicylic Acid ◽  
Knee Arthroplasty ◽  
Major Bleeding ◽  
Dabigatran Etexilate ◽  
Bleeding Risk ◽  
Total Hip ◽  
Increased Risk ◽  
Significant Difference ◽  
Inflammatory Drugs ◽  
Anti Inflammatory

SummaryPatients undergoing total hip or knee arthroplasty should receive anticoagulant therapy because of the high risk of venous thromboembolism. However, many are already taking non-steroidal anti-inflammatory drugs (NSAIDs) or acetylsalicylic acid (ASA) that can have antihaemostatic effects. We assessed the bleeding risk in patients treated with thromboprophylactic dabigatran etexilate, with and without concomitant NSAID or ASA. A post-hoc analysis was undertaken of the pooled data from trials comparing dabigatran etexilate (220 mg and 150 mg once daily) and enoxaparin. Major bleeding event (MBE) rates were determined and odds ratios (ORs) generated for patients who received study treatment plus NSAID (half-life ≤12 hours) or ASA (≤160 mg/day) versus study treatment alone. Relative risks were calculated for comparisons between treatments. Overall, 4,405/8,135 patients (54.1%) received concomitant NSAID and 386/8,135 (4.7%) received ASA.ORs for the comparison with/without concomitant NSAID were 1.05 (95% confidence interval [CI] 0.55–2.01) for 220 mg dabigatran etexilate; 1.19 (0.55–2.55) for 150 mg; and 1.32 (0.67–2.57) for enoxaparin. ORs for the comparison with/without ASA were 1.14 (0.26–5.03); 1.64 (0.36–7.49); and 2.57 (0.83–7.94), respectively. For both NSAIDs and ASA there was no significant difference in bleeding between patients with and without concomitant therapy in any treatment arm. Patients concomitantly taking NSAIDs or ASA have a similar risk of MBE to those taking dabigatran etexilate alone. No significant differences in MBE were detected between dabigatran etexilate and enoxaparin within comedication subgroups, suggesting that no increased major bleeding risk exists when dabigatran etexilate is administered with NSAID or ASA.Investigation performed at multiple centres participating in the RE-MODEL™, RE-NOVATE®, and RE-MOBILIZE® trials.

scholarly journals Platelet Inhibition in Acute Coronary Syndrome and Percutaneous Coronary Intervention: Insights from the Past and Present

2020 ◽  
Vol 120 (04) ◽  
pp. 565-578 ◽  
Author(s):  
Diana A. Gorog ◽  
Tobias Geisler
Keyword(s):  
Percutaneous Coronary Intervention ◽  
Antiplatelet Therapy ◽  
Antiplatelet Agents ◽  
Bleeding Risk ◽  
Coronary Intervention ◽  
Platelet Function Test ◽  
P2y12 Inhibitors ◽  
Coronary Syndrome ◽  
The Past ◽  
Percutaneous Coronary

AbstractPlatelet activation and aggregation have a pivotal role in arterial thrombosis and in the pathogenesis of both acute coronary syndromes (ACS) and in the thrombotic complications that occur in patients undergoing percutaneous coronary intervention (PCI). The past 30 years has seen the progress from early trials of clopidogrel and glycoprotein IIb/IIIa inhibitors to the application of more potent P2Y12 inhibitors prasugrel and ticagrelor. Early enthusiasm for newer and more potent antiplatelet agents, which could reduce ischemic events, has led to the understanding of the importance of bleeding and a desire to individualize and optimize treatment. It has increasingly become apparent that the potency and duration of dual antiplatelet therapy (DAPT) has to reflect the balance between ischemic and bleeding risk. Recently, multiple strategies have been proposed to individualize DAPT intensity and duration to reduce the bleeding and ischemic risks. Strategies of de-escalation of DAPT intensity, as well as shorter (less than a year) or more prolonged (beyond a year) treatment have been proposed, as well as platelet function test and genotype guidance of P2Y12 inhibitor therapy. Herein, we provide an overview of the progress in the field of antiplatelet therapy for ACS and PCI over the years, showing the current directions of travel. Ongoing studies focusing on personalized antiplatelet treatment will hopefully yield further insight into ways of optimizing outcomes for the individual.

scholarly journals Mild Head Trauma: Is Antiplatelet Therapy a Risk Factor for Hemorrhagic Complications?

Medicina ◽  
2021 ◽  
Vol 57 (4) ◽  
pp. 357
Author(s):  
Gabriele Savioli ◽  
Iride Francesca Ceresa ◽  
Sabino Luzzi ◽  
Alice Giotta Lucifero ◽  
Maria Serena Pioli Di Marco ◽  
...  
Keyword(s):  
Risk Factor ◽  
Antiplatelet Therapy ◽  
Head Trauma ◽  
Clinical Condition ◽  
Antiplatelet Agents ◽  
Bleeding Risk ◽  
Control Group ◽  
Risk Of Bleeding ◽  
Level Ii ◽  
Single Center Study

Background and objectives: In patients who receive antiplatelet therapy (APT), the bleeding risk profile after mild head trauma (MHT) still needs clarification. Some studies have demonstrated an association with bleeding risk, whereas others have not. We studied the population of our level II emergency department (ED) trauma center to determine the risk of bleeding in patients receiving APT and whether bleeding results not from antiplatelet agents but rather from age. We assessed the bleeding risk, the incidence of intracranial hemorrhage (ICH) that necessitated hospitalization for observation, the need for cranial neurosurgery, the severity of the patient’s condition at discharge, and the frequency of ED revisits for head trauma in patients receiving APT. Materials and Methods: This retrospective single-center study included 483 patients receiving APT who were in the ED for MHT in 2019. The control group consisted of 1443 patients in the ED with MHT over the same period who were not receiving APT or anticoagulant therapy. Our ED diagnostic therapeutic protocol mandates both triage and the medical examination to identify patients with MHT who are taking any anticoagulant or APT. Results: APT was not significantly associated with bleeding risk (p > 0.05); as a risk factor, age was significantly associated with the risk of bleeding, even after adjustment for therapy. Patients receiving APT had a greater need of surgery (1.2% vs. 0.4%; p < 0.0001) and a higher rate of hospitalization (52.9% vs. 37.4%; p < 0.0001), and their clinical condition was more severe (evaluated according to the exit code value on a one-dimensional quantitative five-point numerical scale) at the time of discharge (p = 0.013). The frequency of ED revisits due to head trauma did not differ between the two groups. Conclusions: The risk of bleeding in patients receiving APT who had MHT was no higher than that in the control group. However, the clinical condition of patients receiving APT, including hospital admission for ICH monitoring and cranial neurosurgical interventions, was more severe.

scholarly journals French vascular physicians’ practices in indicating antiplatelet and anticoagulation therapy in venous thromboembolism

VASA ◽  
2019 ◽  
Vol 48 (4) ◽  
pp. 355-360 ◽  
Author(s):  
Antoine Fayol ◽  
Damien Lanéelle ◽  
Clément Hoffmann ◽  
Guillaume Mahé ◽  
Isabelle Mahé
Keyword(s):  
Venous Thromboembolism ◽  
Antiplatelet Therapy ◽  
Anticoagulation Therapy ◽  
Antiplatelet Agents ◽  
Bleeding Risk ◽  
French Society ◽  
Vascular Medicine ◽  
Online Questionnaire ◽  
Full Dose ◽  
Reduced Dose

Summary. Background: As antiplatelet therapy becomes widespread, physicians face the issue patients being treated with antiplatelet agents (APA) and anticoagulants for venous thromboembolism (VTE). Bleeding risk of this combination is increased 1.5–2.5-fold. The aim of this survey is to assess French vascular physician’s management of this combination at the beginning of the treatment and at 6 months of treatment for VTE. Patients and methods: French vascular physicians were surveyed between September and December 2017, using 4 fictional scenarios regarding a VTE event diagnosed in a patient under antiplatelet therapy plus isolated questions in an online questionnaire, sent by the French Society of Vascular Medicine to its members. Out of 1812 physicians, 179 returned valid questionnaires: the response rate was 9.9%. Results: Firstly 97.2% of respondents acknowledged extra risk with this combination; and 63% ceased antiplatelet therapy when initiating anticoagulants; while 36% did not. Secondly, four strategies emerged: 31.4% ceased APA and prescribed full-dose anticoagulants at initiation and at 6 months; 32% associated reduced-dose anticoagulation with APA at 6 months, regardless of what they decided at initiation; 16.5% prescribed isolated full-dose anticoagulants at initiation and reduced-dose at 6 months; lastly 11.2% associated full-dose anticoagulant with antiplatelet therapy at initiation and at 6 months. Conclusions: French vascular physicians adopted different strategies according to estimated risk/benefit ratio. Prospective randomized controlled trials should compare these strategies in order to make recommendations.

scholarly journals Acetylsalicylic acid (Aspirin®) and liver regeneration: experimental study in rats

2021 ◽  
Vol 48 ◽  
Author(s):  
MARIA DE LOURDES PESSOLE BIONDO-SIMÕES ◽  
VICTOR CEZAR DE AZEVEDO PESSINI ◽  
CAROLINA AYUMI ICHI ◽  
ROGÉRIO RIBEIRO ROBES ◽  
SÉRGIO IOSHII
Keyword(s):  
Body Weight ◽  
Acetylsalicylic Acid ◽  
Partial Hepatectomy ◽  
Daily Administration ◽  
Group 4 ◽  
Significant Difference ◽  
Group 3 ◽  
Group 2 ◽  
Experimental Group ◽  
Group 1

ABSTRACT Objective: to evaluate the influence of acetylsalicylic acid (ASA) on cell proliferation after partial hepatectomy in rats. Methods: 40 male Wistar rats were separated into four groups of ten rats each. Groups 1 and 2 (controls): undergoing 30% partial hepatectomy and, after one day (group 1) and seven days (group 2), to euthanasia; daily administration of 0.9% saline solution (1mL per 200g of body weight). Groups 3 and 4 (experimental): undergoing 30% partial hepatectomy and, after one day (group 3) and seven days (group 4), to euthanasia; daily administration of ASA (40mg/mL, 1mL per 200g of body weight). The absolute number of cells stained with PCNA was counted in photomicrographs, in five fields, and it was calculated the mean of positive cells per animal and per group. Results: the final mean of PCNA+ cells per group was: in group 1, 17.57 ± 6.77; in group 2, 19.31 ± 5.30; in group 3, 27.46 ± 11.55; and, in group 4, 12.40 ± 5.23. There was no significant difference at the two evaluation times in the control group (p=0.491), but there was in the experimental group (p=0.020), with a lower number of PCNA+ cells on the seventh day. The comparison between the two groups, on the first day, showed more PCNA+ cells in the livers of the animals that received ASA (p=0.047), and on the seventh day the number was lower in the experimental group (p=0.007). Conclusion: ASA induced greater hepatocyte proliferation.

scholarly journals A cost-effectiveness and safety analysis of dual antiplatelet therapy comparing aspirin–clopidogrel to aspirin–ticagrelor in patients with acute coronary syndrome

2018 ◽  
Vol 27 (4) ◽  
pp. 262-70
Author(s):  
Nafrialdi Nafrialdi ◽  
Novita M. Handini ◽  
Instiaty Instiaty ◽  
Ika P. Wijaya
Keyword(s):  
Acute Coronary Syndrome ◽  
Cost Effectiveness ◽  
Antiplatelet Therapy ◽  
Major Bleeding ◽  
Dual Antiplatelet Therapy ◽  
Bleeding Risk ◽  
Major Adverse Cardiovascular Events ◽  
Minor Bleeding ◽  
Coronary Syndrome ◽  
Significant Difference

Background: Dual antiplatelet therapy (DAPT) using either an aspirin–clopidogrel (A–C) combination or aspirin–ticagrelor (A–T) combination has become the standard therapy for acute coronary syndrome (ACS). Ticagrelor shows better pharmacokinetic profiles but is more expensive. This study aimed to compare cost-effectiveness and safety profiles of A–C versus A–T in patients with ACS.Methods: This was a retrospective cohort study of ACS patient at the Cipto Mangunkusumo Hospital between 2014 and 2016. ACS patients treated for the first time with A–T or A–C were included. Occurrence of major adverse cardiovascular events (MACE) within 3, 6, 9, and 12 months were used as effectiveness outcomes, while safety outcomes were measured based on the incidence of adverse drug reactions (major and minor bleeding, dyspnea, and hyperuricemia). Cost-effectiveness analysis was presented as incremental cost-effectiveness ratio (ICER).Results: Data records obtained from 123 ACS patients treated with A–C and 57 ACS patients treated with A–T were evaluated. Within the first three months, the MACE rate was 15.8% in the A–T group and 31.7% in the A–C group (RR: 0.498, 95% CI: 0.259–0.957, p=0.039). There was no statistically significant difference observed in the number of MACE between groups after 6, 9, and 12 months. The A–T group had a higher incidence of major bleeding (melena) than the A–C group (5.3% vs 1.62%, p=0.681), especially in geriatric patients. Minor bleeding was observed in three patients of the A–C group, but in none of the patients in the A–T group. The cost of ICER was IDR 279,438, indicating the additional cost needed for avoiding MACE within 3 months, if A–T was used.Conclusion: The aspirin–ticagrelor combination is a clinically superior and cost-effective option for MACE prevention among ACS patients, especially during the first three months of DAPT, with a slight but not significantly higher major bleeding risk when compared to the aspirin–clopidogrel combination.

Abstract WP368: The Association of Prior Use of Antiplatelet Agents and Increased Mortality and Morbidity in Intracerebral Hemorrhage Patients

Stroke ◽  
2017 ◽  
Vol 48 (suppl_1) ◽  
Author(s):  
Nadeem Khan ◽  
Fazeel Siddiqui ◽  
Joshua Goldstein ◽  
Ying Xian ◽  
Margueritte Cox ◽  
...  
Keyword(s):  
Intracerebral Hemorrhage ◽  
Hospital Mortality ◽  
Antiplatelet Therapy ◽  
Antiplatelet Agents ◽  
Mortality And Morbidity ◽  
Significant Difference ◽  
Prior Use ◽  
History Of ◽  
Artery Disease ◽  
Ischemic Attack

Introduction: Use of anti-platelet therapy is common among patients presenting with intracerebral hemorrhage (ICH). There are limited data regarding pre-stroke antiplatelet therapy (APT) and outcomes in patients presenting with spontaneous ICH. We hypothesized that prior use of antiplatelet agents increases mortality and discharge morbidity in ICH patients. Methods: We analyzed data of 82,576 ICH patients not on anticoagulation from 2185 GWTG-Stroke hospitals between Oct 2012 and March 2016. Patients were categorized as no APT, single antiplatelet therapy (SAPT) and dual antiplatelet therapy (DAPT). Logistic regression using generalized estimating equations to account for within-site correlations were used to assess the relationship between outcomes and prior-APT use. Results: No pre-ICH APT was used in 65.8%, SAPT in 29.5%, and DAPT in 4.8%. The median age of the cohort was 69 years and prevalence of females in the cohort was 48.6%, with preponderance of white race (58.9%). Overall onset of symptoms to arrival time was 131 minutes with a median NIHSS of 9. A total of 23.7% had history of previous stroke/transient ischemic attack, 15.3% had prior myocardial infarction/coronary artery disease and 73.4% had known hypertension. There was no significant difference in in-hospital mortality among patients not on any APT vs patients on SAPT. However, in-hospital mortality was higher among ICH patients on DAPT compared with no therapy (adjusted OR 1.41, 95 % CI 1.31-1.51, P<0.0001). Conclusion: Our study suggests that patients on DAPT, but not on SAPT, have higher mortality rates after ICH compared with patients on no APT.

scholarly journals Secondary Stroke Prevention, and the Role of Antiplatelet Therapies

2009 ◽  
Vol 1 ◽  
pp. CMT.S2208
Author(s):  
Howard S. Kirshner
Keyword(s):  
Risk Factor ◽  
Antiplatelet Therapy ◽  
Stroke Prevention ◽  
Extended Release ◽  
Antiplatelet Agents ◽  
Bleeding Risk ◽  
Internal Carotid Artery Stenosis ◽  
Secondary Stroke Prevention ◽  
First Line

This review considers treatments of proved efficacy in secondary stroke prevention, with an emphasis on antiplatelet therapy. Most strokes could be prevented, if readily available lifestyle and risk factor modifications could be applied to everyone. In secondary stroke prevention, the same lifestyle and risk factor modifications are also important, along with anticoagulation for patients with cardiac sources of embolus, carotid procedures for patients with significant internal carotid artery stenosis, and antiplatelet therapy. For patients with noncardioembolic ischemic strokes, FDA-approved antiplatelet agents are recommended and preferred over anticoagulants. ASA, clopidogrel, and ASA + ER-DP are recognized as accepted first-line options for secondary prevention of noncardioembolic ischemic stroke. Combined antiplatelet therapy with ASA + clopidogrel has not been shown to carry benefit greater than risk in stroke or TIA patients. Aspirin and extended release dipyridamole appeared to carry a greater benefit over aspirin alone in individual studies, leading to a recommendation of this agent in the AHA guidelines, but the recently completed PRoFESS trial showed no difference in efficacy between clopidogrel and aspirin with extended release dipyridamole, and clopidogrel had better tolerability and reduced bleeding risk.

scholarly journals Antiplatelet Therapy in Coronary Artery Disease: A Daunting Dilemma

2018 ◽  
Vol 7 (4) ◽  
pp. 74 ◽  
Author(s):  
Surya Chaturvedula ◽  
Daniel Diver ◽  
Aseem Vashist
Keyword(s):  
Antiplatelet Therapy ◽  
Standard Of Care ◽  
Antiplatelet Agents ◽  
Bleeding Risk ◽  
Coronary Intervention ◽  
Coronary Syndrome ◽  
Anticoagulant Drugs ◽  
Percutaneous Coronary ◽  
Artery Disease ◽  
Scientific Attention

Percutaneous coronary intervention (PCI) with stenting for the treatment of acute coronary syndrome (ACS) is the contemporary standard of care. Such treatment is followed by dual antiplatelet therapy (DAPT) comprising of aspirin and a P2Y12 inhibitor. The efficacy of this therapy has been well established but the optimal duration of DAPT remains elusive, and has thus far attracted a prodigious deal of scientific attention. The decision regarding DAPT duration can be clinically challenging in the modern era with the evolution of newer stents, more potent antiplatelet agents, and novel anticoagulant drugs in addition to an older patient population with multiple comorbidities. Major societal guidelines have emphasized comprehensive assessment of ischemic and bleeding risk, in turn recommending individualization of DAPT duration, thus encouraging “shared decision making”. The following review is aimed at critically evaluating the available evidence to help make these crucial clinical decisions regarding duration of DAPT and triple therapy.

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