scholarly journals Dual Antiplatelet Therapy (DAPT) in Coronary Artery Disease: A Daunting Dilemma

2018 ◽  
Author(s):  
Suryateja Chaturvedula ◽  
Daniel J. Diver ◽  
Aseem Vashist
Keyword(s):  
Standard Of Care ◽  
Antiplatelet Agents ◽  
Bleeding Risk ◽  
Coronary Intervention ◽  
Coronary Syndrome ◽  
Anticoagulant Drugs ◽  
Percutaneous Coronary ◽  
Artery Disease ◽  
Scientific Attention ◽  
Modern Era

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 anti-platelet 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. Decision regarding DAPT duration can be challenging clinically 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.

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.

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 Case ReportsClinical effect of ivabradine in patient with congestive heart failure with cardiogenic shock condition: A case reportAcute mesenteric ischemia on extensive anterior STEMI with paroxysmal atrial fibrilation: A rare complicationAcute fulminant myocarditis mimicking ST-elevation myocardial infarctionFractional flow reserve: Nurturing a functional perspective in angioplasty (Case Report)The role of invasive fractional flow reserve (FFR) in multivessel diseaseFibrinolytic followed by early angiography in cardiac arrest survivor patients with ST elevation ACS: A pharmaco-invasive in non-primary PCI capable hospitalEarly accelerated idioventricular rhythm followed by premature ventricular complexes as a marker for successful reperfusion in ST-elevation myocardial infarct patientInferior ST-elevation myocardial infarction complicated by unstable total atrioventricular block and diabetic ketoacidosis in end stage renal failure patientOutlflow tract ventricular arrythmia 3D ablation in LV summit Area: A case reportIntravascular hemolysis complication after transcatheter PDA closure with ADO device: A case reportA very rare case: A patient with extreme levocardia without remarkable symptomTransradial primary percutaneous coronary intervention on a patient with ST-Elevation myocardial infarction with comorbid peripheral artery disease and severe partial obstruction in the abdominal aortaAcute coronary syndrome with ventricular stormCardio-cerebral infaction: A rare case of concomitant acute right ventricular infarction and ischemic strokeTypical ECG pattern of acute pulmonary embolism in a 45 years old dyspneic and chest pain male patient: A case reportPersistent high degree AV block after early invasive strategy in acute decompensated heart failure caused by NSTEMI: A case reportAdult patent ductus arteriosus complicated by pulmonary artery endarteritis and pneumoniaRoutine thrombus aspiration in primary percutaneous coronary intervention: Is it still necessary? (Case Report)Curable severe tachycardiomyopathy due to typical atrial flutter by radiofrequency catheter ablationSinus node dysfunction in right heart failure: A rare caseLipomatous hypertrophy of the interatrial expanding into left atrial appendage mimicking thrombus: A very rare case reportConservative approach for patient in acute heart failure with cor triatriatum dexter and atrial fibrillation: A rare case reportAcute rheumatic fever in juvenile complicated by complete heart block: A case reportA nineteen years old young woman with idiopathic hypertrophic subaortic stenosis: A case reportRecurrent acute coronary syndrome – a manifestation of clopidogrel resistance: A case reportSubarterial doubly committed ventricularseptal defectcomplicated with right-sided fungalinfective endocarditisCase report: The hemodynamic effect of non invasive ventilation in atrial septal defect with severe pulmonary hypertension and respiratory failureEchocardiography-guided percutaneus transvenous mitral commissurotomy in a pregnant woman with severe mitral stenosisThe correlation between endothelial function parameter flow mediated vasodilatation with the complexity of coronary artery disease based on Syntax ScoreRuptured sinuses of valsalva aneurysms: Report of five casesParacetamol as alternative for patent ductus arteriosus (PDA) management

2016 ◽  
Vol 18 (suppl B) ◽  
pp. B51-B57 ◽  
Author(s):  
A. Widya ◽  
A. Jalaludinsyah ◽  
D.G. Widyawati ◽  
E. Hindoro ◽  
E. Supriadi ◽  
...  
Keyword(s):  
Heart Failure ◽  
Rare Case ◽  
Ductus Arteriosus ◽  
Coronary Intervention ◽  
Coronary Syndrome ◽  
Flow Reserve ◽  
Percutaneous Coronary ◽  
St Elevation ◽  
Artery Disease ◽  
Patent Ductus

scholarly journals Subanalysis of the AUGUSTUS trial

2020 ◽  
Vol 25 ◽  
pp. 4104
Author(s):  
T. V. Pavlova ◽  
P. D. Duplyakova ◽  
O. V. Shkaeva ◽  
S. P. Krivova
Keyword(s):  
Acute Coronary Syndrome ◽  
Large Scale ◽  
Coronary Intervention ◽  
The Novel ◽  
Actual Clinical Practice ◽  
Coronary Syndrome ◽  
Hospitalization Rates ◽  
Percutaneous Coronary ◽  
Artery Disease ◽  
European Society Of Cardiology

Comorbidity is a common feature of a modern patient. The combination of atrial fibrillation (AF) and various types of coronary artery disease is widespread in actual clinical practice. In such cases, additional pathophysiological mechanisms appear that worsen the clinical course and patient’s prognosis. The management of AF patients who have undergone acute coronary syndrome and/or percutaneous coronary intervention is a challenging problem, which can be solved by large-scale clinical trials. The AUGUSTUS randomized trial with a two-by-two factorial design proved that full-dose apixaban is superior in safety to the vitamin K antagonist warfarin, while not inferior in effectiveness. This pattern has been preserved in several important subanalysis on stent thrombosis, hospitalization rates, and conservative management of acute coronary syndrome. The obtained results are included in the novel European Society of Cardiology guidelines on AF.

Bleeding with Tirofiban During Percutaneous Coronary Intervention

2021 ◽  
Vol 15 (10) ◽  
pp. 2833-2834
Author(s):  
Muhammad Waqas ◽  
Muhammad Shahzad Azeem ◽  
Muhammad Qasim Khan
Keyword(s):  
Percutaneous Coronary Intervention ◽  
Acute Coronary Syndrome ◽  
Continuous Infusion ◽  
Case Series ◽  
Coronary Intervention ◽  
Male Gender ◽  
Coronary Syndrome ◽  
Percutaneous Coronary ◽  
Modern Era ◽  
Current Guidelines

Objective: To determine the frequency of bleeding with Tirofiban during percutaneous coronary intervention Methodology: In this case series (Descriptive) at Mayo Hospital, Cardiology Deptt. Lahore during the year 2018 and 2019, we enrolled a total of 385 cases of either gender with acute coronary syndrome(ACS) and undergoing percutaneous coronary intervention(PCI)were included. Preloading with aspirin 300 mg and clopidogrel 600 mg was done. Intravenous Tirofiban was given keeping in mind the current guidelines. Tirofiban was given as I/V bolus of 0.25 mcg/kg over 5 minutes during/before the start of PCI. It was followed by a continuous infusion of 0.125 mcg/kg/min for up to eighteen hours. Bleeding during and within 24 hours of percutaneous coronary intervention was noted according to BARC bleeding type Results: Mean age was 50.750± 5.63years. Male gender was dominant i.e. 85.7% as compare to 14.3% females. Bleeding was observed in 3.9% patients Conclusion: In acute coronary syndrome patients undergoing PCI, Tirofiban use was associated with bleeding. In the modern era of PCI, the judicious use of Tirofiban is safe. Keywords: Percutaneous coronary intervention, Tirofiban, Bleeding, Acute coronary syndrome

Antithrombotic Therapy in Patients With Atrial Fibrillation Undergoing Percutaneous Coronary Intervention: Where Are We Now?

2018 ◽  
Vol 52 (9) ◽  
pp. 884-897 ◽  
Author(s):  
Ryan G. D’Angelo ◽  
Thaddeus McGiness ◽  
Laura H. Waite
Keyword(s):  
Atrial Fibrillation ◽  
Percutaneous Coronary Intervention ◽  
Triple Therapy ◽  
Bleeding Risk ◽  
Coronary Intervention ◽  
Low Risk ◽  
Current Evidence ◽  
Patient Specific ◽  
Coronary Syndrome ◽  
Percutaneous Coronary

Objective: To synthesize the literature and provide guidance to practitioners regarding double therapy (DT) and triple therapy (TT) in patients with atrial fibrillation (AF) requiring percutaneous coronary intervention (PCI). Data Sources: PubMed and MEDLINE (January 2000 to February 2018) were searched using the following terms: atrial fibrillation, myocardial infarction, acute coronary syndrome, percutaneous coronary intervention, anticoagulation, dual-antiplatelet therapy, clopidogrel, aspirin, ticagrelor, prasugrel, and triple therapy. Study Selection and Data Extraction: The results included randomized and nonrandomized clinical trials and meta-analyses. Each study was reported based on study design, population, intervention, comparator, and key cardiovascular (CV) and bleeding outcomes. Data Synthesis: A total of 15 studies were included in the review. The majority of studies evaluating DT and TT utilized clopidogrel and warfarin as components of the regimen, although there are emerging data with newer agents. Evidence purporting DT regimens to be equally effective in preventing CV events and improved safety profiles compared with TT regimens included populations with relatively low risk for recurrent CV events, and many of these studies were observational in nature. Overall, current evidence as well as American and European guidelines support the use of TT in patients with AF who require PCI for the least possible amount of time, depending on patient-specific factors involving bleeding and thrombosis. Conclusions: In the majority of patients with AF who require PCI, TT should be used for the shortest period of time possible. DT regimens may be used in patients requiring PCI who have low risk for thrombosis and/or high bleeding risk.

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