Long-term Complications After Stent Assist Coiling Dependent on Clopidogrel Response

Abstract BACKGROUND: Dual antiplatelet therapy (DAPT) is necessary for stent assisted coiling. However, long term use of DAPT has a potential risk of hemorrhagic events. We aimed to examine the relationship between clopidogrel reactivity and complications.METHODS: Patients who underwent stent assisted coiling for unruptured aneurysms and received periprocedural DAPT in our institution between August 2011 to March 2020 were included. Platelet reactivity for clopidogrel was measured by VerifyNow assay system, and we defined the cut off value of P2Y12 Reaction Units (PRU) at 208, and classified patients as hypo-responders (PRU≧208) or responders (PRU＜208). The rates of hemorrhagic and thrombotic events within 30 days (acute phase) and 30 days after the procedure (delayed phase) were compared between the two groups. Furthermore, changes in hemoglobin levels were measured before and after the procedure and at chronic stages (1 to 6 months thereafter).RESULTS: From 62 patients included in this study, 36 patients were hypo-responders and 26 patients were responders. Hemorrhagic events occurred 7.7% only in responders in the acute phase (p = 0.17), and 2.78% in hypo-responders and 23.1% in responders in the delayed phase (p = 0.02). Changes in hemoglobin levels before and after the procedure were 1.21 g/dl in hypo-responders and 1.92 g/dl in responders (p = 0.02) while before the procedure and chronic stages they were 0.39g/dl in hypo-responders and 1.41 g/dl in responders (p < 0.01). Thrombotic events were not significantly different between the two groups.CONCLUSION: Long term use of DAPT after stent assisted coiling is related to hemorrhagic events in the delayed phase. Preventing for hemorrhagic events, the duration of DAPT should be carefully considered in clopidogrel responders.

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Long-term complications after stent assist coiling dependent on clopidogrel response

BMC Neurology ◽

10.1186/s12883-021-02270-0 ◽

2021 ◽

Vol 21 (1) ◽

Author(s):

Kenji Shoda ◽

Yukiko Enomoto ◽

Yusuke Egashira ◽

Takamasa Kinoshita ◽

Daisuke Mizutani ◽

...

Keyword(s):

Acute Phase ◽

Platelet Reactivity ◽

Unruptured Aneurysms ◽

Hemorrhagic Events ◽

Before And After ◽

Verifynow Assay ◽

Previously Treated ◽

The Relationship ◽

Delayed Phase

Abstract Background Dual antiplatelet therapy (DAPT) is necessary for stent assisted coiling. However, long term use of DAPT has a potential risk of hemorrhagic events. We aimed to examine the relationship between clopidogrel reactivity and complications. Methods Patients who underwent stent assisted coiling for unruptured aneurysms or previously treated aneurysms and received periprocedural DAPT in our institution between August 2011 to March 2020 were included. Platelet reactivity for clopidogrel was measured by VerifyNow assay system, and we defined the cut off value of P2Y12 Reaction Units (PRU) at 208 and classified patients as hypo-responders (PRU≧208) or responders (PRU<208). The rates of hemorrhagic and thrombotic events within 30 days (acute phase) and 30 days after the procedure (delayed phase) were compared between the two groups. Furthermore, changes in hemoglobin levels were measured before and after the procedure and at chronic stages (1 to 6 months thereafter). Results From 61 patients included in this study, 36 patients were hypo-responders and 25 patients were responders. Hemorrhagic events occurred 8.0% only in responders in the acute phase (p = 0.16), and 2.78% in hypo-responders and 20.0% in responders in the delayed phase (p = 0.037). Changes in hemoglobin levels before and after the procedure were 1.22 g/dl in hypo-responders and 1.74 g/dl in responders (p = 0.032) while before the procedure and chronic stages they were 0.39 g/dl in hypo-responders and 1.39 g/dl in responders (p < 0.01). Thrombotic events were not significantly different between the two groups. Conclusion Long term use of DAPT after stent assisted coiling is related to hemorrhagic events in the delayed phase. Preventing for hemorrhagic events, the duration of DAPT should be carefully considered in clopidogrel responders.

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Abstract 13846: The Relationship of Platelet Function Measurements with Bleeding Outcomes During Long-term Treatment with Dual Antiplatelet Therapy in Medically Managed NSTE-ACS Patients

Circulation ◽

10.1161/circ.130.suppl_2.13846 ◽

2014 ◽

Vol 130 (suppl_2) ◽

Author(s):

Jan H Cornel ◽

E. M Ohman ◽

Benjamin Neely ◽

Joseph A Jakubowski ◽

Deepak L Bhatt ◽

...

Keyword(s):

Antiplatelet Therapy ◽

Platelet Function ◽

Dual Antiplatelet Therapy ◽

Platelet Reactivity ◽

Bleeding Risk ◽

Minor Bleeding ◽

Cut Point ◽

Relationship Of ◽

The Relationship

Introduction: The relationship of low “on-treatment” platelet reactivity to longitudinal risks of major bleeding following acute coronary syndromes (ACS) has not been clearly delineated. Methods: We analyzed 2428 patients with non-ST-elevation ACS (NSTE ACS) from the TRILOGY ACS trial who were managed without revascularization and had platelet reactivity measurements (P2Y12 reaction units [PRUs]) collected in a platelet function substudy. Patients received aspirin + prasugrel (10 mg/d; 5 mg/d for those ≥75 y or <75 y and <60 kg) or clopidogrel (75 mg/d). Non-CABG severe/moderate GUSTO bleeding and non-CABG TIMI major/minor bleeding were ascertained through 30 months. Contal’s method was used to investigate whether a PRU cut point could distinguish high vs low bleeding risk. Multivariable Cox proportional hazard models were used to evaluate the association between PRU and time to first bleed. Results: Through 30 months, there were 27 GUSTO severe/moderate bleeds and 37 TIMI major/minor bleeds, with gastrointestinal bleeding the most common. Baseline characteristics were stratified by tertiles of PRU values at 5 d, and significant differences were seen across tertiles (Table). Unadjusted bleeding rates appeared highest among those in the lowest PRU tertile but no reliable PRU cut point was found that significantly distinguished bleeding risk. Unadjusted analyses showed continuous measures of PRUs were not associated with GUSTO (HR=1.00, 95% CI: 0.96-1.04) or TIMI bleeding (HR=1.03, 95% CI: 0.99-1.06). This relationship did not change after multivariable adjustment. Conclusions: Among NSTE-ACS patients managed without revascularization and receiving dual antiplatelet therapy, PRU values were not significantly associated with long-term bleeding risk. The relatively small number of bleeding events accrued limited study power, but these results suggest that low “on-treatment” platelet reactivity does not independently predict post-ACS bleeding risk.

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Individual long-term variation of platelet reactivity in patients with dual antiplatelet therapy after myocardial infarction

Platelets ◽

10.1080/09537104.2018.1479519 ◽

2018 ◽

Vol 30 (5) ◽

pp. 572-578 ◽

Cited By ~ 1

Author(s):

Joakim Alfredsson ◽

Eva Swahn ◽

Kerstin M Gustafsson ◽

Magnus Janzon ◽

Lena Jonasson ◽

...

Keyword(s):

Myocardial Infarction ◽

Antiplatelet Therapy ◽

Dual Antiplatelet Therapy ◽

Platelet Reactivity ◽

Term Variation

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The relationship of paroxysmal ventricular tachycardia complicating the acute phase and ventricular arrhythmia during the late hospital phase of myocardial infarction to long-term survival

The American Journal of Medicine ◽

10.1016/0002-9343(78)90215-2 ◽

1978 ◽

Vol 64 (3) ◽

pp. 377-381 ◽

Cited By ~ 49

Author(s):

Neil de Soyza ◽

Frederick A. Bennett ◽

Marvin L. Murphy ◽

Joe K. Bissett ◽

James J. Kane

Keyword(s):

Myocardial Infarction ◽

Ventricular Tachycardia ◽

Ventricular Arrhythmia ◽

Acute Phase ◽

Term Survival ◽

Long Term Survival ◽

Relationship Of ◽

The Relationship

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Coach Mid-Season Replacement and Team Performance in Professional Soccer

Journal of Human Kinetics ◽

10.2478/v10078-011-0028-7 ◽

2011 ◽

Vol 28 (1) ◽

pp. 115-122 ◽

Cited By ~ 6

Author(s):

Carlos Lago-Peñas

Keyword(s):

Team Performance ◽

Positive Impact ◽

Short Term ◽

Shock Effect ◽

Professional Soccer ◽

Before And After ◽

Using Data ◽

The Relationship ◽

The Empirical Analysis

Coach Mid-Season Replacement and Team Performance in Professional SoccerThe coaching carousel or turnover is an extreme but frequently occurring phenomenon in soccer. Among the reasons for firing a coach, the most common is the existence of a shock-effect: a new coach would be able to motivate the players better and therefore to improve results. Using data from the Spanish Soccer League during the seasons from 1997-1998 to 2006-2007, this paper investigates the relationship between team performance and coach change over time. The empirical analysis shows that the shock effect of a turnover has a positive impact on team performance in the short term. Results reveal no impact of coach turnover in the long term. The favourable short-term impact on team performance of a coach turnover is followed by continued gradual worsening of results. The turnover effect is non-existent when the comparison between the new coach and the old coach is done over 10, 15 or 20 matches before and after termination.

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The Evolutionary Characteristics of Reservoir Microstructure under Long-Term Waterflooding Development and Its Fractal Description

Geofluids ◽

10.1155/2021/5557125 ◽

2021 ◽

Vol 2021 ◽

pp. 1-13

Author(s):

Fengjiao Wang ◽

Xu Wang ◽

Yikun Liu ◽

Qingjun Deng ◽

Jianjun Xu ◽

...

Keyword(s):

Pore Structure ◽

Physical Simulation ◽

Structural Parameters ◽

Fractal Theory ◽

Evolution Model ◽

Structure Evolution ◽

Before And After ◽

Water Cut ◽

The Relationship

Generally, long-term waterflooding development often leads to the change of reservoir pore and clay mineral composition, which results in the change of permeability and wettability. In order to explore the relationship between core micropore structure and water cut, based on physical simulation experiments and fractal theory, we proposed a fractal evolutionary model to describe the evolution characteristics of microstructure of long-term water driving reservoirs. In this paper, core pore structure by SEM was first conducted to analyze the change of core pore structure before and after waterflooding under the conditions of magnification of 200 times, 800 times, and 2000 times, respectively. Then, conventional and constant rate mercury injection tests were combined to perform the comparative analysis of core structural parameters before and after waterflooding. Finally, a micropore-throat structure evolution model of core was established. Research shows that the connectivity of larger pores becomes better after long-term water driving, the degree of heterogeneity weakens, and the micro heterogeneity of small pores becomes stronger and stronger. The throat characteristics change in a complex manner, the radius tends to increase, and the sorting becomes better, while the connectivity of small throat changes complex. In general, the heterogeneity of throat increases with the time of water injection in reservoirs with low porosity and permeability. On the basis of fractal theory and variation characteristics of rock pore structure in water driving reservoirs, we have established a micropore-throat structure evolution model of core pore-throat characteristics. This fractal evolution model quantitatively characterized the complexity and evolution law of pore structure and clarified the relationship between fractal dimension of core pore structure and water cut under different stages of water driving.

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Active Participation of Care Partners in a Physical Activity Intervention alongside People with Stroke: A Feasibility Study

Physiotherapy Canada ◽

10.3138/ptc-2020-0035 ◽

2021 ◽

pp. e20200035

Author(s):

Reed Handlery ◽

Elizabeth Regan ◽

Allison Foster Lewis ◽

Chelsea Larsen ◽

Kaci Handlery ◽

...

Keyword(s):

Physical Activity ◽

Social Support ◽

Physical Activity Intervention ◽

Care Partners ◽

Before And After ◽

Physical Activity Adherence ◽

Ongoing Support ◽

The Relationship

Purpose: This study investigated the feasibility of a physical activity intervention for people with stroke and their care partners and the role social support plays in physical activity adherence. Method: The study used a single-group, pretest–posttest design with follow-up. Participants were adults with chronic stroke and their care partners. The intervention consisted of 8 weeks of structured, group-based physical activity classes, followed by 19 weeks of self-directed physical activity. Recruitment, adherence, safety, and retention were assessed. Familial social support was assessed before and after the 8-week structured portion and again 19 weeks later. Results: A total of 21 participants (15 people with stroke, 6 care partners), mean (SD) age 67.6 (11.6) years, were recruited; 19 (90.5%) completed the 19-week assessment. No adverse events were experienced during the programme. Attendance during the 8-week portion was better than during the 19-week portion (mean difference 0.95; p < 0.001; 95% CI: 0.71, 1.19 visits/wk). No relationship was found between social support and physical activity adherence ( p > 0.05). Conclusions: Involvement of care partners in a physical activity intervention is feasible and safe. Both people with stroke and their care partners may require ongoing support to participate in long-term physical activity. The relationship between social support and physical activity adherence requires further study.

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Activity-mediated changes in feed-forward inhibition in the dentate commissural pathway: relationship to EPSP/spike dissociation in the converging perforant path

Journal of Neurophysiology ◽

10.1152/jn.1993.69.1.165 ◽

1993 ◽

Vol 69 (1) ◽

pp. 165-173 ◽

Cited By ~ 14

Author(s):

R. A. Tomasulo ◽

J. J. Ramirez

Keyword(s):

Perforant Path ◽

Excitatory Postsynaptic Potential ◽

Feed Forward ◽

Pulse Trains ◽

Before And After ◽

Commissural Pathway ◽

High Stimulus ◽

The Relationship ◽

Feed Forward Inhibition

1. We tested the hypothesis that long-term synaptic potentiation (LTP)-associated excitatory postsynaptic potential (EPSP)/spike dissociation in the dentate gyrus (DG) is determined, in part, by changes in the feed-forward inhibition evoked by perforant path (PP) stimulation. The dentate commissural pathway (CP) and the PP activate a common pool of interneurons. Therefore a change in synaptic efficacy in the inhibitory circuit due to activation of one pathway could lead to changes in inhibitory efficacy in the other. The relationship between changes in feed-forward inhibition in the CP and EPSP/spike (E-S) functions in the PP should provide information about the site(s) of synaptic modification. 2. In urethan-anesthetized rats, we measured the inhibition of evoked PP population spikes by the CP at interstimulus intervals of 6 and 12 ms. This measure of commissural inhibition and conventional E-S functions for the PP input to the DG were obtained before and after 1) PP tetany (400 Hz, 8-pulse trains) at low, medium, and high stimulus intensities, and 2) CP tetany (200 Hz, 7-pulse trains). 3. Low-intensity PP conditioning (just above population spike threshold) led to a decrease in CP inhibition and large left shifts of the E-S function. High- and medium-intensity PP conditioning yielded increases in commissural inhibition and smaller leftward E-S shifts. 4. Commissural conditioning led to increases in commissural inhibition and inconsistent changes in the E-S functions.(ABSTRACT TRUNCATED AT 250 WORDS)

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Predicting the cumulative medical load of COVID-19 outbreaks after the peak in daily fatalities

10.1101/2020.09.03.20183384 ◽

2020 ◽

Author(s):

Claudius Gros ◽

Roser Valenti ◽

Lukas Schneider ◽

Benedikt Gutsche ◽

Dimitrije Markovic

Keyword(s):

Sir Model ◽

Cumulative Number ◽

Hospitalised Patients ◽

Before And After ◽

The Status ◽

Containment Measures ◽

Short And Long Term ◽

The Relationship ◽

Fixed Period

The distinct ways the COVID-19 pandemics has been unfolding in different countries and regions suggest that local societal and governmental structures play an essential role both for the baseline infection rate and the short-term and long-term reaction to the outbreak. Here we investigate how societies as a whole, and governments, in particular, modulate the dynamics of a novel epidemic using a generalisation of the SIR model, the controlled SIR model. We posit that containment measures correspond to feedback between the status of the outbreak (the daily or the cumulative number of cases and fatalities) and the reproduction factor. We present the exact phase space solution of the controlled SIR model and use it to quantify containment policies for a large number of countries in terms of short- and long-term control parameters. Furthermore, we identified for numerous countries a relationship between the number of fatalities within a fixed period before and after the peak in daily fatalities. As the number of fatalities corresponds to the number of hospitalised patients, the relationship can be used to predict the cumulative medical load, once the effectiveness of outbreak suppression policies is established with sufficient certainty.

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