Antiplatelet for Coronary Artery Disease in Specific Condition “No Size Fits All”

2018 ◽  
Vol 24 (4) ◽  
pp. 478-495
Author(s):  
Benny M. Setiadi ◽  
Beny Hartono ◽  
Adhitia B. Prakoso ◽  
Anggia C. Lubis ◽  
Reza M. Munandar ◽  
...  
Keyword(s):  
Coronary Artery Disease ◽  
Coronary Artery ◽  
Platelet Reactivity ◽  
Antiplatelet Agent ◽  
Current Evidence ◽  
Efficacy And Safety ◽  
Current Recommendation ◽  
Risk Of Bleeding ◽  
Increased Risk ◽  
Artery Disease

Antiplatelet is the cornerstone therapy for patient with coronary artery disease. Several comorbidities can influence the efficacy and safety of antiplatelet agent. Diabetes mellitus is characterized by increased platelet reactivity and reduced response to antiplatelet. Elderly patients have both reduced response to antiplatelet and increased risk of bleeding. Patients with renal dysfunction also had decreased efficacy of antiplatelet accompanied with increased risk of bleeding. In patients with atrial fibrillation, the concomitant use of anticoagulant with antiplatelet poses an increased risk of bleeding. In patients with these comorbidities, caution should be stressed in selecting the best regimen of antiplatelet which translates the most optimal efficacy while minimizing the risk of adverse events. In this review, we will discuss the platelet changes in these comorbidities, current evidence of antiplatelet usage in these group of patients and current recommendation.

scholarly journals The Role of Rivaroxaban in the Treatment of Patients with Stable Coronary Artery Disease

2019 ◽  
pp. 34-41
Author(s):  
O. V. Averkov
Keyword(s):  
Coronary Artery Disease ◽  
Coronary Artery ◽  
Acetylsalicylic Acid ◽  
Stable Coronary Artery Disease ◽  
Antiplatelet Agent ◽  
Alternative Possibilities ◽  
Efficacy And Safety ◽  
Increased Risk ◽  
Long Term Treatment ◽  
Artery Disease

An analytical article discusses the design and results of the recent COMPASS study. Particular attention is paid to the details of comparison of the efficacy and safety of rivaroxaban combined with acetylsalicylic acid and the efficacy and safety of drugs containing acetylsalicylic acid only in patients with stable coronary artery disease. In addition to a significant reduction in the risk of the sum of traditionally recognizable events (myocardial infarction, stroke, cardiovascular mortality), among the arguments in favour of fairly widespread prolonged use of the antiplatelet agent combined with anticoagulant is an attractive effect of the debated antithrombotic strategy on the overall mortality of patients, an acceptable ratio of efficacy and hemorrhagic safety, first of all the absence of the increased risk of fatal bleeding and the risk of intracranial bleeding. The article describes approaches to the selection of patients with coronary artery disease for the participation in the long-term treatment with rivaroxaban combined with acetylsalicylic acid. Alternative possibilities for enhancement of the secondary prophylactic effects of acetylsalicylic acid are mentioned, the arguments supporting the preference of the approach discussed in the article are presented.

Abstract 2041: Low P2Y 12 -Specific Platelet Inhibition in Clopidogrel-Treated Patients with Coronary Artery Disease is Common and not Reliably Detected by Conventional Aggregation Tests

Circulation ◽  
2007 ◽  
Vol 116 (suppl_16) ◽  
Author(s):  
Andreas Schaefer ◽  
Sarah Weinberger ◽  
Martin Eigenthaler ◽  
Georg Ertl ◽  
Johann Bauersachs
Keyword(s):  
Coronary Artery Disease ◽  
Coronary Artery ◽  
Real World ◽  
Platelet Reactivity ◽  
Reactivity Index ◽  
Individual Response ◽  
Specific Assay ◽  
Cardiovascular Morbidity And Mortality ◽  
Increased Risk ◽  
Artery Disease

Background: Incomplete inhibition of P2Y 12 -mediated platelet activation during clopidogrel treatment has been associated with increased cardiovascular morbidity and mortality after percutaneous coronary intervention. This study aimed to investigate the incidence of impaired individual clopidogrel-responsiveness using a P2Y 12 -specific and pre-treatment-independent assay in a real world situation. Methods: 100 consecutive patients with coronary artery disease on clopidogrel treatment (> 5 days including a loading dose of at least 300 mg) were screened for response to ADP-induced platelet signalling. We assessed the vasodilator-stimulated phosphoprotein-based platelet reactivity index (PRI) as the only P2Y 12 -specific assay to determine clopidogrel responsiveness. Insufficient inhibition of P2Y 12 by clopidogrel was defined as a PRI >50% based on previous studies indicating increased risk of stent thrombosis under this condition. The results were compared with conventional assays to assess ADP-induced P-selectin surface-expression and conventional turbinometric platelet aggregation to several concentrations of ADP. Results: Clopidogrel significantly lowered functional platelet reactivity in patients with coronary artery disease compared to untreated patients. However, insufficient individual response to treatment predisposing for adverse events and therefore previously described as “non-response” was diagnosed in 69% of clopidogrel-treated patients using PRI. Conventional aggregation failed to detect insufficient P2Y 12 -inhibition in 1/3of patients with a PRI>50%. Conclusion: Using the PRI as the only P2Y 12 -specific assay to evaluate the treatment effect of clopidogrel in patients with coronary artery disease, insufficient P2Y 12 -inhibition was present in the majority of patients in a real-world scenario. Insufficient P2Y12-inhibition could not be reliably detected by conventional aggregation More prospective studies are needed to evaluate the influence of the high prevalence of incomplete clopidogrel responsiveness to major adverse cardiac events.

scholarly journals Association of the coronary artery disease risk gene GUCY1A3 with ischaemic events after coronary intervention

2019 ◽  
Vol 115 (10) ◽  
pp. 1512-1518 ◽  
Author(s):  
Thorsten Kessler ◽  
Bernhard Wolf ◽  
Niclas Eriksson ◽  
Daniel Kofink ◽  
Bakhtawar K Mahmoodi ◽  
...  
Keyword(s):  
Coronary Artery Disease ◽  
Coronary Artery ◽  
Stent Thrombosis ◽  
Risk Allele ◽  
Platelet Reactivity ◽  
Coronary Intervention ◽  
Cardiovascular Death ◽  
Impedance Aggregometry ◽  
Increased Risk ◽  
Artery Disease

AbstractAimA common genetic variant at the GUCY1A3 coronary artery disease locus has been shown to influence platelet aggregation. The risk of ischaemic events including stent thrombosis varies with the efficacy of aspirin to inhibit platelet reactivity. This study sought to investigate whether homozygous GUCY1A3 (rs7692387) risk allele carriers display higher on-aspirin platelet reactivity and risk of ischaemic events early after coronary intervention.Methods and resultsThe association of GUCY1A3 genotype and on-aspirin platelet reactivity was analysed in the genetics substudy of the ISAR-ASPI registry (n = 1678) using impedance aggregometry. The clinical outcome cardiovascular death or stent thrombosis within 30 days after stenting was investigated in a meta-analysis of substudies of the ISAR-ASPI registry, the PLATO trial (n = 3236), and the Utrecht Coronary Biobank (n = 1003) comprising a total 5917 patients. Homozygous GUCY1A3 risk allele carriers (GG) displayed increased on-aspirin platelet reactivity compared with non-risk allele (AA/AG) carriers [150 (interquartile range 91–209) vs. 134 (85–194) AU⋅min, P < 0.01]. More homozygous risk allele carriers, compared with non-risk allele carriers, were assigned to the high-risk group for ischaemic events (>203 AU⋅min; 29.5 vs. 24.2%, P = 0.02). Homozygous risk allele carriers were also at higher risk for cardiovascular death or stent thrombosis (hazard ratio 1.70, 95% confidence interval 1.08–2.68; P = 0.02). Bleeding risk was not altered.ConclusionWe conclude that homozygous GUCY1A3 risk allele carriers are at increased risk of cardiovascular death or stent thrombosis within 30 days after coronary stenting, likely due to higher on-aspirin platelet reactivity. Whether GUCY1A3 genotype helps to tailor antiplatelet treatment remains to be investigated.

Antithrombotic therapy: what the dental surgeon has to know

2010 ◽  
Vol 1 (3) ◽  
pp. 92-98
Author(s):  
Nadzeya Kuzniatsova ◽  
Gregory YH Lip
Keyword(s):  
Atrial Fibrillation ◽  
Coronary Artery Disease ◽  
Coronary Artery ◽  
Elective Surgery ◽  
Antiplatelet Agents ◽  
Invasive Procedures ◽  
Antithrombotic Drugs ◽  
Risk Of Bleeding ◽  
Increased Risk ◽  
Artery Disease

Antithrombotic drugs are prescribed more and more often in medical practice. With a progressively aging population, the proportion of patients having prothrombotic medical conditions such as coronary artery disease, atrial fibrillation, venous thrombosis and many others increases dramatically. Anticoagulants or antiplatelet agents save thousands of lives annually but also introduce concerns of increased risk of bleeding, especially in the settings of elective surgery or invasive procedures.

scholarly journals Atrial Fibrillation and Coronary Artery Disease: Deciding on The Best Antithrombotic Regimen

2018 ◽  
Vol 13 (SP1) ◽  
Author(s):  
Jason Andrade ◽  
Laurent Macle ◽  
Marc Dyall
Keyword(s):  
Atrial Fibrillation ◽  
Coronary Artery Disease ◽  
Coronary Artery ◽  
Antiplatelet Therapy ◽  
Treatment Strategies ◽  
Current Evidence ◽  
Systemic Embolism ◽  
Increased Risk ◽  
Coronary Events ◽  
Artery Disease

Atrial fibrillation (AF) is a chronic progressive disease characterized by exacerbations and remissions. Up to 20-30% of patients with AF also have coronary artery disease (CAD). In patients with concomitant AF and CAD, the management of antithrombotic therapy is challenging. Oral anticoagulation (OAC) is indicated for the prevention of AF-related stroke and systemic embolism, whereas antiplatelet therapy is indicated for the prevention of coronary events. Each of these therapeutic avenues offers a relative efficacy benefit (e.g. dual antiplatelet therapy [DAPT] is more effective than OAC alone in reducing cardiovascular death, myocardial infarction, stent thrombosis, and ischemic coronary events in an ACS population), but with a relative compromise (e.g. DAPT is significantly inferior to OAC for the prevention of stroke/systemic embolism in an AF population at increased risk of AF-related stroke). The purpose of this review is to explore the current evidence and rationale for antithrombotic treatment strategies in patients with both AF and CAD.

scholarly journals PRIMARY PREVENTION OF CARDIOVASCULAR DISEASE AND ANTIPLATELET THERAPY. CLINICAL LECTURE

2017 ◽  
pp. 89-93
Author(s):  
L. O. Minushkina
Keyword(s):  
Coronary Artery Disease ◽  
Coronary Artery ◽  
Primary Prevention ◽  
Antiplatelet Therapy ◽  
Antithrombotic Therapy ◽  
Antiplatelet Agent ◽  
Term Therapy ◽  
Coronary Syndrome ◽  
Increased Risk ◽  
Artery Disease

Today, treatment with low doses of acetylsalicylic acid (ASA) (alone or in combination with other antiplatelet drugs) is the key element in the secondary prevention of coronary artery disease. Long-term therapy with low-dose ASA is recommended to patients with stable coronary artery disease, patients after acute coronary syndrome with or without ST segment elevation, and after revascularization. [1–3] The need for antithrombotic therapy in the primary prevention of cardiovascular events raises many questions. The currently available guidelines are contradictory – from complete denial of the need for antiplatelet therapy to designation of the specific groups of patients for whom ASA treatment is recommended. [4, 5] Findings of clinical trials underlie those contradictory opinions. ASA is the only antiplatelet agent the administration of which is debated for primary prevention. Administration of ASA in primary prevention usually results in a reduced risk of cardiovascular complications, but the positive effect is largely offset by an increased risk of bleeding, particularly gastrointestinal. Therefore, the challenge is in the selection of patients for whom the benefit from antithrombotic therapy could outweigh the risks associated with bleeding. Risk scores are commonly used to assess the risk of complications.

Aspirin versus P2Y12 inhibitors with anticoagulation therapy for atrial fibrillation

Heart ◽  
2021 ◽  
pp. heartjnl-2021-319321
Author(s):  
Hidehira Fukaya ◽  
Junya Ako ◽  
Satoshi Yasuda ◽  
Koichi Kaikita ◽  
Masaharu Akao ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Coronary Artery Disease ◽  
Coronary Artery ◽  
Antiplatelet Agent ◽  
Primary Efficacy ◽  
Efficacy And Safety ◽  
End Points ◽  
End Point ◽  
Significant Difference ◽  
Artery Disease

ObjectivePatients with coronary artery disease (CAD) and atrial fibrillation (AF) can be treated with multiple antithrombotic therapies including antiplatelet and anticoagulant therapies; however, this has the potential to increase bleeding risk. Here, we aimed to evaluate the efficacy and safety of P2Y12 inhibitors and aspirin in patients also receiving anticoagulant therapy.MethodsWe evaluated patients from the Atrial Fibrillation and Ischaemic Events with Rivaroxaban in Patients with Stable Coronary Artery Disease (AFIRE) trial who received rivaroxaban plus an antiplatelet agent; the choice of antiplatelet agent was left to the physician’s discretion. The primary efficacy and safety end points, consistent with those of the AFIRE trial, were compared between P2Y12 inhibitors and aspirin groups. The primary efficacy end point was a composite of stroke, systemic embolism, myocardial infarction, unstable angina requiring revascularisation or death from any cause. The primary safety end point was major bleeding according to the International Society on Thrombosis and Haemostasis criteria.ResultsA total of 1075 patients were included (P2Y12 inhibitor group, n=297; aspirin group, n=778). Approximately 60% of patients were administered proton pump inhibitors (PPIs) and there was no significant difference in PPI use in the groups. There were no significant differences in the primary end points between the groups (efficacy: HR 1.31; 95% CI 0.88 to 1.94; p=0.178; safety: HR 0.79; 95% CI 0.43 to 1.47; p=0.456).ConclusionsThere were no significant differences in cardiovascular and bleeding events in patients with AF and stable CAD taking rivaroxaban with P2Y12 inhibitors or aspirin in the chronic phase.Trial registration numberUMIN000016612; NCT02642419.

Gender Differences in Non-Obstructive Coronary Artery Disease

2020 ◽  
Vol 26 ◽  
Author(s):  
Maria Bergami ◽  
Marialuisa Scarpone ◽  
Edina Cenko ◽  
Elisa Varotti ◽  
Peter Louis Amaduzzi ◽  
...  
Keyword(s):  
Coronary Artery Disease ◽  
Gender Differences ◽  
Heart Disease ◽  
Coronary Artery ◽  
Ischemic Heart Disease ◽  
Coronary Arteries ◽  
Obstructive Coronary Artery Disease ◽  
Ischemic Heart ◽  
Current Evidence ◽  
Artery Disease

: Subjects affected by ischemic heart disease with non-obstructive coronary arteries constitute a population that has received increasing attention over the past two decades. Since the first studies with coronary angiography, female patients have been reported to have non-obstructive coronary artery disease more frequently than their male counterparts, both in stable and acute clinical settings. Although traditionally considered a relatively infrequent and low-risk form of myocardial ischemia, its impact on clinical practice is undeniable, especially when it comes to infarction, where the prognosis is not as benign as previously assumed. Unfortunately, despite increasing awareness, there are still several questions left unanswered regarding diagnosis, risk stratification and treatment. The purpose of this review is to provide a state of the art and an update on current evidence available on gender differences in clinical characteristics, management and prognosis of ischemic heart disease with non-obstructive coronary arteries, both in the acute and stable clinical setting.

Molecular Evaluation of MicroRNA-146 Gene Variability (rs2910164 C> G) and its Association with Increased Susceptibility to Coronary Artery Disease

MicroRNA ◽  
2020 ◽  
Vol 09 ◽  
Author(s):  
Rashid Mir ◽  
Imadeldin Elfaki ◽  
Chandan k Jha ◽  
Jamsheed Javid ◽  
Suriya Rehman ◽  
...  
Keyword(s):  
Coronary Artery Disease ◽  
Coronary Artery ◽  
Genetic Factors ◽  
Mirna Gene ◽  
Amplification Refractory Mutation System ◽  
Coronary Artery Diseases ◽  
Increased Risk ◽  
Inheritance Model ◽  
Artery Disease ◽  
Increased Susceptibility

Aim: Apart from the modifiable risk factors, genetic factors are believed to also influence the outcome of the coronary artery diseases (CAD). Under the genetic factors, miRNA polymorphisms, namely Hsa-miR-146a-5p (rs2910164) have become an important tool to study the mechanism that underlies the pathogenesis of this disease. Therefore, we investigated the association of miR-146a gene variations with susceptibility of coronary artery diseases. Methodology: This study was conducted on 100 CAD patients and 117 matched healthy individuals. Genotyping of the Hsa-miR-146a-5p C>G gene variation was performed by using amplification refractory mutation system PCR method (ARMS-PCR). Results: The distribution of Hsa-miR-146a-5p rs2910164 C>G genotypes observed between patients and controls was significantly different (P=0.048). Moreover, the frequency of G allele (fG) was found to be significantly higher among patients than in controls (0.36 vs. 0.25). Our findings showed that the Hsa-miR-146a-5p C>G variant was associated with an increased risk of CAD in codominant inheritance model CC vs. CG genotype (OR = 1.84, 95 % CI, 1.02-3.31; p=0.040) and (OR = 3.18, 95 % CI, 1.02-9.9; p=0.045) for CC vs. GG genotype in dominant inheritance model. Whereas the G allele significantly increased the risk of coronary artery disease (OR =1,81, 95 % CI, 1.18-2.78; p=0.006) compared to C allele. Taken together, these results demonstrated that miR-146a/rs2910164 is associated with susceptibility to coronary artery disease, providing novel insights into the genetic etiology and underlying biology of coronary artery disease. Conclusion: Our findings indicated that Hsa-miR-146a-5p rs2910164 GG genotype and G allele are associated with an increased susceptibility to Coronary Artery Disease. A larger sample size can be the key to progress in establishing the genetic co-relation of miRNA gene polymorphisms and cardiovascular diseases.

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