Aspirin withdrawal in high risk cardiac patients before the operation of total colectomy with resection of ileum: Case report

Coronary artery disease is one of the risk factors for myocardial infarction and it is present in 40% of patients who are undergoing noncardiac surgery. Despite evidence of the benefit of the antiplatelet therapy in patients at risk of cardiac complications, aspirin treatment is often discontinued before surgery due to the risk of perioperative bleeding. In many studies and meta-analysis it is shown that aspirin withdrawal in perioperative period was associated with three-fold higher risk of major adverse cardiac events. Perioperative continuation of aspirin increase the rate of bleeding by 1.5, but it doesn?t increase the level of the severity of bleeding complications. In perioperative periode aspirin is discontinued only if it is estimated that the bleeding risk is higher than the risk of thrombosis. In the paper authors present a case report of patient who developed a perioperative myocardial infarction as a consequence of aspirin withdrawal before total colectomy.

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Determination and Treatment of Disorders of Primary Haemostasis

Hämostaseologie ◽

10.1055/s-0038-1660415 ◽

1999 ◽

Vol 19 (04) ◽

pp. 168-175 ◽

Cited By ~ 6

Author(s):

M. Weippert-Kretschmer ◽

V. Kretschmer

Keyword(s):

Platelet Function ◽

Bleeding Risk ◽

Bleeding Complications ◽

Bleeding Tendency ◽

Platelet Counts ◽

Platelet Function Disorders ◽

Perioperative Bleeding ◽

Before And After ◽

Low Sensitivity

SummaryPerioperative bleeding complications due to disorders of primary haemostasis are often underestimated. Routine determination of primary haemostasis is still problematic. The in vivo bleeding time (BT) shows low sensitivity and high variability. In this contribution the results and experiences with the IVBT having been obtained in various studies and during 10 years of routine use are reported. Patients and Methods: Blood donors before and after ASA ingestion, patients with thrombocytopenia as well as congenital and acquired platelet function disorders. Monitoring of desmopressin efficacy. IVBT with Thrombostat 4000 (tests with CaCl2 = TST-CaCl2 and ADP = TST-ADP) and PFA-100 (test cartridges with epinephrine = PFA-EPI and ADP = PFA-ADP). Results and Conclusions: IVBT becomes abnormal with platelet counts <100,000/μl. With platelet counts <50,000/μl the results are mostly outside the methodical range. IVBT proved clearly superior to BT in von Willebrand syndrome (vWS). All 16 patients with vWS were detected by PFA-EPI, whereas with BT 7 of 10 patients with moderate and 1 of 6 patients with mild forms of vWS were spotted. The majority of acquired and congenital platelet function disorders with relevant bleeding tendency were detectable by IVBT. Sometimes diagnostic problems arose in case of storage pool defect. Four to 12 h after ingestion of a single dose of 100 mg ASA the TST-CaCl2 became abnormal in all cases, the PFA-EPI only in 80%. However, the ASA sensitivity of TST-CaCl2 proved even too high when looking for perioperative bleeding complications in an urological study. Therefore, the lower ASS sensitivity of the PFA-100 seems to be rather advantageous for the estimation of a real bleeding risk. The good efficacy of desmopressin in the majority of cases with mild thrombocytopenia, congenital and acquired platelet function disorders and even ASS-induced platelet dysfunction could be proven by means of the IVBT. Thus IVBT may help to increase the reliability of the therapy. However, the IVBT with the PFA-100 is not yet fully developed. Nevertheless, routine use can be recommended when special methodical guidelines are followed.

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P276 A meta-analysis on the association of febuxostat compared to allopurinol on blood pressure and major adverse cardiac events (MACE) among adult patients with hyperuricemia

European Heart Journal ◽

10.1093/ehjci/ehz872.097 ◽

2020 ◽

Vol 41 (Supplement_1) ◽

Author(s):

M Barrientos ◽

R A Macabeo ◽

R A Ragasa

Keyword(s):

Myocardial Infarction ◽

Blood Pressure ◽

Uric Acid ◽

Meta Analysis ◽

Adult Patients ◽

Cardiac Events ◽

Lowering Therapy ◽

Adverse Cardiac Events ◽

All Cause Mortality

Abstract Background Increased uric acid levels have been known to be associated with different cardiovascular and renal diseases. Over the last few years, several studies have examined the role of urate-lowering therapy (ULT) in hypertension and Major Adverse Cardiac Events (MACE) and results are pointing to a potential role of elevated serum uric acid as an emerging independent cardiovascular risk factor. Objective To determine if urate-lowering therapy (Febuxostat vs Allopurinol) has an association on blood pressure and MACE among adult patients with hyperuricemia. Methodology Randomized controlled trials with outcomes of blood pressure, all-cause mortality, myocardial infarction, and stroke were searched through PubMed and Cochrane database. Results Pooled analysis of studies on hyperuricemic patients showed that Febuxostat 40 mg has no significant difference compared with Allopurinol 100/300mg with respect to lowering diastolic (MD -0.56 with 95% CI of -4.28 to 3.15) and systolic blood pressure (MD -0.72 with 95% CI of -4.87 to 6.31). No significant differences were also noted on all-cause mortality (OR 1.21 with 95% CI of 0.35 to 4.12) and myocardial infarction (MI) (OR 1.38 with 95% CI of 0.19 to 9.94). Outcomes on non-fatal stroke were only reported by Becker, et. al (2010) with only 2 events reported in the Febuxostat 80 mg group (0.26%) and no event in the Allopurinol group (CI= 0.082 to 1.155). Conclusion The results of this meta-analysis showed that urate-lowering therapy (Febuxostat vs Allopurinol) has no significant association on blood pressure among adult patients with hyperuricemia. No significant association was also found with respect to all-cause mortality and MI. Outcomes on stroke were inconclusive since only one study reported on its events.

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Current Concepts on Antiplatelet Therapy: Focus on the Novel Thienopyridine and Non-Thienopyridine Agents

Advances in Hematology ◽

10.1155/2010/595934 ◽

2010 ◽

Vol 2010 ◽

pp. 1-7 ◽

Cited By ~ 7

Author(s):

L. Testa ◽

G. G. L. Biondi Zoccai ◽

M. Valgimigli ◽

R. A. Latini ◽

S. Pizzocri ◽

...

Keyword(s):

Myocardial Infarction ◽

Clinical Practice ◽

Drug Targeting ◽

Bleeding Risk ◽

Daily Practice ◽

Adenosine Diphosphate ◽

Bleeding Complications ◽

The Novel ◽

Platelet Activity ◽

Risk Of Bleeding

Thienopyridines are a class of drug targeting the platelet adenosine diphosphate (ADP) 2 receptor. They significantly reduce platelet activity and are therefore clinically beneficial in settings where platelet activation is a key pathophysiological feature, particularly myocardial infarction. Ticlopidine, the first of the class introduced to clinical practice, was soon challenged and almost completely replaced by clopidogrel for its better tolerability. More recently, prasugrel and ticagrelor have been shown to provide a more powerful antiplatelet action compared to clopidogrel but at a cost of higher risk of bleeding complications. Cangrelor, a molecule very similar to ticagrelor, is currently being evaluated against clopidogrel. Considering the key balance of ischemic protection and bleeding risk, this paper discusses the background to the development of prasugrel, ticagrelor, and cangrelor and aims to characterise their risk-benefit profile and possible implementation in daily practice.

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Carotid Endarterectomy Versus Stenting: A Meta-Analysis of Randomized Trials

Canadian Journal of Neurological Sciences / Journal Canadien des Sciences Neurologiques ◽

10.1017/s0317167100011380 ◽

2011 ◽

Vol 38 (2) ◽

pp. 230-235 ◽

Cited By ~ 29

Author(s):

Daniel Yavin ◽

Derek J. Roberts ◽

Michael Tso ◽

Garnette R. Sutherland ◽

Misha Eliasziw ◽

...

Keyword(s):

Myocardial Infarction ◽

Carotid Artery ◽

Carotid Endarterectomy ◽

Carotid Artery Stenosis ◽

Carotid Artery Stenting ◽

Meta Analysis ◽

Artery Stenosis ◽

Cranial Neuropathy ◽

Cardiac Complications ◽

Lower Odds

Background:A meta-analysis of randomized controlled trials (RCTs) was conducted to update the available evidence on the safety and efficacy of carotid endarterectomy (CEA) versus carotid artery stenting (CAS) in the treatment of carotid artery stenosis.Methods:A comprehensive search was performed of MEDLINE, EMBASE, CENTRAL, bibliographies of included articles and past systematic reviews, and abstract lists of recent scientific conferences. For each reported outcome, a Mantel-Haenszel random-effects model was used to calculate odds ratios (ORs) and 95% confidence intervals (CI). The I2 statistic was used as a measure of heterogeneity.Results:Twelve RCTs enrolling 6,973 patients were included in the meta-analysis. Carotid artery stenting was associated with a significantly greater odds of periprocedural stroke (OR 1.72, 95% CI 1.20 to 2.47) and a significantly lower odds of periprocedural myocardial infarction (OR 0.47, 95% CI 0.29 to 0.78) and cranial neuropathy (OR 0.08, 95% CI, 0.04 to 0.16). The odds of periprocedural death (OR 1.11, 95% CI 0.56 to 2.18), target vessel restenosis (OR 1.95, 95% CI 0.63 to 6.06), and access-related hematoma were similar following either intervention (OR 0.60, 95% CI 0.30 to 1.21).Conclusions:In comparison with CEA, CAS is associated with a greater odds of stroke and a lower odds of myocardial infarction. While the results our meta-analysis support the continued use of CEA as the standard of care in the treatment of carotid artery stenosis, CAS is a viable alternative in patients at elevated risk of cardiac complications.

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Meta-analysis and systematic review of the cardiotoxicity of TAS-102.

Journal of Clinical Oncology ◽

10.1200/jco.2020.38.15_suppl.e16053 ◽

2020 ◽

Vol 38 (15_suppl) ◽

pp. e16053-e16053 ◽

Cited By ~ 2

Author(s):

Carlos Alberto Lopez ◽

Elham Azimi-Nekoo ◽

Su Yun Chung ◽

James Newman ◽

Janice Shen ◽

...

Keyword(s):

Myocardial Infarction ◽

Systematic Review ◽

Phase I ◽

Phase Ii ◽

Literature Search ◽

Meta Analysis ◽

Phase Iii ◽

Cardiac Events ◽

Phase Ii Studies ◽

Increased Risk

e16053 Background: Fluoropyrimidines such as 5-FU and capecitabine are known to be cardiotoxic drugs. TAS-102 (trifluridine-tipiracil) is a novel oral fluoropyrimidine that was recently FDA approved to treat gastric and colon cancer. However, the incidence of cardiac related events of TAS-102 is not fully ascertained. We performed a meta-analysis and systematic review to determine the incidence of cardiotoxic events associated with TAS-102. Methods: We performed a literature search through PubMed, Embase, and Web of Science to identify any publications in any language up to December 31st, 2019 where TAS-102 (and equivalent terms such as “trifluridine-tipiracil” and “Lonsurf”) was used. These were then manually reviewed to identify any publications reporting cardiac events. Randomized controlled trials (RCTs) were included for meta-analysis to determine the incidence of cardiotoxic events, which were summarized as pooled odds ratios (OR) when compared to placebo. Non-randomized, non-controlled clinical trials (phase I and phase II studies) were included in the systematic review but excluded from the pooled OR calculation. Results: 869 publications were identified in the initial literature search, of which 17 trials (3 Phase III studies, 6 Phase II studies, and 8 phase I studies) met inclusion criteria. A total of 1,877 patients among 4 RCTs were included in the meta-analysis. Compared with placebo, TAS-102 did not increase the risk of myocardial infarction (OR 1.97 95% CI [0.22-17.89]), hypertension (OR 0.73 95% CI [0.37, 1.44]), palpitations (OR 1.51 95% CI [0.30, 7.56]), cardio-pulmonary arrest (OR 0.83 95% CI [0.11-6.32]), or syncope (OR 1.50 95% CI [0.06-37.14]). Among the 1,252 patients receiving TAS-102, the overall incidence of cardiovascular events was low, with hypertension being the most common side effect (21 events), followed by palpitations (6 events), cardiopulmonary arrest (2 events), and myocardial infarction (3 events), though there was no statistically significant increased risk compared to placebo. No deaths were reported. Conclusions: Unlike other fluoropyrimidines, TAS-102 appears to be a cardiogentle drug, with no increased risk of cardiac events compared to placebo. Since fluoropyrimidines remain the backbone of treatment for gastrointestinal malignancies, TAS-102 can offer an alternative to patients who developed cardiotoxicities from other agents. Prospective studies with consideration of cardiac risk factors are required.

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Rivaroxaban as an Antithrombotic Agent in a Patient With ST-Segment Elevation Myocardial Infarction and Left Ventricular Thrombus

Journal of Investigative Medicine High Impact Case Reports ◽

10.1177/2324709617697991 ◽

2017 ◽

Vol 5 (1) ◽

pp. 232470961769799 ◽

Cited By ~ 9

Author(s):

Rajeev Seecheran ◽

Valmiki Seecheran ◽

Sangeeta Persad ◽

Naveen Anand Seecheran

Keyword(s):

Myocardial Infarction ◽

Bleeding Risk ◽

Coronary Intervention ◽

Left Ventricular ◽

Bleeding Complications ◽

Factor X ◽

Anterior Myocardial Infarction ◽

Antithrombotic Agent ◽

St Segment Elevation ◽

St Segment

The incidence of left ventricular (LV) thrombi in the setting of an anterior myocardial infarction has declined significantly since the advent of primary percutaneous coronary intervention coupled with contemporary antithrombotic strategies in ST-segment elevation myocardial infarctions (STE-ACS). Despite oral anticoagulation with the currently accepted, standard-of-care vitamin K antagonist, warfarin, major bleeding complications still arise. Rivaroxaban is a novel, direct oral factor X anticoagulant that has several advantageous properties, which can attenuate bleeding risk. We present a case in which a patient successfully underwent a 3-month course of rivaroxaban in addition to his dual antiplatelet regimen of aspirin and ticagrelor for his STE-ACS and LV thrombus with resultant complete dissolution.

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Bleeding and ischaemic outcomes in patients treated with dual or triple antithrombotic therapy: systematic review and meta-analysis

European Heart Journal - Cardiovascular Pharmacotherapy ◽

10.1093/ehjcvp/pvz021 ◽

2019 ◽

Vol 5 (4) ◽

pp. 226-236 ◽

Cited By ~ 8

Author(s):

Paul M Haller ◽

Patrick Sulzgruber ◽

Christoph Kaufmann ◽

Bastiaan Geelhoed ◽

Juan Tamargo ◽

...

Keyword(s):

Myocardial Infarction ◽

Stent Thrombosis ◽

Antithrombotic Therapy ◽

Meta Analysis ◽

Bleeding Risk ◽

Coronary Intervention ◽

Power Calculation ◽

Coronary Syndrome ◽

High Bleeding Risk ◽

Triple Antithrombotic Therapy

Abstract Aims The combination of oral anticoagulation with a P2Y12 inhibitor and aspirin in patients with atrial fibrillation (AF) undergoing percutaneous coronary intervention (PCI) is associated with a high bleeding risk. Dual antithrombotic therapy (DAT) with omission of aspirin is a promising option to reduce bleedings, but carries a yet unknown risk of ischaemic events. We therefore sought to systematically review and analyse randomized controlled trials investigating DAT vs. triple antithrombotic therapy (TAT) in patients with AF following PCI and/or acute coronary syndrome (ACS). Methods and results We included four trials with overall 9317 patients (5039 DAT, 4278 TAT) in our analysis. Dual antithrombotic therapy was associated with a significant reduction in thrombolysis in myocardial infarction major bleeding [hazard ratio (HR) 0.52, 95% confidence interval (CI) 0.42–0.65; P = 0.0001], while the composite trial-defined ischaemic endpoint did not differ significantly between DAT and TAT (HR 0.98, 95% CI 0.79–1.22; P = 0.88). There was also no difference regarding the occurrence of myocardial infarction (MI; HR 1.16, 95% CI 0.92–1.46; P = 0.21) or stent thrombosis (HR 1.25, 95% CI 0.69–2.26; P = 0.46). Absolute numbers for MI were 131/4278 (3.1%) with TAT and 182/5039 (3.6%) with DAT, and for stent thrombosis 32/4278 (0.75%) and 52/5039 (1%), respectively. A post hoc power calculation based on the size and event rate of this meta-analysis revealed 80% power to detect a 37% and 100% increase in MI and stent thrombosis, respectively. Conclusion Dual antithrombotic therapy significantly reduces bleedings compared with TAT and seems to have a similar effect in preventing ischaemic endpoints in AF patients post-PCI or ACS. Future investigations are needed to determine its applicability specifically in patients at high risk of ischaemic outcomes.

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54: Effect of fish oil supplementation on secondary prevention of myocardial infarction and major adverse cardiac events; a meta analysis

Journal of Clinical Lipidology ◽

10.1016/j.jacl.2008.08.056 ◽

2008 ◽

Vol 2 (5) ◽

pp. S25

Keyword(s):

Myocardial Infarction ◽

Secondary Prevention ◽

Fish Oil ◽

Meta Analysis ◽

Major Adverse Cardiac Events ◽

Cardiac Events ◽

Adverse Cardiac Events ◽

Fish Oil Supplementation

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Abstract 18745: Major Adverse Cardiac Events After Non-cardiac Surgery Following Previous Percutaneous Coronary Intervention With Stent Implantation

Circulation ◽

10.1161/circ.130.suppl_2.18745 ◽

2014 ◽

Vol 130 (suppl_2) ◽

Author(s):

Marcin Wasowicz ◽

Summer Syed ◽

Lukasz Starzyk ◽

Duminda Wijeysundera ◽

Scott W Beattie

Keyword(s):

Cardiac Surgery ◽

Stent Implantation ◽

Clinical Symptoms ◽

Risk Index ◽

Perioperative Period ◽

Coronary Intervention ◽

Platelet Inhibition ◽

Bleeding Complications ◽

Cardiac Events ◽

Percutaneous Coronary

Introduction: It is estimated that 5-16% of patients (pts) previously treated with percutaneous coronary interventions (PCI) and stent implantation will present for elective non-cardiac surgery (NCS) within 1 year. Despite ACC/AHA recommendations on antiplatelet therapy (ATP) the incidence of perioperative major cardiovascular events (MACE) is high. The objective of this multi-center prospective, cohort study was to determine if APT continued throughout perioperative period decreases the incidence of MI in this population and to determine the mechanism of MACE in post-PCI pts undergoing NCS. Hypothesis: There is an association between inadequate platelet inhibition and the incidence of MACE in pts undergoing NCS after previous PCI. Method: After REB approval pts after previous PCI scheduled for elective NCS were recruited. The primary outcome was Major Adverse Cardiac Event (defined as MI, stent thrombosis, need for revascularization or 30 day mortality). The incidence of MI was blindly adjudicated in duplicate using the 3 rd Univ. definition of MI. Troponin levels were measured every 8h for 2 days, then once daily until discharge in addition to ECG measurements. All pts patient was followed up for any clinical symptoms of MI. The location of MI was also judged based on its location (area of stent or not). The platelet inhibition by aspirin (ASA) and/or clopidogrel was measured using the Platelet Mapping Assay (PMA) performed preoperatively, 1h and 24h after surgery. Results: A total of 201 pts were recruited. The incidence of MACE was 21%. Additionally, 11 pts (5%) had isolated troponin elevation. The location of the MI occurred frequently in the area of the stent placement (71%). Pts. exposed to ASA with 5 days of surgery had better platelet inhibition than pts no exposed. There was no difference in platelet inhibition between pts suffering from MI and those who did not. Several factors were associated with increased MACE. These included higher Revised Cardiac Risk Index and pre- and post-operative anemia. 30 patients (15%) suffered from major bleeding complications. Conclusions: Results of this study indicated that use of ASA, or its withdrawal, was not associated with MACE in post PCI patients undergoing NCS.

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