Antiplatelet Therapy for Secondary Prevention of Acute Coronary Syndrome, Transient Ischemic Attack, and Noncardioembolic Stroke in an Era of Cost Containment

2012 ◽  
Vol 60 (5) ◽  
pp. 792-800 ◽  
Author(s):  
Chad Kessler ◽  
Kurian Thomas ◽  
John Kao
Keyword(s):  
Acute Coronary Syndrome ◽  
Secondary Prevention ◽  
Antiplatelet Therapy ◽  
Transient Ischemic Attack ◽  
Cost Containment ◽  
Coronary Syndrome ◽  
Ischemic Attack

scholarly journals CHA2DS2-VASc risk factors as predictors of stroke after acute coronary syndrome: A systematic review and meta-analysis

2016 ◽  
Vol 7 (3) ◽  
pp. 264-274 ◽  
Author(s):  
Federico Guerra ◽  
Lorena Scappini ◽  
Alessandro Maolo ◽  
Gianluca Campo ◽  
Rita Pavasini ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Acute Coronary Syndrome ◽  
Confidence Interval ◽  
Transient Ischemic Attack ◽  
Odds Ratio ◽  
Observational Studies ◽  
Meta Analysis ◽  
Odds Ratios ◽  
Coronary Syndrome ◽  
Ischemic Attack

Background: Stroke is a rare but serious complication of acute coronary syndrome. At present, no specific score exists to identify patients at higher risk. The aim of the present study is to test whether each clinical variable included in the CHA2DS2-VASc score retains its predictive value in patients with recent acute coronary syndrome, irrespective of atrial fibrillation. Methods: The meta-analysis was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) and Meta-analysis of Observational Studies in Epidemiology (MOOSE) guidelines. All clinical trials and observational studies presenting data on the association between stroke/transient ischemic attack incidence and at least one CHA2DS2-VASc item in patients with a recent acute coronary syndrome were considered in the analysis. Atrial fibrillation diagnosis was also considered. Results: The whole cohort included 558,193 patients of which 7108 (1.3%) had an acute stroke and/or transient ischemic attack during follow-up (median nine months; 1st–3rd quartile 1–12 months). Age and previous stroke had the highest odds ratios (odds ratio 2.60; 95% confidence interval 2.21–3.06 and odds ratio 2.74; 95% confidence interval 2.19–3.42 respectively), in accordance with the two-point value given in the CHA2DS2-VASc score. All other factors were positively associated with stroke, although with lower odds ratios. Atrial fibrillation, while present in only 11.2% of the population, confirmed its association with an increased risk of stroke and/or transient ischemic attack (odds ratio 2.04; 95% confidence interval 1.71–2.44). Conclusions: All risk factors included in the CHA2DS2-VASc score are associated with stroke/ transient ischemic attack in patients with recent acute coronary syndrome, and retain similar odds ratios to what already seen in atrial fibrillation. The utility of CHA2DS2-VASc score for risk stratification of stroke in patients with acute coronary syndrome remains to be determined.

scholarly journals PCV68 COST-EFFECTIVENESS OF GENOTYPE-DRIVEN ANTIPLATELET THERAPY FOR SECONDARY PREVENTION AFTER ACUTE CORONARY SYNDROME

2010 ◽  
Vol 13 (3) ◽  
pp. A162
Author(s):  
DJ Crespin ◽  
JJ Federspiel ◽  
AK Biddle ◽  
D Jonas ◽  
SC Stearns ◽  
...  
Keyword(s):  
Acute Coronary Syndrome ◽  
Cost Effectiveness ◽  
Secondary Prevention ◽  
Antiplatelet Therapy ◽  
Coronary Syndrome

scholarly journals Acute coronary syndrome in a patient with transient ischemic attack: challenges of antithrombotic therapy (a clinical case)

2019 ◽  
Vol 11 (4) ◽  
pp. 156-159
Author(s):  
E. Yu. Kovalchuk ◽  
A. S. Povzun ◽  
V. A. Kostenko ◽  
A. V. Brega
Keyword(s):  
Acute Coronary Syndrome ◽  
Transient Ischemic Attack ◽  
Antithrombotic Therapy ◽  
Critically Ill Patient ◽  
Routine Practice ◽  
Coronary Syndrome ◽  
Incremental Approach ◽  
Potential Risks ◽  
Ischemic Attack ◽  
Triple Antithrombotic Therapy

The paper presents experience with antithrombotic therapy in a critically ill patient with acute coronary syndrome and transient ischemic attack. It characterizes problems in triple antithrombotic therapy in a very ill patient with comorbidity. The paper demonstrates an incremental approach to choosing therapy according to the clinical picture of disease, an assessment of risk factors for ischemic and hemorrhagic complications over time, which is very important in the routine practice of a physician. It also shows how, based on existing recommendations, the optimal anticoagulant is chosen as part of triple and double antithrombotic therapy in terms of its potential risks and possible complications.

New Antiplatelet Drugs in Perspective

2011 ◽  
Vol 7 (3) ◽  
pp. 216
Author(s):  
Diego Penela ◽  
Maríbel Diaz-Ricart ◽  
Magda Heras ◽  
◽  
◽  
...  
Keyword(s):  
Acute Coronary Syndrome ◽  
Secondary Prevention ◽  
Antiplatelet Therapy ◽  
Acute Phase ◽  
Platelet Inhibition ◽  
Antiplatelet Drugs ◽  
Coronary Syndrome ◽  
Urgent Surgery

Treatment with antiplatelet therapy is mandatory in acute coronary syndrome. The effectiveness of aspirin and clopidogrel both in the acute phase and in secondary prevention has been clearly demonstrated, although some problems have also arisen, such as variability of platelet inhibition with clopidogrel or increased bleeding in patients undergoing urgent surgery. New antiplatelet drugs have been tested and are currently incorporated into the therapeutic armamentarium. Their different pharmacokinetic and pharmacodynamic properties are a good addition to the classic antiplatelet therapy, overcoming some of its limitations. In this context, the choice of appropriate antiplatelet therapy requires an individualised approach. The aim of this article is to summarise existing evidence and highlight the main features of the new antiplatelet drugs, as well as offering a vision of some challenges in the use of this therapy.

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