Adjunctive Cilostazol to Dual Antiplatelet Therapy to Enhance Mobilization of Endothelial Progenitor Cell in Patients with Acute Myocardial Infarction: A Randomized, Placebo-Controlled EPISODE Trial

Background: Endothelial progenitor cells (EPCs) have the potential to protect against atherothrombotic event occurrences. There are no data to evaluate the impact of cilostazol on EPC levels in high-risk patients. Methods: We conducted a randomized, double-blind, placebo-controlled trial to assess the effect of adjunctive cilostazol on EPC mobilization and platelet reactivity in patients with acute myocardial infarction (AMI). Before discharge, patients undergoing percutaneous coronary intervention (PCI) were randomly assigned to receive cilostazol SR capsule (200-mg) a day (n = 30) or placebo (n = 30) on top of dual antiplatelet therapy (DAPT) with clopidogrel and aspirin. Before randomization (baseline) and at 30-day follow-up, circulating EPC levels were analyzed using flow cytometry and hemostatic measurements were evaluated by VerifyNow and thromboelastography assays. The primary endpoint was the relative change in EPC levels between baseline and 30-day. Results: At baseline, there were similar levels of EPC counts between treatments, whereas patients with cilostazol showed higher levels of EPC counts compared with placebo after 30 days. Cilostazol versus placebo treatment displayed significantly higher changes in EPC levels between baseline and follow-up (ΔCD133+/KDR+: difference 216%, 95% confidence interval (CI) 44~388%, p = 0.015; ΔCD34+/KDR+: difference 183%, 95% CI 25~342%, p = 0.024). At 30-day follow-up, platelet reactivity was lower in the cilostazol group compared with the placebo group (130 ± 45 versus 169 ± 62 P2Y12 Reaction Unit, p = 0.009). However, there were no significant correlations between the changes of EPC levels and platelet reactivity. Conclusion: Adjunctive cilostazol on top of clopidogrel and aspirin versus DAPT alone is associated with increased EPC mobilization and decreased platelet reactivity in AMI patients, suggesting its pleiotropic effects against atherothrombotic events (NCT04407312).

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P3843Ischemic-bleeding balance according to history of prior bleeding in patients with acute coronary syndrome during treatment with dual antiplatelet therapy

European Heart Journal ◽

10.1093/eurheartj/ehz745.0684 ◽

2019 ◽

Vol 40 (Supplement_1) ◽

Author(s):

P Dominguez Erquicia ◽

S Raposeiras Roubin ◽

E Abu-Assi ◽

F D'Ascenzo ◽

S Manzano Fernandez ◽

...

Keyword(s):

Myocardial Infarction ◽

Antiplatelet Therapy ◽

Major Bleeding ◽

Cumulative Incidence ◽

Dual Antiplatelet Therapy ◽

Bleeding Risk ◽

Short Term ◽

History Of ◽

The Impact

Abstract Introduction ESC guidelines recommend short-term dual antiplatelet therapy (DAPT) in patients with high bleeding risk. In this sense, patients with prior admissions by bleeding are considered of high-risk of bleeding. With our study, we aimed to show the ischemic-bleeding profile of patients with prior bleeding in comparison with those without prior bleeding during treatment with DAPT. Methods The data analyzed in this study were obtained from the fusion of 3 clinical registries of ACS patients: BleeMACS (2004–2013), CardioCHUVI/ARRITXACA (2010–2016) and RENAMI (2013–2016). All 3 registries include consecutive patients discharged after an ACS with DAPT and undergoing PCI. The merged data set contain 26,076 patients. A propensity-matched analysis was performed to match the baseline characteristics of patients with and without prior admission by bleeding. The impact of prior prior bleeding in the ischemic and bleeding risk was assessed by a competitive risk analysis, using a Fine and Gray regression model, with death being the competitive event. For ischemic risk we have considered a new acute myocardial infarction, whereas for bleeding risk we have considered major bleeding defined as bleeding requiring hospital admission. Follow-up time was censored by DAPT suspension/withdrawal. Results From the 26,076 ACS patients, 1,105 have PAD (4.2%). During a mean follow-up of 12.2±4.8 months, 964 patients died (3.7%), 640 had myocardial infarction (2.5%) and 685 had major bleeding (2.6%). After propensity-score matching, we obtained two matched groups of 1,101 patients. In comparison with patients without prior bleeding, those with prior bleeding had higher risk of major bleeding (sHR 2.03, 95% CI 1.33–3.11, p=0.001) with similar risk of myocardial infarction (sHR 0.98, 95% CI 0.61–1.59, p=0.945), in comparison with those without PAD. The cumulative incidence of myocardial infarction was 31 and 32 per 1,000 patients/year in patients with and without prior bleeding, respectively. The cumulative incidence of major bleeding was 63 and 29 per 1,000 patients/year in patients with and without prior bleeding, respectively. The difference between myocardial infarction rate and major bleeding rate was −32 and +3 per 1,000 patient-years in patients with and without prior bleeding (Figure). Conclusions Patients with ACS and prior history of bleeding have a significant increment of bleeding risk during treatment with DAPT. In these patients, short-term DAPT (6 months) should be recommended.

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Association of CYP2C19*2 polymorphisms and high on-treatment platelet reactivity in acute myocardial infarction or coronary artery in-stent restenosis patients during dual antiplatelet therapy

Medicine in Drug Discovery ◽

10.1016/j.medidd.2020.100038 ◽

2020 ◽

Vol 6 ◽

pp. 100038

Author(s):

Yawei Yang ◽

Wei Zhang ◽

Pan Li ◽

Ying Gu ◽

Liping Ma ◽

...

Keyword(s):

Myocardial Infarction ◽

Acute Myocardial Infarction ◽

Coronary Artery ◽

Antiplatelet Therapy ◽

Dual Antiplatelet Therapy ◽

Platelet Reactivity ◽

Stent Restenosis ◽

In Stent Restenosis

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Impact of preprocedural coronary flow grade on duration of dual antiplatelet therapy in acute myocardial infarction

Scientific Reports ◽

10.1038/s41598-021-91130-5 ◽

2021 ◽

Vol 11 (1) ◽

Author(s):

Yong Hoon Kim ◽

Ae-Young Her ◽

Byeong-Keuk Kim ◽

Sung-Jin Hong ◽

Chul-Min Ahn ◽

...

Keyword(s):

Myocardial Infarction ◽

Acute Myocardial Infarction ◽

Antiplatelet Therapy ◽

Dual Antiplatelet Therapy ◽

Minor Bleeding ◽

Bleeding Tendency ◽

Unique Identifier ◽

Clinical Trial Registration ◽

Timi Flow Grade ◽

The Impact

AbstractWe investigated the impact of pre-percutaneous coronary intervention (pre-PCI) thrombolysis in myocardial infarction (TIMI) flow grade (pre-TIMI) on 3-month (3-mo) and 12-mo of dual antiplatelet therapy (DAPT) in patients with acute myocardial infarction (AMI). This was a post hoc analysis of the TICO trial. A total of 2083 patients with AMI (pre-TIMI 0/1: n = 1143; pre-TIMI 2/3: n = 940) were evaluated. The primary outcome was the occurrence of net adverse clinical events (NACE), defined as a composite of TIMI major bleeding and major adverse cardiac and cerebrovascular events (MACCE) within 12-mo following PCI. The secondary outcomes were the occurrence of the individual components of TIMI bleedings and MACCE. In the pre-TIMI 0/1 group, the primary and second outcomes were not significantly different between the 3-mo and 12-mo DAPT groups. However, in the pre-TIMI 2/3 group, the occurrences of TIMI minor (adjusted hazard ratio [aHR]: 0.294; p = 0.016) and major or minor bleeding (aHR: 0.483; p = 0.014) on intention-to-treat analysis were significantly higher in the 12-mo than in the 3-mo DAPT group. The occurrence of MACCE was similar between the two groups. A higher bleeding tendency in 12-mo DAPT compared with 3-mo DAPT was more obvious in the pre-TIMI 2/3 group than in the pre-TIMI 0/1 group.Clinical Trial Registration: URL: http://www.clinicaltrials.gov. Unique identifier: NCT02494895.

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PCV15 POTENTIAL IMPACT OF PROLONGED DUAL ANTIPLATELET THERAPY WITH TICAGRELOR IN 'REAL WORLD' STABLE PATIENTS AFTER ACUTE MYOCARDIAL INFARCTION VERSUS RANDOMIZED CONTROLLED TRIAL POPULATIONS

Value in Health ◽

10.1016/j.jval.2019.09.740 ◽

2019 ◽

Vol 22 ◽

pp. S544

Author(s):

B. Yan ◽

C.K.Y. Chan ◽

D.J.L. Xu ◽

W.H.S. Lai ◽

O.T.L. To

Keyword(s):

Myocardial Infarction ◽

Acute Myocardial Infarction ◽

Randomized Controlled Trial ◽

Antiplatelet Therapy ◽

Real World ◽

Dual Antiplatelet Therapy ◽

Controlled Trial ◽

Randomized Controlled ◽

Potential Impact

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Prehospital fibrinolysis with dual antiplatelet therapy in ST-elevation acute myocardial infarction: a substudy of the randomized double blind CLARITY-TIMI 28 trial

Journal of Thrombosis and Thrombolysis ◽

10.1007/s11239-006-9047-y ◽

2006 ◽

Vol 23 (3) ◽

pp. 173-179 ◽

Cited By ~ 22

Author(s):

Freek W. A. Verheugt ◽

Gilles Montalescot ◽

Marc S. Sabatine ◽

Louis Soulat ◽

Yves Lambert ◽

...

Keyword(s):

Myocardial Infarction ◽

Acute Myocardial Infarction ◽

Antiplatelet Therapy ◽

Dual Antiplatelet Therapy ◽

Double Blind ◽

St Elevation ◽

Elevation Acute Myocardial Infarction

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The Clinical Impact of Proton Pump Inhibitors When Co-Administered With Dual Antiplatelet Therapy in Patients Having Acute Myocardial Infarction With Low Risk of Gastrointestinal Bleeding: Insights From the China Acute Myocardial Infarction Registry

Frontiers in Cardiovascular Medicine ◽

10.3389/fcvm.2021.685072 ◽

2021 ◽

Vol 8 ◽

Author(s):

Wence Shi ◽

Lin Ni ◽

Jingang Yang ◽

Xiaoxue Fan ◽

Mei Yu ◽

...

Keyword(s):

Myocardial Infarction ◽

Acute Myocardial Infarction ◽

Gastrointestinal Bleeding ◽

Protective Effect ◽

Antiplatelet Therapy ◽

Proton Pump ◽

Dual Antiplatelet Therapy ◽

Low Risk ◽

Increased Risk

Background: The latest guidelines recommend the use of proton pump inhibitors (PPIs) to minimize gastrointestinal bleeding (GIB) in patients receiving dual antiplatelet therapy (DAPT), even though this co-administration may increase the risk of ischemia due to drug interactions. We have noticed that there are few studies conducted on patients with a lower risk of GIB. Therefore, we investigated the clinical effect of co-administration of PPI on DAPT patients with low GIB risk.Methods and Results: From January 2013 to September 2014, a total of 17,274 consecutive patients on DAPT from 108 hospitals with low risk for GIB in the China Acute Myocardial Infarction (CAMI) registry were analyzed. The primary endpoints were GIB and major adverse cardiovascular and cerebrovascular events (MACCE). Multivariate logistic regression analysis and Cox proportional hazard models were used to assess the effect of PPIs use. Of the analyzed patients, 66.6% (n = 11,487) were treated with PPIs. PPI use did not show an extra gastrointestinal protective effect in patients with low risk for GIB who were hospitalized and on follow-up after 2 years. Moreover, it was associated with an increased risk of stroke during the 2-year follow-up [hazard ratio (HR) 2.072, 95% confidence interval (CI) 1.388–3.091, p = 0.0003] and an increased risk of MI after 6 months (HR 1.580, 95% CI 1.102–2.265, p = 0.0119). We found the same results after propensity score matching.Conclusion: PPI use is prevalent in DAPT patients with low GIB risk. PPIs did not show an extra gastrointestinal protective effect, while an increased risk of stroke was observed during the 2-year follow-up.Clinical Trial Registration:www.clinicaltrials.gov, identifier NCT01874691.

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