scholarly journals New Antithrombotic Drugs in Acute Coronary Syndrome

2020 ◽  
Vol 9 (7) ◽  
pp. 2059
Author(s):  
Bastiaan Zwart ◽  
William A. E. Parker ◽  
Robert F. Storey
Keyword(s):  
Acute Coronary Syndrome ◽  
Bleeding Risk ◽  
Antithrombotic Drugs ◽  
P2y12 Inhibitors ◽  
Coronary Syndrome ◽  
Anticoagulant Drugs ◽  
Antithrombotic Efficacy ◽  
Made In

In recent years, much progress has been made in the field of antithrombotic drugs in acute coronary syndrome (ACS) treatment, as reflected by the introduction of the more potent P2Y12-inhibitors prasugrel and ticagrelor, and novel forms of concomitant anticoagulation, such as fondaparinux and bivalirudin. However, despite substantial improvements in contemporary ACS treatment, there remains residual ischemic risk in this group and hence the need for even more effective antithrombotic drugs, while balancing antithrombotic efficacy against bleeding risk. This review discusses recently introduced and currently developed antiplatelet and anticoagulant drugs in ACS treatment.

scholarly journals Antithrombotic Therapy in Patients with Atrial Fibrillation and Acute Coronary Syndrome

2020 ◽  
Vol 9 (7) ◽  
pp. 2020
Author(s):  
Wilbert Bor ◽  
Diana A. Gorog
Keyword(s):  
Atrial Fibrillation ◽  
Acute Coronary Syndrome ◽  
Combination Therapy ◽  
Bleeding Risk ◽  
Careful Consideration ◽  
P2y12 Inhibitor ◽  
Coronary Syndrome ◽  
Antithrombotic Efficacy ◽  
Selection Of ◽  
Made In

Acute coronary syndrome and atrial fibrillation are both common and can occur in the same patient. Combination therapy with dual antiplatelet therapy and oral anticoagulation increases risk of bleeding. Where the two conditions coexist, careful consideration is needed to determine the optimal antithrombotic treatment to reduce the risks of future ischaemic events associated with both conditions. Choices can be made in intraprocedural anticoagulation, type and dosing of oral anticoagulant, duration of combination therapy, and selection of P2Y12 inhibitor including genetic testing. This review article provides an overview of the available evidence to support clinicians in finding the delicate balance between antithrombotic efficacy and bleeding risk in patients with acute coronary syndrome and atrial fibrillation.

scholarly journals Diagnosis and Management of Acute Coronary Syndrome: What is New and Why? Insight From the 2020 European Society of Cardiology Guidelines

2020 ◽  
Vol 9 (11) ◽  
pp. 3474
Author(s):  
Paul Guedeney ◽  
Jean-Philippe Collet
Keyword(s):  
Acute Coronary Syndrome ◽  
European Society ◽  
Bleeding Risk ◽  
St Segment Elevation ◽  
P2y12 Inhibitors ◽  
Diagnosis And Management ◽  
Coronary Syndrome ◽  
St Segment ◽  
European Society Of Cardiology ◽  
Rule Out

The management of acute coronary syndrome (ACS) has been at the center of an impressive amount of research leading to a significant improvement in outcomes over the last 50 years. The 2020 European Society of Cardiology (ESC) Guidelines for the management of patients presenting without persistent ST-segment elevation myocardial infarction have incorporated the most recent breakthroughs and updates from large randomized controlled trials (RCT) on the diagnosis and management of this disease. The purpose of the present review is to describe the main novelties and the rationale behind these recommendations. Hence, we describe the accumulating evidence against P2Y12 receptors inhibitors pretreatment prior to coronary angiography, the preference for prasugrel as leading P2Y12 inhibitors in the setting of ACS, and the numerous available antithrombotic regimens based on various durations of dual or triple antithrombotic therapy, according to the patient ischemic and bleeding risk profiles. We also detail the recently implemented 0 h/1 h and 0 h/2 h rule in, rule out algorithms and the growing role of computed coronary tomography angiography to rule out ACS in patients at low-to-moderate risk.

scholarly journals Efficacy and safety of newer P2Y12 inhibitors for acute coronary syndrome: a network meta-analysis

2020 ◽  
Vol 10 (1) ◽  
Author(s):  
Yue Fei ◽  
Cheuk Kiu Lam ◽  
Bernard Man Yung Cheung
Keyword(s):  
Myocardial Infarction ◽  
Acute Coronary Syndrome ◽  
Cardiovascular Events ◽  
Meta Analysis ◽  
Bleeding Risk ◽  
Antiplatelet Drug ◽  
Major Adverse Cardiovascular Events ◽  
Minor Bleeding ◽  
P2y12 Inhibitors ◽  
Coronary Syndrome

Abstract Whether newer P2Y12 inhibitors are more efficacious and safer than clopidogrel and whether there is a superior one remain uncertain. We compared the effect of P2Y12 inhibitors on clinical outcomes in patients with acute coronary syndrome (ACS). Randomized controlled trials comparing clopidogrel, prasugrel, ticagrelor, or cangrelor, in combination with aspirin were searched. Sixteen trials with altogether 77,896 patients were included. Compared to clopidogrel, cardiovascular mortality was reduced with prasugrel (OR 0.85, 95% CI 0.75–0.97) and ticagrelor (0.82, 0.73–0.93). Myocardial infarction (0.75, 0.63–0.89) and major adverse cardiovascular events (0.80, 0.69–0.94) were reduced by prasugrel. Stent thrombosis was reduced by prasugrel (0.49, 0.38–0.63), ticagrelor (0.72, 0.57–0.90), and cangrelor (0.59, 0.43–0.81). It was reduced more by prasugrel than ticagrelor (0.69, 0.51–0.93). There were more major bleeds with prasugrel (1.24, 1.05–1.48). Thrombolysis in Myocardial Infarction (TIMI) major bleeding was increased with prasugrel compared to clopidogrel (1.36, 1.11–1.66) and ticagrelor (1.33, 1.06–1.67). TIMI minor bleeding was increased with prasugrel (1.44, 1.16–1.77) and cangrelor (1.47, 1.01–2.16) compared to clopidogrel while it was increased with prasugrel compared to ticagrelor (1.32, 1.01–1.72). Prasugrel is preferable to those ACS patients at low bleeding risk to reduce cardiovascular events whereas ticagrelor is a relatively safe antiplatelet drug of choice for most patients.

scholarly journals Combined Use of Warfarin and Oral P2Y12 Inhibitors in Patients With Atrial Fibrillation and Acute Coronary Syndrome

2013 ◽  
Vol 37 (3) ◽  
pp. 152-159 ◽  
Author(s):  
W. Schuyler Jones ◽  
Xiaojuan Mi ◽  
Manesh R. Patel ◽  
Roger Mills ◽  
Adrian F. Hernandez ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Acute Coronary Syndrome ◽  
P2y12 Inhibitors ◽  
Coronary Syndrome ◽  
Combined Use

scholarly journals P4650Ischemic and bleeding risk prediction in Acute Coronary Syndrome - The search for an almighty risk score

2017 ◽  
Vol 38 (suppl_1) ◽  
Author(s):  
M. Coutinho Cruz ◽  
A.T. Timoteo ◽  
R. Ilhao Moreira ◽  
S. Aguiar Rosa ◽  
L. Ferreira ◽  
...  
Keyword(s):  
Acute Coronary Syndrome ◽  
Risk Prediction ◽  
Risk Score ◽  
Bleeding Risk ◽  
Coronary Syndrome

Strangulated Morgagni hernia masquerading as an acute coronary syndrome

2021 ◽  
Vol 14 (7) ◽  
pp. e244045
Author(s):  
May Honey Ohn ◽  
Jun Rong Ng ◽  
Theviga Neela Mehan ◽  
Ng Pey Luen
Keyword(s):  
Acute Coronary Syndrome ◽  
Chest Pain ◽  
Surgical Repair ◽  
Bleeding Risk ◽  
Emergency Laparotomy ◽  
Morgagni Hernia ◽  
X Ray ◽  
Coronary Syndrome ◽  
The Right ◽  
Rule Out

Morgagni hernia is the rarest type of congenital diaphragmatic hernia, which can present late in adulthood. Here, we report a case of Morgagni hernia in an elderly woman who presented as an acute coronary syndrome with raised troponin level. X-ray of the chest (CXR) showed air–fluid level in the right lower hemithorax with loss of right diaphragmatic outline and subsequently confirmed strangulated Morgagni hernia with CT. She was treated with emergency laparotomy to reduce the hernia content and surgical repair with mesh done. In conclusion, Troponin can be falsely positive in Morgagni hernia patients, possibly due to strain on the heart by herniated bowel contents. Basic imaging such as a (CXR) is useful in the case of chest pain to rule out the non-cardiac causes. Although ‘time is the myocardium’ in the setting of all cases of chest pain with raised troponin, CXR should be done before treatment that poses bleeding risk and unnecessary delay in laparotomy.

461Modulation of ischemic and bleeding risk by peripheral artery disease after an acute coronary syndrome

2019 ◽  
Vol 40 (Supplement_1) ◽  
Author(s):  
M Cespon Fernandez ◽  
S Raposeiras Roubin ◽  
E Abu-Assi ◽  
S Manzano-Fernandez ◽  
F Dascenzo ◽  
...  
Keyword(s):  
Acute Coronary Syndrome ◽  
Peripheral Artery Disease ◽  
Cumulative Incidence ◽  
Bleeding Risk ◽  
Peripheral Artery ◽  
Data Set ◽  
Coronary Syndrome ◽  
Artery Disease ◽  
The Impact

Abstract Introduction Peripheral artery disease (PAD) is associated with heightened ischemic and bleeding risk in patients with acute coronary syndrome (ACS). With this study from real-life patients, we try to analyze the balance between ischemic and bleeding risk during treatment with dual antiplatelet therapy (DAPT) after an ACS according to the presence or not of PAD. 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 PAD. The impact of prior PAD 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 (AMI), whereas for bleeding risk we have considered major bleeding (MB) defined as bleeding requiring hospital admission. Follow-up time was censored by DAPT suspension/withdrawal. Results From the 26,076 ACS patients, 1,600 have PAD (6.1%). Patients with PAD were older, and with more cardiovascular risk factors. DAPT with prasugrel/ticagrelor was less frequently prescribed in patients with PAD in comparison with the rest of the population (8.2% vs 22.8%, p<0.001). During a mean follow-up of 12.2±4.8 months, 964 patients died (3.7%), and 640 AMI (2.5%) and 685 MB (2.6%) were reported. After propensity-score matching, we obtained two matched groups of 1,591 patients. Patients with PAD showed a significant higher risk of both AMI (sHR 2.17, 95% CI 1.51–3.10, p<0.001) and MB (sHR 1.51, 95% CI 1.07–2.12, p=0.018), in comparison with those without PAD. The cumulative incidence of AMI was 63.9 and 29.8 per 1,000 patients/year in patients with and without PAD, respectively. The cumulative incidence of MB was 55.9 and 37.6 per 1,000 patients/year in patients with and without PAD, respectively. The rate difference per 1,000 patient-years for AMI between patients with and without PAD was +34.1 (95% CI 30.1–38.1), and for MB +18.3 (16.1–20.4). The net balance between ischemic and bleeding events comparing patients with and without PAD was positive (+15.8 per 1,000 patients/year, 95% CI 9.7–22.0). Conclusions PAD was associated with higher ischemic and bleeding risk after hospital discharge for ACS treated with DAPT. However, the balance between ischemic and bleeding risk was positive for patients with PAD in comparison with patients without PAD. As summary, ACS patients with PAD had an ischemic risk greater than the bleeding risk.

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