scholarly journals Dual Antiplatelet Therapy in Secondary Prevention of Ischemic Stroke: A Ghost from the Past or a New Frontier?

2010 ◽  
Vol 2010 ◽  
pp. 1-8
Author(s):  
Clotilde Balucani ◽  
Kristian Barlinn ◽  
Zeljko Zivanovic ◽  
Lucilla Parnetti ◽  
Mauro Silvestrini ◽  
...  
Keyword(s):  
Clinical Trials ◽  
Secondary Prevention ◽  
Extended Release ◽  
Standard Of Care ◽  
Antiplatelet Agents ◽  
Minor Stroke ◽  
Early Management ◽  
New Frontier ◽  
Ischemic Events

With majority of ischemic strokes attributable to atherothrombosis and many being predictable after transient ischemic attacks (TIA), the role of early secondary prevention with antiplatelet agents is under renewed investigation. Prior major clinical trials of various secondary stroke prevention regimens pointed to a greater efficacy of dual antiplatelet agents if initiated early from symptom onset. This paper examines data and rationale behind dual antiplatelet regimens across the completed clinical trials. The safety of dual antiplatelets approach is of concern, but it could be outweighed, at least in early management, by a greater reduction in recurrence of ischemic events since this risk is “front loaded” after minor stroke or TIA. Aspirin monotherapy, though considered standard of care, is compared to aspirin-extended release dipiridamole and its combination with clopidogrel in early-phase completed and efficacy-phase ongoing clinical trials.

Updates in Local-Regionally Advanced Non–Small Cell Lung Cancer

2019 ◽  
pp. 553-562 ◽  
Author(s):  
Anne S. Tsao ◽  
Shruti Jolly ◽  
Jay M. Lee
Keyword(s):  
Lung Cancer ◽  
Clinical Trials ◽  
Small Cell Lung Cancer ◽  
Cell Lung Cancer ◽  
Advanced Nsclc ◽  
Early Stage ◽  
Standard Of Care ◽  
Small Cell ◽  
Small Cell Lung

The landscape for therapy in local-regionally advanced non–small cell lung cancer (NSCLC) has shifted dramatically in the last year as a result of the PACIFIC trial, which demonstrated a significant survival benefit with the addition of 1 year of durvalumab after concurrent chemoradiation. This is a new standard of care for unresectable local-regionally advanced NSCLC and is the first trial to show that immunotherapy can increase survival in earlier-stage NSCLC. Several clinical trials are underway or in development to explore the role of adding immunotherapy to concurrent chemoradiation, followed by a year of immunotherapy or to even replace chemotherapy in this treatment paradigm. In resectable disease, adjuvant chemotherapy is still the standard of care for stage IB (tumors ≥ 4 cm) through stage III disease. However, new studies are investigating the role of adding immunotherapy to neoadjuvant chemotherapy or as adjuvant therapy for 1 year after resection. Molecular profiling for early-stage disease is not currently the standard of care, but several national clinical trials are studying the benefit of adding adjuvant-targeted therapies. This article will detail the current standard practices in early-stage and local-regionally advanced NSCLC and describe the evolving strategies that are under investigation that may further refine our current practice.

scholarly journals Platelets, atherothrombosis, and atherosclerosis

2016 ◽  
Author(s):  
Karl Egan ◽  
Fionnuala Ni Ainle ◽  
Dermot Kenny
Keyword(s):  
Cardiovascular Disease ◽  
Antiplatelet Agents ◽  
Vascular Lesions ◽  
Atherosclerotic Plaques ◽  
Arterial Circulation ◽  
Chronic Inflammatory Condition ◽  
Artery Disease ◽  
Ischemic Events ◽  
Progression Of Atherosclerosis

Cardiovascular disease is the leading cause of morbidity and mortality worldwide. In 2008 alone, 17.3 million deaths (representing 30% of all deaths) were attributable to the complications of cardiovascular disease. Of these deaths, 7.3 million were due to coronary artery disease while 6.2 million were attributable to stroke. Cardiovascular disease is expected to remain the leading cause of death globally, with the number of deaths expected to reach 23.6 million annually by 2030 (WHO statistics, 2012). Vascular disease arises through the complications of atherosclerosis, a complex chronic inflammatory condition affecting the arterial circulation. It leads to the development of vascular lesions or atherosclerotic plaques, which manifest as asymmetrical thickenings of the intima of medium to large sized elastic and muscular arteries. Arterial thrombosis on ruptured atherosclerotic plaques can lead to acute events, such as myocardial infarction (MI) and ischemic stroke. Platelets are the key cellular component of arterial thrombi with platelet adhesion under high shear conditions being central to atherothrombosis. In addition, platelets play a role in the progression of atherosclerosis. In this review, we will discuss the evidence for the role of platelets in atherothrombosis, notably the efficacy of antiplatelet agents in the prevention of ischemic events, and finally their role in the progression of atherosclerosis (atherogenesis).

scholarly journals The Role of Antiplatelet agents in ischemic events

2021 ◽  
Vol 11 (4-S) ◽  
pp. 187-194
Author(s):  
Sara Shreen ◽  
Mohammed Baleeqh Uddin ◽  
Mir Salman Ali ◽  
Zoha Sultana
Keyword(s):  
Coronary Heart Disease ◽  
Heart Disease ◽  
Blood Vessel ◽  
Pharmacological Treatment ◽  
Antiplatelet Agents ◽  
Antiplatelet Treatment ◽  
Coronary Diseases ◽  
Ischemic Events ◽  
Dual Antiplatelet Treatment

Antiplatelet treatment could be a key in pharmacological treatment for avoidance of coronary heart disease (CHD) and stroke. Depending on sign, term of antiplatelet monotherapy or double treatment is shifted. Antiplatelet treatment is shown to avoid a repeat of cardiovascular occasion, in any case, expanded term of dual antiplatelet treatment (DAPT) related with expanded hazard of bleeding. Unstable angina happens due to partially or totally block of the blood coronary blood vessel driving to coronary ischaemia. Intense coronary infection happens due to drawn out coronary ischaemia which causes coronary diseases. Keywords: dual antiplatelet treatment (DAPT), coronary heart disease (CHD) and stroke.

Management of patients after ischemic stroke

2020 ◽  
Vol 25 (5) ◽  
pp. 51-57
Author(s):  
V. A. Parfenov
Keyword(s):  
Ischemic Stroke ◽  
Secondary Prevention ◽  
Antihypertensive Drugs ◽  
Oral Anticoagulants ◽  
Antiplatelet Agents ◽  
International Normalized Ratio ◽  
Excess Body Weight ◽  
Nonvalvular Atrial Fibrillation ◽  
Regular Intake

Rehabilitation and secondary prevention of ischemic stroke (IS) is the basis for the management of patients with ischemic stroke. The important role of non-drug methods of secondary prevention of IS should be noted: cessation of smoking and alcohol abuse, regular physical activity, proper nutrition, reduction of excess body weight. The normalization of blood pressure is one of the most effective areas of IS prevention. It is based on the regular intake of antihypertensive drugs in most cases. After noncardioembolic IS, antiplatelet agents are required: acetylsalicylic acid (ASA), clopidogrel, or a combination of dipyridamole and ASA. The possibility of taking a combination of clopidogrel and ASA for 21 days after IS with a subsequent switch to monotherapy with ASA or clopidogrel is discussed in patients with non-disabling IS. After cardiomoembolic IS, warfarin is required under the control of an international normalized ratio or with nonvalvular atrial fibrillation of new oral anticoagulants: apixaban, dabigatran or rivaroxaban. Most patients after IS require statins, and the doses are selected individually. Carotid endarterectomy is most effective in severe stenosis (narrowing of 70–99% of the diameter) of the internal carotid artery on the side of the involved hemisphere during the first 3–7 days after non-disabling IS. The data of multicenter placebo-controlled and open observational studies on the use of the metabolic drug Cytoflavin, which is widely used in our country in the rehabilitation of patients with IS, are presented.

The role of pharmacogenetics for antithrombotic therapy management: new achievements and barriers yet to overcome

2020 ◽  
Vol 28 ◽  
Author(s):  
V. Conti ◽  
G. Corbi ◽  
V. Manzo ◽  
C. Sellitto ◽  
F. Iannello ◽  
...  
Keyword(s):  
Clinical Trials ◽  
Genetic Background ◽  
Randomized Clinical Trials ◽  
Antiplatelet Agents ◽  
Review Of The Literature ◽  
Pharmacological Treatments ◽  
Antithrombotic Drugs ◽  
Antiplatelet Treatment ◽  
Shed Light

Background: Pharmacogenetics investigates the response to pharmacological treatments based on individual genetic background. Actually, numerous pharmacogenetic tests help to predict the response to drugs used in different medical areas, contributing to the so-called personalized medicine. Objective: This review aims to update the available data on the genotype-guided treatment with both the anticoagulant and antiplatelet agents. Moreover, it shed light on the pitfalls still contrasting the implementation of cardiovascular pharmacogenetics. Methods: A review of the literature on the studies investigating the effects of the genotype-guided anticoagulant and antiplatelet treatment was performed. Results: Considering the large use of antithrombotic drugs, pharmacogenetics has particular importance in this field. Several polymorphisms influence the response to both anticoagulant and antiplatelet agents, and tests, based on their identification, are now available. Conclusions: Recent randomized clinical trials demonstrated that pharmacogenetics might successfully contribute to optimizing the antiplatelet therapy also in patients particularly complicated to treat. However, despite accumulating evidence on the utility and feasibility of some pharmacogenetics tests, several barriers still contrast their implementation into clinical practice.

scholarly journals Secondary Stroke Prevention, and the Role of Antiplatelet Therapies

2009 ◽  
Vol 1 ◽  
pp. CMT.S2208
Author(s):  
Howard S. Kirshner
Keyword(s):  
Risk Factor ◽  
Antiplatelet Therapy ◽  
Stroke Prevention ◽  
Extended Release ◽  
Antiplatelet Agents ◽  
Bleeding Risk ◽  
Internal Carotid Artery Stenosis ◽  
Secondary Stroke Prevention ◽  
First Line

This review considers treatments of proved efficacy in secondary stroke prevention, with an emphasis on antiplatelet therapy. Most strokes could be prevented, if readily available lifestyle and risk factor modifications could be applied to everyone. In secondary stroke prevention, the same lifestyle and risk factor modifications are also important, along with anticoagulation for patients with cardiac sources of embolus, carotid procedures for patients with significant internal carotid artery stenosis, and antiplatelet therapy. For patients with noncardioembolic ischemic strokes, FDA-approved antiplatelet agents are recommended and preferred over anticoagulants. ASA, clopidogrel, and ASA + ER-DP are recognized as accepted first-line options for secondary prevention of noncardioembolic ischemic stroke. Combined antiplatelet therapy with ASA + clopidogrel has not been shown to carry benefit greater than risk in stroke or TIA patients. Aspirin and extended release dipyridamole appeared to carry a greater benefit over aspirin alone in individual studies, leading to a recommendation of this agent in the AHA guidelines, but the recently completed PRoFESS trial showed no difference in efficacy between clopidogrel and aspirin with extended release dipyridamole, and clopidogrel had better tolerability and reduced bleeding risk.

scholarly journals The Role of Clopidogrel in 2020: A Reappraisal

2020 ◽  
Vol 2020 ◽  
pp. 1-12 ◽  
Author(s):  
Giuseppe Patti ◽  
Giuseppe Micieli ◽  
Claudio Cimminiello ◽  
Leonardo Bolognese
Keyword(s):  
Secondary Prevention ◽  
Antiplatelet Therapy ◽  
Minor Stroke ◽  
Clinical Settings ◽  
Coronary Syndrome ◽  
Increased Risk ◽  
Integral Role ◽  
Artery Disease ◽  
Ischemic Attack

Antiplatelet therapy is the mainstay of treatment and secondary prevention of cardiovascular disease (CVD), including acute coronary syndrome (ACS), transient ischemic attack (TIA) or minor stroke, and peripheral artery disease (PAD). The P2Y12 inhibitors, of which clopidogrel was the first, play an integral role in antiplatelet therapy and therefore in the treatment and secondary prevention of CVD. This review discusses the available evidence concerning antiplatelet therapy in patients with CVD, with a focus on the role of clopidogrel. In combination with aspirin, clopidogrel is often used as part of dual antiplatelet therapy (DAPT) for the secondary prevention of ACS. Although newer, more potent P2Y12 inhibitors (prasugrel and ticagrelor) show a greater reduction in ischemic risk compared with clopidogrel in randomized trials of ACS patients, these newer P2Y12 inhibitors are often associated with an increased risk of bleeding. Deescalation of DAPT by switching from prasugrel or ticagrelor to clopidogrel may be required in some patients with ACS. Furthermore, real-world studies of ACS patients have not confirmed the benefits of the newer P2Y12 inhibitors over clopidogrel. In patients with very high-risk TIA or stroke, short-term DAPT with clopidogrel plus aspirin for 21–28 days, followed by clopidogrel monotherapy for up to 90 days, is recommended. Clopidogrel monotherapy may also be used in patients with symptomatic PAD. In conclusion, there is strong evidence supporting the use of clopidogrel antiplatelet therapy in several clinical settings, which emphasizes the importance of this medication in clinical practice.

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