scholarly journals Use of the HAS-BLED Score in Risk Stratifying Patients on Dual Antiplatelet Therapy After Coronary Stent

2021 ◽  
Vol 35 ◽  
pp. 248-253
Author(s):  
Pham Nhu Hung ◽  
Nguyen Thi Thanh Loan
Keyword(s):  
Antiplatelet Therapy ◽  
Stent Placement ◽  
Dual Antiplatelet Therapy ◽  
Area Under The Curve ◽  
Coronary Stent ◽  
Severe Bleeding ◽  
Post Procedure ◽  
Bleeding Area

Objectives: Use of the HAS-BLED score in risk stratifying patients on dual antiplatelet therapy after stent placement. Methods & Results: 304 patients who underwent stent placement from June, 2018 to December 2018. There is 6,57% patients with medium & severe bleeding. Area under the curve of HAS-BLED score (AUC); PRECISE-DAPT score and CRUSADE were sequential 0.59; 0,79 and 0,84 (p=0,0001) at post-PCI procedures; were sequential 0,72; 0,94 và 0,88 (p=0,00001) at less than 6 months after PCI procedures, and were sequential 0,87; 0,73 và 0,70 (p=0,0068) at more than 6 months after PCI procedures.     Conclusion: the HAS-BLED score was most useful for predicting bleeding in patients on on dual antiplatelet therapy after stent placement at more than 6 months after PCI procedures. PRECISE-DAPT score was most useful for predicting bleeding at less than 6 months after PCI procedures and CRUSADE score was most useful for predicting bleeding at post procedure.

Anticoagulation in addition to dual antiplatelet therapy has no impact on long-term follow-up after endovascular treatment of (sub)acute lower limb ischemia

VASA ◽  
2019 ◽  
Vol 48 (4) ◽  
pp. 321-329
Author(s):  
Mariya Kronlage ◽  
Erwin Blessing ◽  
Oliver J. Müller ◽  
Britta Heilmeier ◽  
Hugo A. Katus ◽  
...  
Keyword(s):  
Endovascular Treatment ◽  
Antiplatelet Therapy ◽  
Dual Antiplatelet Therapy ◽  
Limb Ischemia ◽  
Bleeding Complications ◽  
Severe Bleeding ◽  
Short Term ◽  
Long Term Follow Up

Summary. Background: To assess the impact of short- vs. long-term anticoagulation in addition to standard dual antiplatelet therapy (DAPT) upon endovascular treatment of (sub)acute thrombembolic occlusions of the lower extremity. Patient and methods: Retrospective analysis was conducted on 202 patients with a thrombembolic occlusion of lower extremities, followed by crirical limb ischemia that received endovascular treatment including thrombolysis, mechanical thrombectomy, or a combination of both between 2006 and 2015 at a single center. Following antithrombotic regimes were compared: 1) dual antiplatelet therapy, DAPT for 4 weeks (aspirin 100 mg/d and clopidogrel 75 mg/d) upon intervention, followed by a lifelong single antiplatelet therapy; 2) DAPT plus short term anticoagulation for 4 weeks, followed by a lifelong single antiplatelet therapy; 3) DAPT plus long term anticoagulation for > 4 weeks, followed by a lifelong anticoagulation. Results: Endovascular treatment was associated with high immediate revascularization (> 98 %), as well as overall and amputation-free survival rates (> 85 %), independent from the chosen anticoagulation regime in a two-year follow up, p > 0.05. Anticoagulation in addition to standard antiplatelet therapy had no significant effect on patency or freedom from target lesion revascularization (TLR) 24 months upon index procedure for both thrombotic and embolic occlusions. Severe bleeding complications occurred more often in the long-term anticoagulation group (9.3 % vs. 5.6 % (short-term group) and 6.5 % (DAPT group), p > 0.05). Conclusions: Our observational study demonstrates that the choice of an antithrombotic regime had no impact on the long-term follow-up after endovascular treatment of acute thrombembolic limb ischemia whereas prolonged anticoagulation was associated with a nominal increase in severe bleeding complications.

scholarly journals The Acute Stroke or Transient Ischemic Attack Treated with Ticagrelor and Aspirin for Prevention of Stroke and Death (THALES) trial: Rationale and design

2019 ◽  
Vol 14 (7) ◽  
pp. 745-751 ◽  
Author(s):  
S Claiborne Johnston ◽  
Pierre Amarenco ◽  
Hans Denison ◽  
Scott R Evans ◽  
Anders Himmelmann ◽  
...  
Keyword(s):  
Cerebral Ischemia ◽  
Acute Stroke ◽  
Antiplatelet Therapy ◽  
Transient Ischemic Attack ◽  
Dual Antiplatelet Therapy ◽  
Bleeding Event ◽  
Severe Bleeding ◽  
Major Hemorrhage ◽  
Acute Cerebral Ischemia ◽  
Ischemic Attack

Rationale In patients with acute cerebral ischemia, the rate of stroke, myocardial infarction, or death during 90 days was reported to be non-significantly lower with ticagrelor compared with aspirin, with no increase in major hemorrhage. Dual antiplatelet therapy may be more effective in this setting. Aim To investigate whether ticagrelor combined with aspirin are superior to aspirin alone in preventing stroke or death in patients with non-severe, non-cardioembolic ischemic stroke or high-risk transient ischemic attack. Design The Acute Stroke or Transient Ischemic Attack Treated with Ticagrelor and Aspirin for Prevention of Stroke and Death (THALES) trial is a randomized, placebo-controlled, double-blind, event-driven study. Patients will be randomized within 24 h of onset of acute ischemic symptoms. THALES is expected to randomize 13,000 at ∼450 sites worldwide, to collect 764 primary outcome events. Study treatments are ticagrelor 180 mg loading dose on day 1, then 90 mg twice daily on days 2–30, or matching placebo. All patients will also receive open-label aspirin 300–325 mg on day 1, then 75–100 mg once daily on days 2–30. Study outcomes The primary efficacy outcome is time to the composite endpoint of stroke or death through 30-day follow-up. The primary safety outcome is time to first severe bleeding event. Discussion The THALES trial will provide important information about the benefits and risks of dual antiplatelet therapy with ticagrelor and aspirin in patients with acute cerebral ischemia in a global setting (funding: AstraZeneca). Clinical Trial Registration URL http://www.clinicaltrials.gov . Unique identifier: NCT03354429.

scholarly journals Perioperative management of antiplatelet therapy in patients undergoing non-cardiac surgery following coronary stent placement: a systematic review

2018 ◽  
Vol 7 (1) ◽  
Author(s):  
Christopher P. Childers ◽  
Melinda Maggard-Gibbons ◽  
Jesus G. Ulloa ◽  
Ian T. MacQueen ◽  
Isomi M. Miake-Lye ◽  
...  
Keyword(s):  
Systematic Review ◽  
Cardiac Surgery ◽  
Antiplatelet Therapy ◽  
Stent Placement ◽  
Perioperative Management ◽  
Coronary Stent
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