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Antiplatelet treatments: recent evidence from randomized controlled trials
Purpose of review: To provide an overview of selected randomized studies reported over the last 2 years evaluating antiplatelet therapies in patients with either acute or stable manifestations of atherosclerosis. Recent findings: From large outcome trials included evidence for reduced risk of ischemic events associated with use of ticagrelor and aspirin versus aspirin alone, albeit with an increased bleeding risk in patients with stable coronary artery disease and history of myocardial infarction. No benefit regarding ischemic outcomes could be demonstrated for ticagrelor monotherapy compared with aspirin or clopidogrel i...
Source: Current Opinion in Cardiology - June 7, 2017 Category: Cardiology Tags: CLINICAL TRIALS: Edited by Neal S. Kleiman Source Type: research

Sepsis favors high-on-clopidogrel platelet reactivity.
Authors: Akinosoglou K, Perperis A, Theodoraki S, Alexopoulos D, Gogos C Abstract High-on-treatment platelet reactivity (HPR) is associated with ischemic events in patients on antiplatelet therapy with a history of cardiovascular disease. On the other hand, recent data have associated sepsis with adverse cardiovascular events in patients admitted with bacteremia or respiratory infection. We aimed to assess P2Y12-mediated platelet reactivity (PR) during sepsis and recovery in patients under clopidogrel. This was a prospective observational study. Incoming patients presenting with signs/symptoms of sepsis already on ...
Source: Platelets - June 23, 2017 Category: Hematology Tags: Platelets Source Type: research

Antithrombotic treatment in peripheral artery disease.
Abstract This review treats antithrombotic use for peripheral arterial disease (PAD). In asymptomatic patients, there are no scientific data to support single antiplatelet therapy (SAPT) for primary prophylaxis. In symptomatic PAD, SAPT with aspirin or clopidogrel is indicated. The efficacy of aspirin is controversial. Clopidogrel may be preferred over aspirin. Ticagrelor is not superior to clopidogrel in reducing major adverse cardiovascular events and major adverse limb events, but lowers the risk of ischaemic stroke. In symptomatic PAD, dual antiplatelet therapy (DAPT) with clopidogrel and aspirin does not prov...
Source: VASA. Zeitschrift fur Gefasskrankheiten. Journal for Vascular Diseases - November 21, 2017 Category: Surgery Authors: Olinic DM, Tataru DA, Homorodean C, Spinu M, Olinic M Tags: Vasa Source Type: research

Outcomes of Patients with Critical Limb Ischaemia in the EUCLID Trial.
CONCLUSIONS: Nearly 5% of patients enrolled in EUCLID had CLI at baseline. Milder forms of CLI dominated, a result of the trial design. Patients with CLI had a significantly higher rate of cardiovascular mortality and morbidity versus those without CLI. Further efforts are required to reduce the risk of cardiovascular events in PAD, especially in patients with CLI. CLINICALTRIALS.GOV: NCT01732822. PMID: 29273390 [PubMed - as supplied by publisher]
Source: PubMed: Eur J Vasc Endovasc ... - December 19, 2017 Category: Surgery Authors: Norgren L, Patel MR, Hiatt WR, Wojdyla DM, Fowkes FGR, Baumgartner I, Mahaffey KW, Berger JS, Jones WS, Katona BG, Held P, Blomster JI, Rockhold FW, Björck M, EUCLID Steering Committee and Investigators Tags: Eur J Vasc Endovasc Surg Source Type: research

Antithrombotic therapy in peripheral artery disease: A review of the EUCLID trial results and current ongoing trials
In addition to risk‐factor modification, antithrombotic therapy is the hallmark of management to reduce cardiovascular ischemic events in patients with peripheral artery disease (PAD). Currently, the guidelines recommend long‐term antiplatelet therapy with aspirin or clopidogrel in this patient population to reduce myocardial infarction, stroke, and vascular death. Past outcomes studies have shown some benefit of ticagrelor, another antiplatelet agent, as compared with clopidogrel in patients with coronary disease and concomitant PAD. However, most recently, the Examining Use of Ticagrelor in Peripheral Artery Disease ...
Source: Clinical Cardiology - January 22, 2018 Category: Cardiology Authors: Rachael Ward, Chandler Long, Manesh R. Patel, William S. Jones Tags: REVIEW Source Type: research

Aspirin and clopidogrel high on ‐treatment platelet reactivity and genetic predictors in peripheral arterial disease
ConclusionClopidogrel HoTPR was significantly associated with TVR, while aspirin HoTPR was not associated with adverse clinical outcomes in patients with PAD.
Source: Catheterization and Cardiovascular Interventions - February 7, 2018 Category: Cardiovascular & Thoracic Surgery Authors: Khung ‐Keong Yeo, Ehrin J. Armstrong, Javier E. López, Debbie C. Chen, Gregory G. Westin, Chin‐Shang Li, David Anderson, Amy Hua, Anil Singapuri, Ezra A. Amsterdam, Nipavan Chiamvimonvat, John R. Laird Tags: PERIPHERAL VASCULAR DISEASE Source Type: research

On-Treatment Platelet Reactivity is a Predictor of Adverse Events in Peripheral Artery Disease Patients Undergoing Percutaneous Angioplasty.
CONCLUSIONS: In this study a high prevalence of on-clopidogrel and aspirin high platelet reactivity was found, which was significantly associated with the risk of death. Conversely, a low on-clopidogrel platelet reactivity was associated with a higher risk of bleeding. These results document that the entity of platelet inhibition is associated with both thrombotic and bleeding complications in PAD patients. PMID: 30025662 [PubMed - as supplied by publisher]
Source: PubMed: Eur J Vasc Endovasc ... - July 16, 2018 Category: Surgery Authors: Grifoni E, Gori AM, Giusti B, Valenti R, Migliorini A, Basili S, Paniccia R, Elmahdy MF, Pulli R, Pratesi C, Antoniucci D, Violi F, Marcucci R Tags: Eur J Vasc Endovasc Surg Source Type: research

Clopidogrel Hypersensitivity: Overview of the Problem.
Abstract Clopidogrel is one of the most commonly prescribed drugs worldwide. It plays an essential therapeutic role in a variety of vascular conditions including acute coronary syndromes, ischemic heart disease treated with coronary stents, stroke, and peripheral vascular disease. Hypersensitivity reactions to clopidogrel are not uncommon and lead to its discontinuation in 1-2% of patients. Clopidogrel hypersensitivity is especially problematic in patients with newly implanted drug-eluting coronary stents. Premature discontinuation of dual antiplatelet therapy after recent coronary intervention is the most importa...
Source: Current Vascular Pharmacology - August 20, 2018 Category: Drugs & Pharmacology Authors: Savage MP, Fischman DL Tags: Curr Vasc Pharmacol Source Type: research

Anti-platelet and anti-coagulant therapy in peripheral arterial disease prior to surgical intervention.
CONCLUSION: Peripheral artery disease is a complex and multifactorial clinical condition. The use of dual anti-platelets, such as aspirin and clopidogrel, are the key in preventing major cardiovascular events as well as stroke and death. Utilization of anti-coagulation such as direct oral anti-coagulants' as additional parameters for the prevention of disease progression, is paramount. Eventually, the choice of either dual-antiplatelet therapy or combined anti-coagulation with anti-platelets should be carefully considered, particularly following the most recent published debatable studies. PMID: 30539687 [PubMed - as ...
Source: Vascular - December 12, 2018 Category: Surgery Authors: Harky A, Maskell P, Burgess M Tags: Vascular Source Type: research

Acute Limb Ischemia in Peripheral Artery Disease: Insights from EUCLID.
CONCLUSIONS: Prior peripheral revascularization, baseline atrial fibrillation, and lower ABI identify PAD patients at heightened risk for ALI, an event associated with subsequent cardiovascular and limb-related morbidity and mortality. CLINICAL TRIAL REGISTRATION: URL: https://clinicaltrials.gov Unique Identifier: NCT01732822. PMID: 31238713 [PubMed - as supplied by publisher]
Source: Circulation - June 25, 2019 Category: Cardiology Authors: Hess CN, Huang Z, Patel MR, Baumgartner I, Berger JS, Blomster JI, Fowkes FGR, Held P, Jones WS, Katona B, Mahaffey KW, Norgren L, Rockhold FW, Hiatt WR Tags: Circulation Source Type: research

Rivaroxaban and Aspirin in Peripheral Artery Disease Lower Extremity Revascularization: Impact of Concomitant Clopidogrel on Efficacy and Safety.
Conclusions: In the VOYAGER PAD trial, rivaroxaban plus aspirin reduced the risk of adverse cardiovascular and limb events with an early benefit for ALI regardless of clopidogrel use. The safety of rivaroxaban was consistent regardless of clopidogrel use, but with a trend for more ISTH major bleeding with clopidogrel use > 30 days than a shorter duration. These data support the addition of rivaroxaban to aspirin after LER regardless of concomitant clopidogrel with a short (course ≤ 30 days) associated with less bleeding. Clinical Trial Registration: URL: https://clinicaltrials.gov Unique Identifier: NCT02504216. ...
Source: Circulation - November 3, 2020 Category: Cardiology Authors: Hiatt WR, Bonaca MP, Patel MR, Nehler MR, Debus ES, Anand SS, Capell WH, Brackin T, Jaeger N, Hess C, Pap AF, Berkowitz SD, Muehlhofer E, Haskell L, Brasil D, Madaric J, Sillesen H, Szalay D, Bauersachs R Tags: Circulation Source Type: research

Reduction in Acute Limb Ischemia with Rivaroxaban versus Placebo in Peripheral Artery Disease after Lower Extremity Revascularization: Insights from VOYAGER PAD
Conclusions: After LER for symptomatic PAD, ALI is frequent, particularly early after LER, and is associated with poor prognosis. Low-dose rivaroxaban plus aspirin reduces ALI after LER, including ALI events associated with the most severe outcomes. The benefit of rivaroxaban for ALI appears early, continues over time, and is consistent regardless of revascularization approach or clopidogrel use.PMID:34637332 | DOI:10.1161/CIRCULATIONAHA.121.055146
Source: Circulation - October 12, 2021 Category: Cardiology Authors: Connie N Hess E Sebastian Debus Mark R Nehler Sonia S Anand Manesh R Patel Michael Szarek Warren H Capell Judith Hsia Joshua A Beckman Marianne Brodmann Rafael Diaz Peter Habertheuer Nicholas J Leeper Richard J Powell Henrik Sillesen Eva Muehlhofer Scott Source Type: research

Update on Cilostazol: A Critical Review of its Antithrombotic and Cardiovascular Actions and its Clinical Applications
This article is protected by copyright. All rights reserved.PMID:34671983 | DOI:10.1002/jcph.1988
Source: The Journal of Clinical Pharmacology - October 21, 2021 Category: Drugs & Pharmacology Authors: Antonis A Manolis Theodora A Manolis Helen Melita Dimitri P Mikhailidis Antonis S Manolis Source Type: research

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