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A randomized clinical trial comparing long-term clopidogrel vs aspirin monotherapy beyond dual antiplatelet therapy after drug-eluting coronary stent implantation: Design and rationale of the Harmonizing Optimal Strategy for Treatment of coronary artery stenosis-Extended Antiplatelet Monotherapy (HOST-EXAM) trial
Conclusions The HOST-EXAM will be the first large-scale randomized controlled study to directly compare the efficacy and safety of long-term antiplatelet monotherapy beyond DAPT after DES implantation. This study will provide clinical evidence to establish optimal regimen for long-term antiplatelet therapy after DES implantation.
Source: American Heart Journal - December 20, 2016 Category: Cardiology Source Type: research

A randomized clinical trial comparing long-term clopidogrel versus aspirin monotherapy beyond dual antiplatelet therapy after drug-eluting coronary stent implantation: Design and rationale of the HOST-EXAM trial
Conclusions The HOST-EXAM will be the first large-scale randomized controlled study to directly compare the efficacy and safety of long-term antiplatelet monotherapy beyond DAPT after DES implantation. This study will provide clinical evidence to establish optimal regimen for long-term antiplatelet therapy after DES implantation.
Source: American Heart Journal - December 9, 2016 Category: Cardiology Source Type: research

Reduced number of cardiovascular events and increased cost-effectiveness by genotype-guided antiplatelet therapy in patients undergoing percutaneous coronary interventions in the Netherlands.
CONCLUSION: This study provides evidence that for CYP2C19-related poor metabolisers prasugrel may be more effective than clopidogrel to prevent major adverse cardiovascular events after PCI and this approach could be cost-effective. PMID: 27573042 [PubMed - as supplied by publisher]
Source: Netherlands Heart Journal - August 28, 2016 Category: Cardiology Authors: Deiman BA, Tonino PA, Kouhestani K, Schrover CE, Scharnhorst V, Dekker LR, Pijls NH Tags: Neth Heart J Source Type: research

Assessment of Ticagrelor Versus Clopidogrel Treatment in Patients With ST-elevation Myocardial Infarction Undergoing Primary Percutaneous Coronary Intervention
Conclusions: Among patients with STEMI undergoing PPCI, ticagrelor reduces the incidence of MACCE and the composite end point of cardiovascular death, nonfatal MI, and stroke compared with clopidogrel. Ticagrelor also reduces the need for GPIIb/IIIa inhibitors. However, no significant difference was observed in the risk of bleeding between the 2 groups.
Source: Journal of Cardiovascular Pharmacology - August 1, 2016 Category: Cardiology Tags: Original Article Source Type: research

Design and Rationale of the RE ‐DUAL PCI Trial: A Prospective, Randomized, Phase 3b Study Comparing the Safety and Efficacy of Dual Antithrombotic Therapy With Dabigatran Etexilate Versus Warfarin Triple Therapy in Patients With Nonvalvular Atrial Fibrillation Who Have Undergone Percutaneous Coronary Intervention With Stenting
Antithrombotic management of patients with atrial fibrillation (AF) undergoing coronary stenting is complicated by the need for anticoagulant therapy for stroke prevention and dual antiplatelet therapy for prevention of stent thrombosis and coronary events. Triple antithrombotic therapy, typically comprising warfarin, aspirin, and clopidogrel, is associated with a high risk of bleeding. A modest‐sized trial of oral anticoagulation with warfarin and clopidogrel without aspirin showed improvements in both bleeding and thrombotic events compared with triple therapy, but large trials are lacking. The RE‐DUAL PCI trial (NCT...
Source: Clinical Cardiology - July 31, 2016 Category: Cardiology Authors: Christopher P. Cannon, Savion Gropper, Deepak L. Bhatt, Stephen G. Ellis, Takeshi Kimura, Gregory Y.H. Lip, Ph. Gabriel Steg, Jurri ën M. Berg, Jenny Manassie, Jörg Kreuzer, Jon Blatchford, Joseph M. Massaro, Martina Brueckmann, Ernesto Ferreiros Ripoll Tags: Trial Designs Source Type: research

Rationale and design of the SAFE-A study: SAFety and Effectiveness trial of Apixaban use in association with dual antiplatelet therapy in patients with atrial fibrillation undergoing percutaneous coronary intervention.
CONCLUSION: The SAFE-A study is the first randomized controlled trial to compare 1-month vs. 6-month P2Y12 inhibitor therapy in combination with aspirin and apixaban, in patients with atrial fibrillation who undergo DES implantation. This study will provide data that may guide the optimal management of triple antithrombotic therapy. PMID: 27443596 [PubMed - as supplied by publisher]
Source: Journal of Cardiology - July 17, 2016 Category: Cardiology Authors: Hoshi T, Sato A, Nogami A, Gosho M, Aonuma K, SAFE-A Investigators Tags: J Cardiol Source Type: research

Longer dual antiplatelet therapy (DAPT) after percutaneous coronary intervention has higher anti-ischaemic efficacy than shorter DAPT but is associated with more frequent bleeding
Commentary on: Spencer FA, Prasad M, Vandvik PO, et al.. Longer- versus shorter-duration dual-antiplatelet therapy after drug-eluting stent placement: a systematic review and meta-analysis. Ann Intern Med 2015;163:118–26. Context Dual antiplatelet therapy (DAPT) with aspirin plus a P2Y12 receptor antagonist is recommended after drug eluting stent implantation (DES) for at least 12 months by the American College of Cardiology/American Heart Association1 and for 6–12 months by European guidelines. Recent randomised controlled trials (RCT) suggested comparable efficacy of short-term DAPT versus therapy o...
Source: Evidence-Based Medicine - January 22, 2016 Category: Internal Medicine Authors: Navarese, E. P. Tags: Journalology, Clinical trials (epidemiology), Epidemiologic studies, Drugs: cardiovascular system, Stroke, Interventional cardiology, Ischaemic heart disease, Venous thromboembolism, Radiology, Clinical diagnostic tests, Ethics Therapeutics/Prevention Source Type: research

Antithrombotic therapy in patients with combined coronary heart disease and atrial fibrillation.
CONCLUSION: In each clinical scenario, the risks of coronary artery or stent thrombosis in CHD and risks of stroke in AF need to be carefully balanced against the risks of bleeding. We make recommendations for management based on the evidence which is available at this time and indicate the many gaps which are currently being addressed by randomised clinical trials. PMID: 26658287 [PubMed - as supplied by publisher]
Source: Panminerva Medica - December 15, 2015 Category: Journals (General) Tags: Panminerva Med Source Type: research

Clinical characteristics, management and 1-year outcomes of patients with acute coronary syndrome in Iran: the Iranian Project for Assessment of Coronary Events 2 (IPACE2)
Conclusions Our study showed that the composition of Iranian patients with ACS regarding the type of ACS is similar to that in developed European countries and is unlike that in developing countries of the Middle East and Africa. We found that our patients with ACS are treated with high levels of adherence to guideline-recommended in-hospital medications.
Source: BMJ Open - December 15, 2015 Category: Journals (General) Authors: Kassaian, S. E., Masoudkabir, F., Sezavar, H., Mohammadi, M., Pourmoghaddas, A., Kojouri, J., Ghaffari, S., Sanaati, H., Alaeddini, F., Pourmirza, B., Mir, E., on-behalf of the IPACE2 registry investigators Tags: Open access, Cardiovascular medicine, Evidence based practice, Medical management Research Source Type: research

Percutaneous left atrial appendage occlusion: Device thrombosis in clopidogrel non-responders
Percutaneous left atrial appendage closure (LAAC) has been recently proposed as a safe and effective strategy to reduce the embolic stroke risk in patients with atrial fibrillation that are not amenable to long lasting oral anticoagulation [1]. After LACC, a temporary double anti-platelets regimen with aspirin and clopidogrel is suggested to prevent closure device thrombosis and enhance its endothelization [2]. Although clopidogrel resistance has been associated with recurrent cardiac events after percutaneous coronary intervention [3], no reports exist concerning the occurrence of LAAC device thrombosis in patients with c...
Source: International Journal of Cardiology - November 24, 2015 Category: Cardiology Authors: Ulrike Ketterer, Giuseppe D´ Ancona, Isabel Siegel, Jasmin Ortak, Hueseyin Ince, Stephan Kische Tags: Correspondence Source Type: research

Is platelet transfusion the solution to reverse platelet inhibition in patients on triple antiplatelet therapy?
Antiplatelet therapy is the cornerstone of secondary prevention against acute thrombotic events in patients with cardiovascular disease [1]. Health Organizations around the world recommend combination therapy with aspirin and a P2Y12 receptor inhibitor for up to one year following an acute coronary syndrome (ACS) or percutaneous coronary intervention (PCI), and lifelong aspirin therapy thereafter [2]. Vorapaxar, a first-in-class novel protease-activated receptor (PAR)-1 antagonist, was approved in addition to standard antiplatelet therapy, to further reduce the risk of myocardial infarction (MI), stroke, cardiovascular dea...
Source: Thrombosis Research - October 30, 2015 Category: Hematology Authors: Marie Lordkipanidzé Source Type: research

Current antiplatelet agents: place in therapy and role of genetic testing
Abstract Antiplatelet therapies play a central role in reducing the risk of cardiovascular events such as myocardial infarction and stroke. While aspirin, a cyclo-oxygenase-1 inhibitor has been the cornerstone of antithrombotic treatment for several decades, P2Y12 receptor inhibitors cangrelor, clopidogrel, prasugrel, and ticagrelor and protease-activated receptor-1 antagonist vorapaxar, have emerged as additional therapies to reduce the risk of recurrent cardiovascular events in high-risk patients. Recent clinical trials evaluating the role of these agents and major society guideline updates for use of antiplatel...
Source: Journal of Thrombosis and Thrombolysis - February 21, 2015 Category: Hematology Source Type: research

Meta-analysis Of Randomized Controlled Trials and Adjusted Observational Results Of Use Of Clopidogrel, Aspirin and Oral Anti-coagulants In Patients Undergoing Percutaneous Coronary Intervention
The optimal antiaggregant therapy after coronary stenting in patients receiving oral anticoagulation (OAC) is currently debated. Medline and Cochrane Library were searched for studies reporting outcomes of patients undergoing PCI and who were on triple therapy (TT)or dual antiplatelet therapy (DAPT) with aspirin and clopidogrel or dual therapy(DT) with OAC and clopidogrel. Major bleeding was the primary end point, while all-cause death, myocardial infarction (MI), stent thrombosis and stroke were secondary ones.
Source: The American Journal of Cardiology - February 11, 2015 Category: Cardiology Authors: Fabrizio D’Ascenzo, Salma Taha, Claudio Moretti, Pierluigi Omedè, Walter Grossomarra, Jonas Persson, Morten Lamberts, Willem Dewilde, Andrea Rubboli, Sergio Fernández, Enrico Cerrato, Ilaria Meynet, Flavia Ballocca, Umberto Barbero, Giorgio Quadri, Fr Source Type: research

Effect of Prasugrel Pre-Treatment Strategy in Patients Undergoing Percutaneous Coronary Intervention for NSTEMI The ACCOAST-PCI Study
ConclusionsThese findings support deferring treatment with prasugrel until a decision is made about revascularization in patients with NSTEMI undergoing angiography within 48 h of admission. (A Comparison of prasugrel at the time of percutaneous Coronary intervention Or as pre-treatment At the time of diagnosis in patients with non—ST-segment elevation myocardial infarction [ACCOAST]; NCT01015287)
Source: Journal of the American College of Cardiology - December 15, 2014 Category: Cardiology Source Type: research

Analysis of gastrointestinal prophylaxis in patients receiving dual antiplatelet therapy with aspirin and clopidogrel.
CONCLUSION: More than half of the patients did not receive GI prophylaxis appropriately. The most common reason for nonadherence to the consensus document was no prophylaxis when indicated. Vascular events could not be directly attributed to PPI use, and GI events occurred despite prophylaxis. Overall, there was a low incidence of adverse events related to the use of PPI therapy.  PMID: 24456320 [PubMed - indexed for MEDLINE]
Source: Journal of Managed Care Pharmacy - November 14, 2014 Category: Drugs & Pharmacology Tags: J Manag Care Pharm Source Type: research

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