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Multisite Investigation of Outcomes With Implementation of CYP2C19 Genotype-Guided Antiplatelet Therapy After Percutaneous Coronary Intervention
Conclusions These data from real-world observations demonstrate a higher risk for cardiovascular events in patients with a CYP2C19 loss-of-function allele if clopidogrel versus alternative therapy is prescribed. A future randomized study of genotype-guided antiplatelet therapy may be of value.
Source: Journal of the American College of Cardiology: Cardiovascular Interventions - January 15, 2018 Category: Cardiology Authors: Cavallari, L. H., Lee, C. R., Beitelshees, A. L., Cooper-DeHoff, R. M., Duarte, J. D., Voora, D., Kimmel, S. E., McDonough, C. W., Gong, Y., Dave, C. V., Pratt, V. M., Alestock, T. D., Anderson, R. D., Alsip, J., Ardati, A. K., Brott, B. C., Brown, L., Ch Tags: Coronary Source Type: research

Associations Between Chronic Kidney Disease and Outcomes With Use of Prasugrel Versus Clopidogrel in Patients With Acute Coronary Syndrome Undergoing Percutaneous Coronary Intervention: A Report From the PROMETHEUS Study
Conclusions Although risks for 1-year MACE were significantly higher in ACS PCI patients with versus without CKD, prasugrel use was 50% lower in patients with renal impairment. Irrespective of CKD status, outcomes associated with prasugrel use were not significant after propensity adjustment. These data highlight the need for randomized studies evaluating the optimal antiplatelet therapy in CKD patients with ACS.
Source: Journal of the American College of Cardiology: Cardiovascular Interventions - October 16, 2017 Category: Cardiology Authors: Baber, U., Chandrasekhar, J., Sartori, S., Aquino, M., Kini, A. S., Kapadia, S., Weintraub, W., Muhlestein, J. B., Vogel, B., Faggioni, M., Farhan, S., Weiss, S., Strauss, C., Toma, C., DeFranco, A., Baker, B. A., Keller, S., Effron, M. B., Henry, T. D., Tags: Coronary Source Type: research

Risk of Early Adverse Events After Clopidogrel Discontinuation in Patients Undergoing Short-Term Dual Antiplatelet Therapy: An Individual Participant Data Analysis
Conclusions Among patients undergoing PCI with predominantly new-generation DES, discontinuation of clopidogrel after 3 or 6 months DAPT duration was not associated with an early increase in adverse clinical events. An early increase in MACCE was observed after long-term (≥12 months) DAPT exposure.
Source: Journal of the American College of Cardiology: Cardiovascular Interventions - August 21, 2017 Category: Cardiology Authors: Piccolo, R., Feres, F., Abizaid, A., Gilard, M., Morice, M.-C., Hong, M.-K., Kim, H.-S., Colombo, A., Bhatt, D. L., Palmerini, T., Stone, G. W., Windecker, S., Valgimigli, M. Tags: Coronary: Focus on Antithrombotic Drugs Source Type: research

Aspirin Versus Aspirin Plus Clopidogrel as Antithrombotic Treatment Following Transcatheter Aortic Valve Replacement With a Balloon-Expandable Valve: The ARTE (Aspirin Versus Aspirin + Clopidogrel Following Transcatheter Aortic Valve Implantation) Randomized Clinical Trial
Conclusions This small trial showed that SAPT (vs. DAPT) tended to reduce the occurrence of major adverse events following TAVR. SAPT reduced the risk for major or life-threatening events while not increasing the risk for MI or stroke. Larger studies are needed to confirm these results. (Aspirin Versus Aspirin + Clopidogrel Following Transcatheter Aortic Valve Implantation: The ARTE Trial [ARTE], NCT01559298; Aspirin Versus Aspirin+Clopidogrel as Antithrombotic Treatment Following TAVI [ARTE], NCT02640794)
Source: Journal of the American College of Cardiology: Cardiovascular Interventions - July 3, 2017 Category: Cardiology Authors: Rodes-Cabau, J., Masson, J.-B., Welsh, R. C., Garcia del Blanco, B., Pelletier, M., Webb, J. G., Al-Qoofi, F., Genereux, P., Maluenda, G., Thoenes, M., Paradis, J.-M., Chamandi, C., Serra, V., Dumont, E., Cote, M. Tags: Structural Source Type: research

6- Versus 24-Month Dual Antiplatelet Therapy After Implantation of Drug-Eluting Stents in Patients Nonresistant to Aspirin: Final Results of the ITALIC Trial (Is There a Life for DES After Discontinuation of Clopidogrel)
Conclusions Two-year outcomes in the ITALIC trial confirmed the 1-year results and showed that patients receiving 6-month DAPT after percutaneous coronary intervention with second-generation drug-eluting stent have similar outcomes to those receiving 24-month DAPT.
Source: Journal of the American College of Cardiology: Cardiovascular Interventions - June 19, 2017 Category: Cardiology Authors: Didier, R., Morice, M. C., Barragan, P., Noryani, A. A. L., Noor, H. A., Majwal, T., Hovasse, T., Castellant, P., Schneeberger, M., Maillard, L., Bressolette, E., Wojcik, J., Delarche, N., Blanchard, D., Jouve, B., Ormezzano, O., Paganelli, F., Levy, G., Tags: Coronary Source Type: research

Prevalence, Management, and Long-Term (6-Year) Outcomes of Atrial Fibrillation Among Patients Receiving Drug-Eluting Coronary Stents
Conclusions Among patients receiving DES implantation, AF was not rare and was associated with increased ischemic and bleeding risk. In patients with AF, triple therapy was not associated with decreased ischemic events but was associated with increased bleeding risk compared to DAPT.
Source: Journal of the American College of Cardiology: Cardiovascular Interventions - June 5, 2017 Category: Cardiology Authors: Choi, H.-I., Ahn, J.-M., Kang, S. H., Lee, P. H., Kang, S.-J., Lee, S.-W., Kim, Y.-H., Lee, C. W., Park, S.-W., Park, D.-W., Park, S.-J. Tags: Coronary Source Type: research

Triple Therapy for Atrial Fibrillation and Percutaneous Coronary Intervention A Contemporary Review
Chronic oral anticoagulant therapy is recommended (class I) in patients with mechanical heart valves and in patients with atrial fibrillation with a CHA2DS2-VASc (Congestive heart failure, Hypertension, Age ≥75 years, Diabetes mellitus, prior Stroke or transient ischemic attack or thromboembolism, Vascular disease, Age 65 to 74 years, Sex category) score ≥1. When these patients undergo percutaneous coronary intervention with stenting, treatment with aspirin and a P2Y12 receptor inhibitor also becomes indicated. Before 2014, guidelines recommended the use of triple therapy (vitamin K antagonists, aspirin, and clopidog...
Source: Journal of the American College of Cardiology: Cardiovascular Interventions - September 15, 2014 Category: Cardiology Source Type: research

Frequency and Practice-Level Variation in Inappropriate and Nonrecommended Prasugrel Prescribing Insights From the NCDR PINNACLE Registry
Prasugrel significantly decreased cardiovascular death, myocardial infarction (MI), and stroke compared with clopidogrel in TRITON-TIMI 38 (Trial to Assess Improvement in Therapeutic Outcomes by Optimizing Platelet Inhibition with Prasugrel—Thrombolysis in Myocardial Infarction 38) (1). However, prasugrel use was associated with increased bleeding in patients with a history of previous stroke or transient ischemic attack (TIA) and was not associated with benefit in those ≥75 years of age. The prasugrel package insert (2) includes a black box warning for patients with previous stroke/TIA and also recommends against it...
Source: Journal of the American College of Cardiology: Cardiovascular Interventions - June 23, 2014 Category: Cardiology Source Type: research

Antithrombotic Treatment in Transcatheter Aortic Valve Implantation Insights for Cerebrovascular and Bleeding Events
Transcatheter aortic valve implantation (TAVI) has emerged as a therapeutic alternative for patients with symptomatic aortic stenosis at high or prohibitive surgical risk. However, patients undergoing TAVI are also at high risk for both bleeding and stroke complications, and specific mechanical aspects of the procedure itself can increase the risk of these complications. The mechanisms of periprocedural bleeding complications seem to relate mainly to vascular/access site complications (related to the use of large catheters in a very old and frail elderly population), whereas the pathophysiology of cerebrovascular events re...
Source: Journal of the American College of Cardiology: Cardiovascular Interventions - December 16, 2013 Category: Cardiology Source Type: research

Left Atrial Appendage Closure With the Watchman Device in Patients With a Contraindication for Oral Anticoagulation The ASAP Study (ASA Plavix Feasibility Study With Watchman Left Atrial Appendage Closure Technology)
ConclusionsLAA closure with the Watchman device can be safely performed without a warfarin transition, and is a reasonable alternative to consider for patients at high risk for stroke but with contraindications to systemic oral anticoagulation. (ASA Plavix Feasibility Study With Watchman Left Atrial Appendage Closure Technology [ASAP]; NCT00851578)
Source: Journal of the American College of Cardiology: Cardiovascular Interventions - June 17, 2013 Category: Cardiology Source Type: research

Platelet Responsiveness to Clopidogrel Treatment After Peripheral Endovascular Procedures The PRECLOP Study: Clinical Impact and Optimal Cutoff Value of On-Treatment High Platelet Reactivity
This study aimed to assess the clinical implications and optimal cutoff value of high platelet reactivity (HPR) in patients receiving clopidogrel for peripheral endovascular procedures.BackgroundAs noted in coronary studies, HPR could be related to increased adverse events.MethodsThis prospective trial included patients receiving clopidogrel 75 mg daily, before and after infrainguinal angioplasty or stenting. Platelet inhibition was assessed with the VerifyNow P2Y12 point-of-care test. Primary endpoints were 1-year clinical events rate (composite endpoint of death, major stroke, major amputation, target vessel revasculariz...
Source: Journal of the American College of Cardiology: Cardiovascular Interventions - June 10, 2013 Category: Cardiology Source Type: research

Triple Antithrombotic Therapy With Prasugrel in the Stented Patient Concern for More Bleeding ⁎ ⁎
There is a large body of evidence, including results of prospective trials, that supports oral anticoagulation therapy (OAT) as the optimal strategy to prevent fibrin-centric thrombotic events (FCTEs). Examples of FCTEs include thromboembolism in patients with mechanical heart valves, deep vein thrombosis, and atrial fibrillation (AF) (1). In a large prospective trial, warfarin was found to be superior to dual antiplatelet therapy (DAPT) with aspirin + clopidogrel in the prevention of vascular events in patients with AF plus 1 or more risk factors for stroke (2). European and American guidelines include a Class I recommend...
Source: Journal of the American College of Cardiology: Cardiovascular Interventions - May 13, 2013 Category: Cardiology Source Type: research

Triple Therapy With Aspirin, Prasugrel, and Vitamin K Antagonists in Patients With Drug-Eluting Stent Implantation and an Indication for Oral Anticoagulation
This study sought to evaluate whether prasugrel may serve as an alternative to clopidogrel in patients with triple therapy.BackgroundApproximately 10% of patients who receive dual antiplatelet therapy after percutaneous coronary intervention have an indication for oral anticoagulation and are thus treated with triple therapy. The standard adenosine diphosphate receptor blocker in this setting is clopidogrel. Data regarding prasugrel as part of triple therapy are not available.MethodsWe analyzed a consecutive series of 377 patients who underwent drug-eluting stent implantation and had an indication for oral anticoagulation ...
Source: Journal of the American College of Cardiology: Cardiovascular Interventions - May 13, 2013 Category: Cardiology Source Type: research

Strategies of Clopidogrel Load and Atorvastatin Reload to Prevent Ischemic Cerebral Events in Patients Undergoing Protected Carotid Stenting Results of the Randomized ARMYDA-9 CAROTID (Clopidogrel and Atorvastatin Treatment During Carotid Artery Stenting) Study
ConclusionsIn patients undergoing carotid stenting, a strategy using both a 600-mg clopidogrel load and a short-term reload with high-dose atorvastatin protects against early ischemic cerebral events. These results, obtained along with routine mechanical neuroprotection, provide new evidence of the optimization of drug therapy before percutaneous carotid intervention. (Clopidogrel and Atorvastatin Treatment During Carotid Artery Stenting [ARMYDA-9 CAROTID]; NCT01572623)
Source: Journal of the American College of Cardiology: Cardiovascular Interventions - March 25, 2013 Category: Cardiology Source Type: research

Low-Dose Colchicine for Secondary Prevention of Cardiovascular Disease
The objective of this study was to determine whether colchicine 0.5 mg/day can reduce the risk of cardiovascular events in patients with clinically stable coronary disease.BackgroundThe presence of activated neutrophils in culprit atherosclerotic plaques of patients with unstable coronary disease raises the possibility that inhibition of neutrophil function with colchicine may reduce the risk of plaque instability and thereby improve clinical outcomes in patients with stable coronary disease.MethodsIn a clinical trial with a prospective, randomized, observer-blinded endpoint design, 532 patients with stable coronary diseas...
Source: Journal of the American College of Cardiology: Cardiovascular Interventions - January 21, 2013 Category: Cardiology Source Type: research