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Alteplase for acute ischemic stroke after heparin reversal with protamine – a case report and review
ConclusionsGiven the lack of adverse events associated with IV alteplase in our patient, we advocate cautious evaluation for potential reversal of acutely administered anticoagulation to facilitate alteplase administration in severely disabled patients who are not eligible for mechanical intervention, and who would have been excluded from definitive AIS treatment.This article is protected by copyright. All rights reserved.
Source: Pharmacotherapy: The Journal of Human Pharmacology and Drug Therapy - July 25, 2017 Category: Drugs & Pharmacology Authors: Gabriel V. Fontaine, Shawn M. Smith Tags: Case Report Source Type: research

Alteplase for Acute Ischemic Stroke after Heparin Reversal with Protamine: A Case Report and Review
We describe the first reported case of a patient receiving full‐dose intravenous (IV) alteplase for AIS after heparin reversal with protamine. A 73‐year‐old man presented with AIS. He was treated with IV heparin, tirofiban, loading‐dose prasugrel, and aspirin before percutaneous coronary intervention (PCI) for placement of a right coronary artery stent. One hour following PCI, he abruptly developed left hemiparesis and dysphagia. The National Institutes of Health Stroke Scale was 12, and activated partial thromboplastin time (aPTT) was longer than 150 seconds. Head computed tomography (CT) showed no acute patholog...
Source: Pharmacotherapy: The Journal of Human Pharmacology and Drug Therapy - September 4, 2017 Category: Drugs & Pharmacology Authors: Gabriel V. Fontaine, Shawn M. Smith Tags: Case Report Source Type: research

Dual anti-platelet therapy following percutaneous coronary intervention in a population of patients with thrombocytopenia at baseline: a meta-analysis.
CONCLUSIONS: According to the results of this analysis, DAPT might have to be cautiously be used following PCI in a population of patients with thrombocytopenia at baseline due to the significantly higher bleeding rate including gastro-intestinal, intra-cranial bleeding and hemorrhagic stroke. Hence, special care might have to be taken when considering anti-platelet agents following PCI in these high risk patients. However, considering the present limitations of this analysis, this hypothesis will have to be confirmed in future trials. PMID: 32334636 [PubMed - as supplied by publisher]
Source: BMC Pharmacology and Toxicology - April 27, 2020 Category: Drugs & Pharmacology Tags: BMC Pharmacol Toxicol Source Type: research

Comparative efficacy and safety of antiplatelet or anticoagulant therapy in patients with chronic coronary syndromes after percutaneous coronary intervention: A network meta-analysis of randomized controlled trials
Aimed to evaluate and compare the interactive effects of different antiplatelet or anticoagulation strategies in patients with chronic coronary syndromes (CCS) after percutaneous coronary intervention (PCI). Randomized controlled trials comparing different antiplatelet or anticoagulant strategies in patients with CCS after PCI were included. The primary outcomes were major adverse cardiovascular event (MACE), mortality, ischemic and bleeding events. Compared to aspirin alone, addition of prasugrel or ticagrelor to aspirin resulted in lower risk of myocardial infarction (MI) [odds ratio (OR): 0.38 (95% confidence interval 0...
Source: Frontiers in Pharmacology - September 30, 2022 Category: Drugs & Pharmacology Source Type: research

Clopidogrel Versus Aspirin for the Treatment of Acute Coronary Syndrome After a 12-Month Dual Antiplatelet Therapy: A Cost-effectiveness Analysis From China Payer's Perspective.
Abstract PURPOSE: Monotherapy with either aspirin or clopidogrel is recommended for long-term use after discontinuation of dual-antiplatelet therapy (DAPT) for acute coronary syndrome (ACS) management after percutaneous coronary intervention (PCI). The present study is to evaluate the cost-effectiveness of clopidogrel versus aspirin after 12-month DAPT for patients with ACS who underwent PCI in China. METHODS: A 2-part model was developed to estimate the cost-effectiveness of clopidogrel compared with aspirin. The short-term part was a decision tree that included health states such as myocardial infarction (M...
Source: Clinical Therapeutics - November 20, 2018 Category: Drugs & Pharmacology Authors: Zhang L, Lin Z, Yin H, Liu J, Xuan J Tags: Clin Ther Source Type: research

Comparative Effectiveness and Safety of Prasugrel versus Ticagrelor following Percutaneous Coronary Intervention: An Observational Study
ConclusionWhen compared with ticagrelor, prasugrel use following PCI for ACS was associated with a lower risk of death, MI, or stroke, as well as a reduced risk of major bleeding.
Source: Pharmacotherapy: The Journal of Human Pharmacology and Drug Therapy - May 1, 2021 Category: Drugs & Pharmacology Authors: Nicholas Belviso, Herbert D. Aronow, Richard Wyss, Marilyn Barbour, Yichi Zhang, Xuerong Wen, Stephen Kogut Tags: ORIGINAL RESEARCH ARTICLE Source Type: research

Utilization of triple antithrombotic therapy in patients with atrial fibrillation undergoing percutaneous coronary intervention
ConclusionsThe utilization of TAT following PCI among high-stroke risk AF patients steadily increased from 2011 to 2020, reaching 65.4% by the end of the study period. However, in 2020, a significant proportion of 29.4% of patients still received DAPT, indicating that many AF patients undergoing PCI did not receive adequate antithrombotic therapy.
Source: European Journal of Clinical Pharmacology - February 24, 2023 Category: Drugs & Pharmacology Source Type: research

Clinical and Economic Burden in Patients with Diagnosis of Peripheral Arterial Disease in a Claims Database in Japan.
Abstract PURPOSE: The effect of peripheral arterial disease (PAD) among young and middle-aged adults can be significant, but no previous study has examined the prognosis and the associated health care cost of the disease in this population. We evaluated the clinical and economic burden of PAD in patients from a large claims database to clarify the effect of the disease on a relatively young working Japanese population. METHODS: Patients aged ≥45 and ≤64 years with first PAD diagnosis between 2005 and 2011 comprised the PAD cohort (n = 362); an age- and sex-matched non-PAD comparison cohort (n = 362) was a...
Source: Clinical Therapeutics - July 7, 2014 Category: Drugs & Pharmacology Authors: Hosaka A, Miyata T, Onishi Y, Liao L, Zhang Q Tags: Clin Ther Source Type: research

P2Y12 receptor antagonists: which one to choose? A systematic review and meta-analysis.
Conclusion: Newer P2Y12 receptor antagonists are associated with better cardiovascular outcomes in patients with ACS and/or undergoing PCI. Prasugrel use resulted in higher major bleeding rates and no overall mortality benefit compared with clopidogrel. PMID: 27290917 [PubMed - as supplied by publisher]
Source: Current Pharmaceutical Design - June 7, 2016 Category: Drugs & Pharmacology Authors: Briasoulis A, Telila T, Palla M, Siasos G, Tousoulis D Tags: Curr Pharm Des Source Type: research

Antithrombotic strategies in patients with atrial fibrillation undergoing percutaneous coronary intervention.
Abstract The optimal strategy of antithrombotic therapy for patients with atrial fibrillation (AF) undergoing percutaneous coronary intervention remains to be a question to be answered. The major challenge in such population is the balance between the benefit of reduced stroke and coronary ischemic events, against the risk of increased bleeding complications. Thus, both thrombotic and bleeding risk assessments should be included into clinical decision-making process for such patients. Currently, there is limited evidence based on randomized trials with adequate power to show the superiority of any strategy in the ...
Source: Current Pharmaceutical Design - December 27, 2017 Category: Drugs & Pharmacology Authors: Pan D, Ren X, Hu Z Tags: Curr Pharm Des Source Type: research

The association between clopidogrel and 2-oxo-clopidogrel plasma levels and the long-term clinical outcome after acute myocardial infarction 
.
CONCLUSION: In patients with acute MI treated with PCI, lower dose-adjusted clopidogrel and dose-adjusted 2-oxo-clopidogrel plasma concentrations were associated with an increased risk of ischemic events.
. PMID: 30431425 [PubMed - as supplied by publisher]
Source: International Journal of Clinical Pharmacology and Therapeutics - November 17, 2018 Category: Drugs & Pharmacology Tags: Int J Clin Pharmacol Ther Source Type: research

Oral Anticoagulants With Dual Antiplatelet Therapy Versus Clopidogrel in Patients After Percutaneous Coronary Intervention: A Meta-Analysis
Conclusions: In patients who are on OAC with vitamin K antagonist and underwent percutaneous coronary intervention, no significant differences were found in mortality, ischemic, and hemorrhagic complications between the patients treated with TT and DT. Thus, tailored treatment based on individual thromboembolic and bleeding risk might be the most reasonable approach in these patients.
Source: American Journal of Therapeutics - December 29, 2018 Category: Drugs & Pharmacology Tags: Reviews Source Type: research

A drug safety evaluation of apixaban for the treatment of atrial fibrillation, acute coronary syndrome and percutaneous coronary intervention.
Authors: Gumprecht J, Domek M, Lip GY Abstract Introduction: The non-vitamin K antagonist oral anticoagulants (NOACs) are changing the landscape for stroke prevention in atrial fibrillation (AF) and prevention or treatment of venous thromboembolism (VTE). In patients with AF and concomitant acute coronary syndrome (ACS), the treatment regimen of combined NOACs and P2Y12 inhibitors is gaining popularity. Areas covered: The authors conducted a review of studies published in the last 10 years regarding safety evaluation and effectiveness of apixaban for the treatment of AF and ACS, both alone and in combination with d...
Source: Expert Opinion on Drug Safety - October 4, 2019 Category: Drugs & Pharmacology Tags: Expert Opin Drug Saf Source Type: research

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