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Finding the right balance
Patients with an indication for oral anticoagulation (OAC) that receive antiplatelet therapy after percutaneous coronary intervention (PCI) are challenging for the treating physician. It is of importance to balance their antithrombotic treatment to protect them from ischemic events, such as stent thrombosis as well as ischemic stroke without exposing them to an excess in bleeding. The current guidelines recommend a so-called triple therapy consisting of aspirin, clopidogrel and OAC for 1 –6 months after PCI depending on the patient's ischemic risk [1].
Source: International Journal of Cardiology - September 27, 2018 Category: Cardiology Authors: Alexander Goedel, Nikolaus Sarafoff Tags: Editorial Source Type: research

Inferiority of ticagrelor in the PHILO trial: Play of chance in East Asians or nightmare confirmation of PLATO-USA?
Long-awaiting PHILO trial, conducted in 2011–2012 has been submitted and published late in 2015. In contrast to overall PLATO results, but similar to PLATO-US cohort, PHILO revealed numerical inferiority of ticagrelor with regard to death, myocardial infarction, stroke, and bleeding over clopidogrel. Hence, we comprehend the PHILO results in light of the PLATO-US evidence. To assess the PHILO (n=801) outcomes, applied statistics, and trial conduct, matching them with the PLATO-US (n=1413) patients.
Source: International Journal of Cardiology - April 18, 2016 Category: Cardiology Authors: Victor L. Serebruany, Ales Tomek, Yury Pya, Makhabbat Bekbossynova, Moo Hyun Kim Tags: Editorial Source Type: research

Clopidogrel is safer than ticagrelor in regard to bleeds: A closer look at the PLATO trial
Conclusions: Clopidogrel is safer than ticagrelor in regard to bleeding. Additionally, ticagrelor's purported faster antiplatelet ‘offset’ is substantially longer than its pharmacokinetics indicate. Considering the fact that the mortality, stent thrombosis and myocardial infarction ‘benefit’ of ticagrelor have recently been challenged, and that the increase in stroke on ticagrelor has recently been shown to be worse than originally published, the decision to use ticagrelor over clopidogrel in the face of a higher risk for bleeds is not advised.
Source: International Journal of Cardiology - July 31, 2013 Category: Cardiology Authors: James J. DiNicolantonio, Fabrizio D'Ascenzo, Ales Tomek, Saurav Chatterjee, Asfandyar K. Niazi, Giuseppe Biondi-Zoccai Tags: Editorials Source Type: research

Stroke risk and suboptimal thromboprophylaxis in Chinese patients with atrial fibrillation: Would the novel oral anticoagulants have an impact?
Abstract: Background: The risk of stroke associated with atrial fibrillation (AF) is higher in Far Eastern population than in Western population, and warfarin use suboptimal. There is uncertainty whether the novel oral anticoagulants (NOACs) would have a major impact on stroke prevention in Far Eastern populations with AF.Objectives: We investigated current antithrombotic therapy use on stroke and bleeding risk, determinants of warfarin use and performed a modeling analysis of the net clinical benefit of the NOACs (apixaban, dabigatran) in a large cohort of Chinese patients with AF.Methods: We studied 1034 Chinese patients...
Source: International Journal of Cardiology - October 24, 2012 Category: Cardiology Authors: Yutao Guo, Ron Pisters, Stavros Apostolakis, Andrew D. Blann, Haijun Wang, Xiaoning Zhao, Yu Zhang, Dexian Zhang, Jingling Ma, Yutang Wang, Gregory Y.H. Lip Tags: Original Articles Source Type: research