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Source: Journal of the American College of Cardiology
Drug: Clopidogrel
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Total 21 results found since Jan 2013.
The Development of Therapeutics for Peripheral Artery Disease A Unique Cardiovascular Risk Population ∗
Peripheral artery disease (PAD) primarily manifests as occlusive atherosclerosis in the peripheral circulation to the lower extremities (1). Symptomatic patients have either a profound exercise limitation or develop critical limb ischemia, and all of these patients are at heightened risk for major cardiovascular and ischemic limb events (2). Despite a severe morbidity and mortality risk, historically, little attention has been paid to developing targeted therapies to reduce this risk in patients with PAD (3). However, there were early signals that PAD may be responsive to potent antiplatelet therapy in the CAPRIE (Clopidog...
Source: Journal of the American College of Cardiology - June 7, 2016 Category: Cardiology Source Type: research
Left Atrial Appendage Closure in Patients With Contraindications to Oral Anticoagulation
The PROTECT AF (Watchman Left Atrial Appendage Closure Technology for Embolic Protection in Patients With Atrial Fibrillation) and PREVAIL (Prospective Randomized Evaluation of the Watchman LAA Closure Device In Patients With Atrial Fibrillation Versus Long-Term Warfarin Therapy) trials revealed that in atrial fibrillation (AF) patients suitable for oral anticoagulation (OAC), mechanical left atrial appendage closure (LAAC) with a catheter-delivered heart implant device (Watchman; Boston Scientific, Marlborough, Massachusetts) is effective for stroke prevention (1,2). Importantly, these patients received at least 6 weeks ...
Source: Journal of the American College of Cardiology - May 3, 2016 Category: Cardiology Source Type: research
Proton-Pump Inhibitors Reduce Gastrointestinal Events Regardless of Aspirin Dose in Patients Requiring Dual Antiplatelet Therapy
ConclusionsGastroprotection with PPI therapy should be utilized in appropriately selected patients with coronary artery disease requiring DAPT, even if the patients are on low-dose aspirin. (Clopidogrel and the Optimization of Gastrointestinal Events Trial [COGENT]; NCT00557921)
Source: Journal of the American College of Cardiology - April 4, 2016 Category: Cardiology Source Type: research
Impact of CYP2C19 Metabolizer Status on Patients With ACS Treated With Prasugrel Versus Clopidogrel
ConclusionsCYP2C19 metabolizer status is not associated with the composite outcome of cardiovascular death, MI, or stroke in medically managed ACS patients treated with clopidogrel or prasugrel. Our findings do not support routine CYP2C19 genetic testing in this population. (A Comparison of Prasugrel and Clopidogrel in Acute Coronary Syndrome Subjects [TRILOGY ACS]; NCT00699998)
Source: Journal of the American College of Cardiology - February 23, 2016 Category: Cardiology Source Type: research
Duration of Triple Therapy in Patients Requiring Oral Anticoagulation After Drug-Eluting Stent Implantation
We read with much interest the paper and editorial by Fiedler et al. (1) and Bhatt et al. (2) regarding the optimal duration of dual antiplatelet therapy (DAPT) in patients on systemic anticoagulation in a recent issue of the Journal. In this randomized, open-label trial, 614 patients underwent drug-eluting stent (DES) implantation and were randomized to either 6 weeks or 6 months of clopidogrel therapy. They found no difference in the primary endpoint (composite of death, myocardial infarction, definite stent thrombosis, stroke, or TIMI [Thrombolysis In Myocardial Infarction] major bleeding) between the 2 groups (9.8...
Source: Journal of the American College of Cardiology - August 24, 2015 Category: Cardiology Source Type: research
The Challenge of Getting it Just Right Optimizing Long-Term Antithrombotic Therapy After Acute Coronary Syndrome ∗
Acute coronary syndrome (ACS) is associated with substantial morbidity and mortality (1,2). Initial treatment in the hospital consists of intensive antithrombotic therapy combining parenteral anticoagulation with antiplatelet therapy, whereas secondary prevention relies primarily on dual antiplatelet therapy (DAPT), most commonly aspirin and clopidogrel. However, patients with ACS remain at significant risk of recurrent adverse cardiovascular events (3). Mitigation of this risk requires a delicate balance between escalation of antithrombotic therapy to reduce ischemic events, while hoping the increase in bleeding is tolera...
Source: Journal of the American College of Cardiology - August 10, 2015 Category: Cardiology Source Type: research
Apixaban Plus Mono Versus Dual Antiplatelet Therapy in Acute Coronary Syndromes Insights From the APPRAISE-2 Trial
ConclusionsPost-ACS treatment with apixaban versus placebo showed no efficacy, but it increased bleeding regardless of concomitant therapy with aspirin alone or aspirin plus clopidogrel. (Apixaban for Prevention of Acute Ischemic Events 2 [APPRAISE-2]; NCT00831441)
Source: Journal of the American College of Cardiology - August 10, 2015 Category: Cardiology Source Type: research
Duration of Triple Therapy in Patients Requiring Oral Anticoagulation After Drug-Eluting Stent Implantation The ISAR-TRIPLE Trial
ConclusionsSix weeks of triple therapy was not superior to 6 months with respect to net clinical outcomes. These results suggest that physicians should weigh the trade-off between ischemic and bleeding risk when choosing the shorter or longer duration of triple therapy. (Triple Therapy in Patients on Oral Anticoagulation After Drug Eluting Stent Implantation [ISAR-TRIPLE]; NCT00776633)
Source: Journal of the American College of Cardiology - April 20, 2015 Category: Cardiology Source Type: research
6- Versus 24-Month Dual Antiplatelet Therapy After Implantation of Drug-Eluting Stents in Patients Nonresistant to Aspirin The Randomized, Multicenter ITALIC Trial
ConclusionsRates of bleeding and thrombotic events were not significantly different according to 6- versus 24-month DAPT after PCI with new-generation DES in good aspirin responders. (Is There A LIfe for DES After Discontinuation of Clopidogrel [ITALICplus]; NCT01476020)
Source: Journal of the American College of Cardiology - February 23, 2015 Category: Cardiology 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
Vorapaxar, Combination Antiplatelet Therapy, and Stroke ∗
Drugs that inhibit platelet activation and aggregation reduce vascular events, notably myocardial infarction (MI) and ischemic stroke, and are generally associated with low rates of bleeding (1). Available agents inhibit platelets via distinct mechanisms (Table 1) (2), and combining antiplatelet drugs with different mechanisms of action should enhance net antithrombotic activity. For over a decade, the standard of care in patients with acute coronary syndromes, particularly those undergoing coronary stent implantation, has been dual antiplatelet therapy with aspirin plus an adenosine diphosphate receptor antagonist. When ...
Source: Journal of the American College of Cardiology - December 1, 2014 Category: Cardiology Source Type: research
The Effect of Dabigatran Plasma Concentrations and Patient Characteristics on the Frequency of Ischemic Stroke and Major Bleeding in Atrial Fibrillation Patients: The RE-LY Trial (Randomized Evaluation of Long-Term Anticoagulation Therapy)
Objectives: The goal of this study was to analyze the impact of dabigatran plasma concentrations, patient demographics, and aspirin (ASA) use on frequencies of ischemic strokes/systemic emboli and major bleeds in atrial fibrillation patients.Background: The efficacy and safety of dabigatran etexilate were demonstrated in the RE-LY (Randomized Evaluation of Long-Term Anticoagulation Therapy) trial, but a therapeutic concentration range has not been defined.Methods: In a pre-specified analysis of RE-LY, plasma concentrations of dabigatran were determined in patients treated with dabigatran etexilate 110 mg twice daily (bid) ...
Source: Journal of the American College of Cardiology - September 30, 2013 Category: Cardiology Authors: Paul A. Reilly, Thorsten Lehr, Sebastian Haertter, Stuart J. Connolly, Salim Yusuf, John W. Eikelboom, Michael D. Ezekowitz, Gerhard Nehmiz, Susan Wang, Lars Wallentin, RE-LY Investigators Tags: Antithrombotic Therapy Source Type: research
Oral Anticoagulation and Antiplatelets in Atrial Fibrillation Patients After Myocardial Infarction and Coronary Intervention
Conclusions: In real-life AF patients with indication for multiple antithrombotic drugs after MI/PCI, OAC and clopidogrel was equal or better on both benefit and safety outcomes compared to triple therapy.
Source: Journal of the American College of Cardiology - June 10, 2013 Category: Cardiology Authors: Morten Lamberts, Gunnar H. Gislason, Jonas Bjerring Olesen, Søren Lund Kristensen, Anne-Marie Schjerning Olsen, Anders Mikkelsen, Christine Benn Christensen, Gregory Y.H. Lip, Lars Køber, Christian Torp-Pedersen, Morten Lock Hansen Tags: Coronary Artery Disease Source Type: research
Antithrombotic Regimens in Patients With Atrial Fibrillation and Coronary Disease: Optimizing Efficacy and Safety∗
Clear evidence supports the value of oral anticoagulation (OAC) with vitamin K antagonists in preventing stroke and thromboembolism in patients with atrial fibrillation (AF) who have well-established risk factors. For this indication, vitamin K antagonists have been shown to be superior to single or dual antiplatelet agents in reducing thromboembolic complications . Yet, up to 30% of patients with AF also have indications for antiplatelet therapy because of coronary artery disease . Dual antiplatelet therapy with aspirin and a P2Y12 receptor inhibitor (e.g., clopidogrel) is usually recommended after stent implantation or a...
Source: Journal of the American College of Cardiology - June 10, 2013 Category: Cardiology Authors: Steven M. Markowitz Tags: Coronary Artery Disease: Editorial Comment 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.Background: As noted in coronary studies, HPR could be related to increased adverse events.Methods: This 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 revascul...
Source: Journal of the American College of Cardiology - April 18, 2013 Category: Cardiology Authors: Stavros Spiliopoulos, Georgios Pastromas, Konstantinos Katsanos, Panagiotis Kitrou, Dimitrios Karnabatidis, Dimitrios Siablis Tags: Interventional Cardiology Source Type: research
