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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

Another side effect of ticagrelor: Atrial fibrillation
Ticagrelor, a novel direct and reversible P2Y12 receptor antagonist, was superior to clopidogrel in reducing cardiovascular events among patients with acute coronary syndrome (ACS) as demonstrated in the PLATO trial [1]. In addition, the recent PEGASUS-TIMI 54 trial also suggested that ticagrelor significantly decreased the risk of cardiovascular death, myocardial infarction or stroke in patients with prior myocardial infarction during a 33-month follow-up [2]. However, several adverse effects have been observed during the treatment with ticagrelor, such as bradyarrhythmias including sinus node pause and atrioventricular b...
Source: International Journal of Cardiology - March 21, 2016 Category: Cardiology Authors: Nixiao Zhang, Kang-Yin Chen, Jianping Zhao, Gang Xu, Guangping Li, Tong Liu Tags: Correspondence 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

Side effects of ticagrelor: sinus node dysfunction with ventricular pause
The PLATO study has demonstrated that treatment with ticagrelor (versus clopidogrel) significantly reduced the rate of a composite primary end point (death from vascular causes, myocardial infarction or stroke) in patients presenting with acute coronary syndrome [1,2]. However, some adverse effects may occur [3–6].
Source: International Journal of Cardiology - April 24, 2015 Category: Cardiology Authors: Martin Nicol, Julien Deblaise, Rémi Choussat, Olivier Dubourg, Nicolas Mansencal Source Type: research

Acute Myocardial Infarction and Acute Stroke: Between a Rock and a Hard Place
A 53year-old woman developed severe chest pain, breathlessness and palpitations whilst being told some very devastating news. As the symptoms persisted for more than 15minutes, electrocardiography was undertaken in the community confirming an anterolateral STEMI. Following the electrocardiographic findings the patient was loaded orally in the community with aspirin 300mg and clopidogrel 600mg and was urgently transferred via the community activation primary PCI route to our institution for emergency coronary angiography.
Source: International Journal of Cardiology - October 22, 2014 Category: Cardiology Authors: Vassilios Vassiliou, Bushra Rana, Martin Goddard, Denise Braganza Tags: Letter to the editor Source Type: research

Review of the accumulated PLATO documentation supports reliable and consistent superiority of ticagrelor over clopidogrel in patients with acute coronary syndrome: Commentary on: DiNicolantonio JJ, Tomek A, Inactivations, deletions, non-adjudications, and downgrades of clinical endpoints on ticagrelor: Serious concerns over the reliability of the PLATO trial, International Journal of Cardiology, 2013
Four years ago we presented the first results from Platelet Inhibition and Patient Outcomes (PLATO) trial testing the superiority of ticagrelor as compared with clopidogrel in 18,624 patients with ST-elevation myocardial infarction (STE-MI) or non-ST-elevation acute coronary syndromes (NSTE-ACS) from 41 countries . The trial met its primary objective and showed a significant reduction in the primary composite (death from vascular causes, myocardial infarction, or stroke) with ticagrelor compared to clopidogrel (9.8% vs. 11.7%, Hazard Ratio [HR] 0.84, 95% confidence interval [CI]: 0.77–0.92, p
Source: International Journal of Cardiology - December 2, 2013 Category: Cardiology Authors: Lars Wallentin, Richard C. Becker, Christopher P. Cannon, Claes Held, Anders Himmelmann, Steen Husted, Stefan K. James, Hugo S. Katus, Kenneth W. Mahaffey, Karen S. Pieper, Robert F. Storey, Philippe Gabriel Steg, Robert A. Harrington Tags: Online Letters to the Editor 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

High post-clopidogrel platelet reactivity assessed by a point-of-care assay predicts long-term clinical outcomes in patients with ST-segment elevation myocardial infarction who underwent primary coronary stenting
Abstract: Background: Recent studies have shown that post-clopidogrel high platelet reactivity (HPR), assessed by a point-of-care assay, is associated with a higher risk of adverse events after percutaneous coronary intervention (PCI). We assessed the clinical impact of HPR by the VerifyNow P2Y12 point-of-care assay in 181 patients with ST-segment elevation myocardial infarction (STEMI) who underwent primary PCI with drug-eluting stents (DES) at 3 hospitals.Methods: The primary endpoint of the study was the 12-month major adverse cardiovascular events (MACE), which comprised cardiovascular death, nonfatal MI and ischemic s...
Source: International Journal of Cardiology - June 11, 2012 Category: Cardiology Authors: Han-Young Jin, Tae-Hyun Yang, Doo-Il Kim, Sang-Ryul Chung, Jeong-Sook Seo, Jae-Sik Jang, Dae-Kyeong Kim, Dong-Kie Kim, Ki-Hun Kim, Sang-Hoon Seol, Chang-Wook Nam, Seung-Ho Hur, Woong Kim, Jong-Seon Park, Young-Jo Kim, Dong-Soo Kim Tags: Original Articles Source Type: research

Dual non-responsiveness to antiplatelet treatment is a stronger predictor of cardiac adverse events than isolated non-responsiveness to clopidogrel or aspirin
Conclusions: Dual low responsiveness to clopidogrel and aspirin is a strong predictor of cardiac adverse events, especially in patients with diabetes mellitus, which underlines the need for personalized antiplatelet treatment.
Source: International Journal of Cardiology - February 3, 2012 Category: Cardiology Authors: Jolanta M. Siller-Matula, Georg Delle-Karth, Günter Christ, Thomas Neunteufl, Gerald Maurer, Kurt Huber, Alexander Tolios, Christa Drucker, Bernd Jilma Tags: Original Articles Source Type: research