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Relationship between activated clotting time and ischemic or hemorrhagic complications: analysis of 4 recent randomized clinical trials of percutaneous coronary intervention.

BACKGROUND: Unfractionated heparin (UFH) is the most widely used antithrombin during percutaneous coronary intervention (PCI). Despite significant pharmacological and mechanical advancements in PCI, uncertainty remains about the optimal activated clotting time (ACT) for prevention of ischemic or hemorrhagic complications. METHODS AND RESULTS: We analyzed the outcome of all UFH-treated patients enrolled in 4 large, contemporary PCI trials with independent adjudication of ischemic and bleeding events. Of 9974 eligible patients, maximum ACT was available in 8369 (84%). The median ACT was 297 sec

Clinical Manifestations, Treatment Characteristics, and Clinical Outcomes in Patients with Immune Thrombotic Thrombocytopenic Purpura (iTTP) in a Real-World Setting: An Interim Analysis of the Turkish iTTP Registry

OBJECTIVE: This study aimed to investigate the clinical manifestations, treatment patterns, and clinical outcomes of patients with immune thrombotic thrombocytopenic purpura (iTTP) across Türkiye via an interim analysis of the Turkish iTTP Registry. MATERIALS AND METHODS: A total of 215 patients with iTTP (median age at diagnosis: 41 years; 58.6% female) diagnosed between 2001 and 2023 were retrospectively analyzed in the interim analysis of a prospective non-interventional observational multicenter iTTP registry study (ClinicalTrials.gov Identifier: NCT05950750) conducted at 19 tertiary hema

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… The clopidogrel, cyclosporin, and quinine usage rates within the 3 weeks prior to diagnosis were 1.9%, 1.4%, and 0.9%, respectively ( Table 1 ). Table 1. Demographic characteristics and potential triggers. … Clopidogrel-induced refractory thrombotic thrombocytopenic purpura successfully treated with rituximab. Hematol Oncol Stem Cell Ther. 2016;9(2):76–79. doi: 10.1016/j.hemonc.2015.11.003. 35. …

[Comments on the 2010 guidelines on cardiopulmonary resuscitation of the European Resuscitation Council].

ADULTS: Administer chest compressions (minimum 100/min, minimum 5 cm depth) at a ratio of 30:2 with ventilation (tidal volume 500-600 ml, in … hospital 12-lead ECG. In parallel to pain therapy, administer aspirin (160-325 mg p.o. or i.v.) and clopidogrel (75-600 mg depending on strategy); in ST-elevation myocardial infarction (STEMI) and planned PCI also prasugrel (60 mg p.o.). Antithrombins, such as heparin (60 IU/kgBW, max. 4000 IU), enoxaparin, bivalirudin or fondaparinux depending on the diagnos …

Community pharmacists' experience with pharmacogenetic testing.

OBJECTIVE: Appendix 1 Statements of knowledge of correct medication use Appendix 2 Statements of self-efficacy of correct medication use Appendix 3 Statements of skills of correct medication use To characterize the experiences and feasibility of offering pharmacogenetic (PGx) testing in a community pharmacy setting. DESIGN: Pharmacists were invited to complete a survey about PGx testing for each patient who was offered testing. If the patient consented, pharmacists were also asked to complete a follow-up survey about the process of returning PGx testing results to patients and follow-up with

The HEART study: a real-world experience using the CID Chrono Carbostent in primary and rescue PCI.

BACKGROUND: Chrono Carbostent (CID, Saluggia, Italy) is characterized by a peculiar coating with Carbofilm which could reduce the risk of thrombosis as compared to other bare metal stents (BMS). This feature should be particularly useful in the setting of primary or rescue percutaneous coronary intervention (PCI) in patients with ST-segment elevation myocardial infarction (STEMI). METHODS: We tested the efficacy and safety of this stent in patients with STEMI undergoing primary or rescue PCI. Inclusion criteria included the diagnosis of STEMI, a coronary anatomy suitable for stenting and no c

Reduced antiplatelet therapy after drug-eluting stenting: multicenter Janus Flex carbostent implantation with short dual antiplatelet treatment for 2 or 6 months-MATRIX study.

OBJECTIVES: The Multicentre registry with Antiplatelet TReatment two-sIX months (MATRIX) evaluated safety and efficacy at 12-month follow-up of Janus Flex stenting with 2- or 6-month dual antiplatelet therapy (DAT) period. BACKGROUND: There are no data of Janus Flex stent (Carbostent and Implantable Devices-CID, Saluggia, Italy), a polymer-free, tacrolimus-eluting coronary stent, followed by short-term DAT, in daily practice. METHODS: Patients were prospectively enrolled at 12 high-volume procedures centres. After stenting, four sites prescribed 2-month DAT, eight sites 6-month DAT. Major ad

RESEARCH COMMUNICATIONS OF THE 28th ECVIM-CA CONGRESS.

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… A double‐blinded, placebo‐controlled trial was performed using 24 healthy adult dogs (median age 3 years, range 2‐7)> Dogs were randomized to 4 groups: placebo, clopidogrel 2‐3mg/kg/d, prednisone 2mg/kg/d, or combined prednisone/clopidogrel PO for 28 days. … clopidogrel [day 14, PE/IE 5 (1‐45); day 28, PE/IE 0 (0‐14)] groups. …

< < Уолл-Эйд > > , двусторонняя межядерное офтальмоплегия с конкомитной диплегией: тематический доклад и обзор литературы.

Синдром офтальмоплегии (WEBINO) - это редкое нейро-офтальмологическое заболевание. Его связь с диплегией лиц является еще более редкой, что делает эту комбинацию одним из самых редких синдромов мозга, о чем сообщается лишь в нескольких случаях в литературе. Мы сообщаем о случае 62-летней женщины с множественными факторами сердечно-сосудистого риска и инсультом, обусловленным болезнью малых судов. Она познакомилась с внезапным наступлением диплопии и двусторонним параличом лица. Неврологический анализ показал, что синдром WEBINO связан с диплегией лиц. Мозговые магнитные резонансные изображения

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… Dual antiplatelet therapy with acetylsalicylic acid (160 mg once daily) and clopidogrel (75 mg once daily) was initiated for three months, with strict control of cerebrovascular risk factors and rehabilitation therapy. … Hypertension, type 2 diabetes mellitus     Sudden-onset WEBINO and gait disturbance, followed by facial diplegia on day 3 Midline dorsal pontine infarction; posterior circulation stenosis     Ischemic stroke; possible perforating artery variant supplying both sides of the dorsal tegmentum     Aspirin, clopidogrel …

An update of comprehensive evidence-based guidelines for interventional techniques in chronic spinal pain. Part II: guidance and recommendations.

OBJECTIVE: To develop evidence-based clinical practice guidelines for interventional techniques in the diagnosis and treatment of chronic sp … gation inhibitors to avoid bleeding and epidural hematomas and/or to continue antiplatelet therapy (clopidogrel, ticlopidine, prasugrel) during interventional techniques to avoid cerebrovascular and cardiovascular thromboembolic fatalities. • There is limited evidence in reference to newer antithrombotic agents dabigatran (Pradaxa) and rivaroxan (Xarelto) to …

Outcomes of Individuals With and Without Heart Failure Presenting With Acute Coronary Syndrome.

Major adverse cardiac event (MACE) and bleeding risks following percutaneous coronary intervention (PCI) for acute coronary syndromes (ACS) are not well defined in individuals with heart failure (HF). We followed 1,145 individuals in the Pharmacogenomic Resource to improve Medication Effectiveness Genotype Guided Antiplatelet Therapy cohort for MACE and bleeding events following PCI for ACS. We constructed Cox proportional hazards models to compare MACE and bleeding in those with versus without HF, adjusting for sociodemographics, comorbidities, and medications. We also determined predictors o

Platelet Reactivity and Clinical Outcomes After Coronary Artery Implantation of Drug-Eluting Stents in Subjects With Peripheral Arterial Disease: Analysis From the ADAPT-DES Study (Assessment of Dual Antiplatelet Therapy With Drug-Eluting Stents).

BACKGROUND: Patients with peripheral arterial disease (PAD) have high rates of adverse cardiovascular events after percutaneous coronary intervention and may additionally have heightened platelet reactivity. This study assessed the relationship between platelet reactivity and clinical outcomes after percutaneous coronary interventions among subjects with and without PAD. METHODS AND RESULTS: ADAPT-DES (Assessment of Dual Antiplatelet Therapy With Drug-Eluting Stents) was a prospective, multicenter registry of patients treated with coronary drug-eluting stents. Platelet reactivity was assessed

Impact of Anemia on the Risk of Bleeding Following Percutaneous Coronary Interventions in Patients ≥75 Years of Age.

Bleeding risk stratification is an unresolved issue in older adults. Anemia may reflect subclinical blood losses that can be exacerbated after percutaneous coronary intervention . We sought to prospectively determine the contribution of anemia to the risk of bleeding in 448 consecutive patients aged 75 or more years, treated by percutaneous coronary interventions without concomitant indication for oral anticoagulation. We evaluated the effect of WHO-defined anemia on the incidence of 1-year nonaccess site-related major bleeding. The prevalence of anemia was 39%, and 13.1% of anemic and 5.2% of

Emergency percutaneous coronary intervention (PCI) for the care of patients with ST-elevation myocardial infarction (STEMI).

There is general consensus that emergency percutaneous coronary intervention (PCI) is the preferred treatment for patients with ST-elevation … a inhibitors (especially abciximab), dual antiplatelet therapy (the addition of the thienopyridine, clopidogrel, to aspirin use), and bare-metal stents (BMS), for a broad range of STEMI patients. The added value of drug-eluting stents (DES) to bare-metal stents (BMS), primarily in terms of reducing restenosis and repeat revascularization, is supported by seve …

Safety and efficacy of factor XIa inhibition with milvexian for secondary stroke prevention (AXIOMATIC-SSP): a phase 2, international, randomised, double-blind, placebo-controlled, dose-finding trial.

BACKGROUND: People with factor XI deficiency have lower rates of ischaemic stroke than the general population and infrequent spontaneous ble … aily, or 200 mg twice daily) or matching placebo twice daily for 90 days. All participants received clopidogrel 75 mg daily for the first 21 days and aspirin 100 mg daily for the first 90 days. Investigators, site staff, and participants were masked to treatment assignment. The primary efficacy endpoint was the composite of ischaemic stroke or incident covert …

Research progress on bleeding risk assessment models in anticoagulant therapy.

Balancing thromboembolic prevention against bleeding complications remains a critical challenge in anticoagulant therapy. While established bleeding risk assessment models (RAMs) such as HAS-BLED and HEMORR2HAGES were initially developed for warfarin-treated patients, their applicability to non-vitamin K antagonist oral anticoagulant (NOAC) users and venous thromboembolism (VTE) populations remained uncertain. This review synthesized recent advancements in bleeding risk stratification for atrial fibrillation (AF) and VTE patients, focusing on model performance, drug-specific adaptations, and e

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… Model | Original study design/validation cohort | Sample size ( n ) | Main predictive factors | Risk stratification | Major bleeding incidence (%) | C-statistic (AUC) | Key features HAS-BLED | Derived from the Euro Heart Survey; external validation in multiple AF cohorts | OAC: 2,115 Aspirin/Clopidogrel … : 828 Neither: 352 | Hypertension, Abnormal renal/liver function, Stroke, Bleeding history, Labile INR, Elderly (≥65), Drugs/alcohol use | Low risk: 0–2 points High risk: ≥3 points | OAC: 1.75% Aspirin/Clopidogrel:0.97% Neither: 1.42% | OAC: 0.72 Aspirin/Clopidogrel: 0.91 Neither: 0.85 | Simple and widely …

Polycythemia Vera: Barriers to and Strategies for Optimal Management.

Polycythemia vera (PV) is a subtype of myeloproliferative neoplasms characterized by impaired quality of life and severe complications. Despite the increasingly in-depth knowledge of this condition, it necessitates a multifaceted management approach to mitigate symptoms and prevent thrombotic and hemorrhagic events, ensuring prolonged survival. The therapeutic landscape has been revolutionized in recent years, where venesection and hydroxycarbamide associated with antiplatelet therapy have a central role and are now accompanied by other drugs, such as interferon and Janus kinase inhibitors. On

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… ratio (HR) 0.4; 95% confidence interval (CI) 0.18–0.91; p = 0.02] without a significant increase of major bleeding in the aspirin group [relative risk (RR), 1.62; 95% CI, 0.27 to 9.71]. 26 In the case of intolerance to aspirin, such as mild indigestion, gastric ulcers or bleeding events, among others, clopidogrel … Furthermore, it raises an important question in those patients with acute coronary syndrome where clopidogrel is recommended as prevention in the general population, as well as the combined usage with aspirin in indicated cases. 27 Anticoagulation Therapy Direct oral anticoagulation (DOAC) therapy …

Pharmacological treatment for Buerger's disease.

BACKGROUND: Buerger's disease (thromboangiitis obliterans) is a non-atherosclerotic, segmental inflammatory pathology that most commonly aff … , and folic acid with placebo. No studies assessed other pharmacological agents such as cilostazol, clopidogrel and pentoxifylline or compared oral versus intravenous prostanoid.Compared with aspirin, intravenous prostacyclin analogue iloprost improved ulcer healing (risk ratio (RR) 2.65; 95% confidence interval (CI) 1.15 to 6.11; 98 participants; one study; …

Pharmacological treatment for Buerger's disease.

BACKGROUND: Buerger's disease (thromboangiitis obliterans) is a non-atherosclerotic, segmental inflammatory pathology that most commonly aff … , and folic acid with placebo. No studies assessed other pharmacological agents such as cilostazol, clopidogrel and pentoxifylline or compared oral versus intravenous prostanoid.Compared with aspirin, intravenous prostacyclin analogue iloprost improved ulcer healing (risk ratio (RR) 2.65; 95% confidence interval (CI) 1.15 to 6.11; 98 participants; one study; …

Cardiac Interventions in Patients With Active, Advanced Solid and Hematologic Malignancies: JACC: CardioOncology State-of-the-Art Review.

Invasive cardiac interventions are recommended to treat ST-segment elevation myocardial infarction, non-ST-segment elevation acute coronary syndromes, multivessel coronary disease, severe symptomatic aortic stenosis, and cardiomyopathy. These recommendations are based on randomized controlled trials that historically included few individuals with active, advanced malignancies. Advanced malignancies represent a significant competing risk for mortality, and there is limited evidence to inform the risks and benefits of invasive cardiac interventions in affected patients. We review the benefit con

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… Ticagrelor versus clopidogrel in patients with acute coronary syndromes N Engl J Med 361 11 2009 1045 1057 10.1056/NEJMoa0904327 19717846 35 Wiviott S.D. Braunwald E. McCabe C.H. … Prasugrel versus clopidogrel in patients with acute coronary syndromes N Engl J Med 357 20 2007 2001 2015 10.1056/NEJMoa0706482 17982182 36 Ahsan M.J. Lateef N. Latif A. …