Dual Antiplatelet Therapy in Coronary Artery Disease

Sharma, Raghav; Kumar, Pravin; Prashanth, S. P.; Belagali, Yogesh

doi:10.1007/s40119-020-00197-0

Cited by 29 publications

(21 citation statements)

References 37 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Anticoagulants are particularly effective at reducing emboli from venous thrombi 58 but are less effective with thrombi that form on atherosclerotic lesions in large arteries. 59 The potential deleterious effects of arterial emboli on stroke outcomes have been previously reported in preclinical studies investigating the effects of inhibitors of the von Willebrand factor-glycoprotein Ib interaction. 60 This adhesive mechanism is critical for the initiation of platelet adhesion and aggregation at sites of arterial injury; however, in the context of thrombolysis, inhibiting this adhesion mechanism can increase arterial embolization and exacerbate cerebral injury.…”

Section: Discussionmentioning

confidence: 95%

Development of a carotid artery thrombolysis stroke model in mice

et al. 2022

View full text Add to dashboard Cite

Recanalization with restored cerebral perfusion is the primary goal of thrombolytic therapy in acute ischemic stroke. The identification of adjunctive therapies that can be safely used to enhance thrombolysis in stroke remains an elusive goal. We report here the development of a mouse in situ carotid artery thrombolysis (iCAT) stroke model involving graded cerebral ischemia to induce unihemispheric infarction after thrombotic occlusion of the common carotid artery (CCA). Electrolytic-induced thrombotic occlusion of the left CCA enabled real-time assessment of recanalization and rethrombosis events after thrombolysis with recombinant tissue-type plasminogen activator (rtPA). Concurrent transient stenosis of the right CCA induced unihemispheric hypoperfusion and infarction in the left middle cerebral artery territory. Real-time assessment of thrombolysis revealed recanalization rates <30% in rtPA-treated animals with high rates of rethrombosis. Addition of the direct thrombin inhibitor argatroban increased recanalization rates to 50% and reduced rethrombosis. Paradoxically, this was associated with increased cerebral ischemia and stroke-related mortality (25%-42%). Serial analysis of carotid and cerebral blood flow showed that coadministration of argatroban with rtPA resulted in a marked increase in carotid artery embolization, leading to distal obstruction of the middle cerebral artery. Real-time imaging of carotid thrombi revealed that adjunctive anticoagulation destabilized platelet-rich thrombi at the vessel wall, leading to dislodgement of large platelet emboli. These studies confirm the benefits of anticoagulants in enhancing thrombolysis and large artery recanalization; however, at high levels of anticoagulation (∼3-fold prolongation of activated partial thromboplastin time), this effect is offset by increased incidence of carotid artery embolization and distal middle cerebral artery occlusion. The iCAT stroke model should provide important new insight into the effects of adjunctive antithrombotic agents on real-time thrombus dynamics during thrombolysis and their correlation with stroke outcomes.

show abstract

Section: Discussionmentioning

confidence: 95%

Development of a carotid artery thrombolysis stroke model in mice

et al. 2022

View full text Add to dashboard Cite

show abstract

“…Also, PCI is an invasive therapy and patients always receive dual anti-platelet therapy after PCI in accordance with guidelines ( 36 ). Anti-platelet levels downregulate after 1 year due to bleeding concerns ( 37 – 39 ), leaving patients in a potentially hypercoagulable state. Likewise, platelet activation has been implicated in COPD ( 40 ).…”

Section: Discussionmentioning

confidence: 99%

Long-Term Outcomes for Chinese COPD Patients After PCI: A Propensity Score Matched, Double-Cohort Study

Zheng

Qian

Seery

et al. 2022

Front. Cardiovasc. Med.

View full text Add to dashboard Cite

ObjectivesThe aim of this study was to analyze long-term outcomes of Chinese coronary artery disease (CAD) patients with (and without) chronic obstructive pulmonary disease (COPD) after percutaneous coronary intervention (PCI).BackgroundChronic obstructive pulmonary disease is a chronic condition which often develops in conjunction with CAD. PCI is a core therapy for CAD, although we still need to understand CAD-COPD outcomes and to identify factors that influence prognoses, across ethnicities.MethodsThis double-cohort study involved 12,343 Chinese CAD patients who received PCI. Baseline characteristics were collected in two independent, specialty centers. Propensity-score matching was performed to control confounding factors, using a nearest neighbor matching method within a 0.02 caliper and on a propensity score scale of 0.1 for each center. Comorbid CAD-COPD cases were compared to non-COPD patients in terms of major adverse cardiac events (MACEs).ResultsPatients with COPD were generally older than those without COPD (65.4 ± 9.2 vs. 58.2 ± 10.3, p < 0.001). There were no significant differences in the end points between COPD and non-COPD groups after PCI (All p > 0.05); however, the incidence of MACEs increased after 450 days. Further subgroup analysis suggests that COPD is approximately four times more prevalent among those aged over 75 years (HR, 3.818; 95%CI, 1.10–13.29; p = 0.027) and those aged below 55 years (HR = 4.254; 95% CI, 1.55–11.72; p = 0.003).ConclusionHaving COPD does not appear to have a significant impact on CAD outcomes 2 years after PCI, and beyond. However, an increasing number of MACEs was observed after 450 days, which suggests that there may be a double-stage effect of COPD on PCI prognosis. There is a need for focused comorbidity management, specifically for those aged below 55 years and above 75 years.

show abstract

“…According the current ACC/AHA/ESC guidelines, daily aspirin is recommended for all patients with documented history of CAD, as it has shown to significantly reduce the risk of future vascular events [26,27]. Other modifications to this regimen, in the forms of increasing the dose or adding other antiplatelet agents, might be utilized in patients with a cluster of other cardiovascular risk factors [28].…”

Section: Discussionmentioning

confidence: 99%

Prevalence, Epidemiological Characteristics, and Pharmacotherapy of Coronary Artery Disease among Patients with Atrial Fibrillation: Data from Jo-Fib Study

et al. 2021

View full text Add to dashboard Cite

Background and Objectives: Patients with AF are at increased risk for Coronary Artery Disease (CAD) owing to their shared etiologies and risk factors. This study aimed to assess the prevalence, cardiovascular risk factors, and used medications of CAD in AF patients. Materials and Methods: This retrospective, case-control study utilized data from the Jordanian Atrial Fibrillation (Jo-Fib) registry. Investigators collected clinical features, history of co-existing comorbidities, CHA2DS2-VASc, and HAS BLED scores for all AF patients aged >18 visiting 19 hospitals and 30 outpatient cardiology clinics. A multivariable binary logistic regression was used to asses for factors associated with higher odds of having CAD. Results: Out of 2000 patients with AF, 227 (11.35%) had CAD. Compared to the rest of the sample, those with CAD had significantly higher prevalence of hypertension (82.38%; p < 0.01), hypercholesterolemia (66.52%, p < 0.01), diabetes (56.83%, p < 0.01), and smoking (18.06%, p = 0.04). Patients with AF and CAD had higher use of anticoagulants/antiplatelet agents combination (p < 0.01) compared to the rest of the sample. Females had lower CAD risk than males (OR = 0.35, 95% CI: 0.24–0.50). AF Patients with dyslipidemia (OR = 2.5, 95% CI: 1.8–3.4), smoking (OR = 1.7, 95% CI: 1.1–2.6), higher CHA2DS2-VASc score (OR = 1.5, 95% CI: 1.4–1.7), and asymptomatic AF (OR = 1.9, 95% CI: 1.3–2.6) had higher risk for CAD. Conclusions: Owing to the increased prevalence of CAD in patients with AF, better control of cardiac risk factors is recommended for this special group. Future studies should investigate such interesting relationships to stratify CAD risk in AF patients. We believe that this study adds valuable information regarding the prevalence, epidemiological characteristics, and pharmacotherapy of CAD in patients with AF.

show abstract

Dual Antiplatelet Therapy in Coronary Artery Disease

Cited by 29 publications

References 37 publications

Development of a carotid artery thrombolysis stroke model in mice

Development of a carotid artery thrombolysis stroke model in mice

Long-Term Outcomes for Chinese COPD Patients After PCI: A Propensity Score Matched, Double-Cohort Study

Prevalence, Epidemiological Characteristics, and Pharmacotherapy of Coronary Artery Disease among Patients with Atrial Fibrillation: Data from Jo-Fib Study

Contact Info

Product

Resources

About