Dual Antiplatelet Therapy in Coronary Artery Disease: Comparison Between ACC/AHA 2016 and ESC 2017 Guidelines

Floyd, Christopher N.

doi:10.15420/ecr.2019.09

Cited by 8 publications

(7 citation statements)

References 22 publications

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“…After stent placement, dual treatment with a P2Y 12 inhibitor (such as clopidogrel, prasugrel or ticagrelor) and aspirin is recommended for ≥1 month in those in whom a bare metal stent was placed and ≥1 year after for those implanted with a drug-eluding stent. [ 84 ] Other major trials compared prasugrel or ticagrelor to clopidogrel on a background of aspirin and showed similar results for men and women. [ 83 , 85 , 86 ] Women made up approximately one-quarter of the population studied in these trials.…”

Section: Treatment Modalities For Secondary Prevention Of Cvdmentioning

confidence: 99%

Secondary Prevention of Cardiovascular Disease in Women: Closing the Gap

2021

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Cardiovascular disease (CVD) remains the leading cause of death in women globally. Younger women (<55 years of age) who experience MI are less likely to receive guideline-directed medical therapy (GDMT), have a greater likelihood of readmission and have higher rates of mortality than similarly aged men. Women have been under-represented in CVD clinical trials, which limits the generalisability of results into practice. Available evidence indicates that women derive a similar benefit as men from secondary prevention pharmacological therapies, such as statins, ezetimibe, proprotein convertase subtilisin/kexin type 9 inhibitors, icosapent ethyl, antiplatelet therapy, sodium–glucose cotransporter 2 inhibitors and glucagon-like peptide-1 receptor agonists. Women are less likely to be enrolled in cardiac rehabilitation programs than men. Mitigating risk and improving outcomes is dependent on proper identification of CVD in women, using appropriate GDMT and continuing to promote lifestyle modifications. Future research directed at advancing our understanding of CVD in women will allow us to further develop and tailor CVD guidelines appropriate by sex and to close the gap between diagnoses, treatment and mortality.

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Section: Treatment Modalities For Secondary Prevention Of Cvdmentioning

confidence: 99%

Secondary Prevention of Cardiovascular Disease in Women: Closing the Gap

2021

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“…The 2010 Expert Consensus from the American College of Cardiology Foundation/American College of Gastroenterology/American Heart Association (ACCF/ACG/AHA) stipulates that only patients at high risk of bleeding should receive PPI [ 7 , 8 ]. On the other hand, the 2018 ESC guidelines recommend routine use of PPI for all patients on DAPT [ 9 ].…”

Section: Reviewmentioning

confidence: 99%

“…Clinicians have become wary of balancing the bleeding risks associated with DAPT with the risk of stent thrombosis plus other major adverse cardiovascular and cerebrovascular events (MACCE) [ 7 ]. Gastrointestinal bleeding, particularly upper gastrointestinal bleed (UGIB), is one of the most common serious bleeding adverse effects of antiplatelet therapy, which has led to the concurrent prescription of proton pump inhibitors (PPIs).…”

Section: Introductionmentioning

confidence: 99%

Co-prescription of Dual-Antiplatelet Therapy and Proton Pump Inhibitors: Current Guidelines

Saven¹,

Zhong²,

McFarlane³

2022

Cureus

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Dual-antiplatelet therapy (DAPT) prevents thrombotic complications associated with coronary artery disease, acute coronary syndrome, and stent thrombosis following the percutaneous coronary intervention or coronary artery bypass grafting. When initiating DAPT, the risk of thrombosis must be balanced with the increased risk of upper gastrointestinal bleed (UGIB). Proton-pump inhibitors (PPIs) are concurrently prescribed with DAPT to reduce bleeding risk. In this review, we discuss the benefits and potential complications of DAPT/PPI co-prescription. The only large international randomized control trial (RCT), Clopidogrel and the Optimization of Gastrointestinal Events Trial (COGENT), shows robust evidence that PPIs are a safe and effective method to reduce the risk of bleeding in patients on DAPT. However, more large-scale RCTs are needed to study potential long-term effects and draw a stronger conclusion on this topic.

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“…ASA and P2Y 12 inhibitors are commonly prescribed antiplatelet drugs for the secondary prevention of major adverse cardiovascular events. 27,28 Platelet inhibition with ASA did not show a significant effect on CCL5 release from convulxinactivated platelets, whereas CCL5 release after thrombin activation was reduced (►Fig. 3A).…”

Section: Single or Dual Antiplatelet Therapy Influences Ccl5 And Cxcl4 Releasementioning

confidence: 99%

Combined Antiplatelet Therapy Reduces the Proinflammatory Properties of Activated Platelets

Heinzmann

Coenen

Vajen

et al. 2021

TH Open

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The cause of atherothrombosis is rupture or erosion of atherosclerotic lesions, leading to an increased risk on myocardial infarction or stroke. Here, platelet activation plays a major role, leading to the release of bioactive molecules, e.g. chemokines and coagulation factors, and to platelet clot formation. Several antiplatelet therapies have been developed for secondary prevention of cardiovascular events, in which anticoagulant drugs are often combined. Besides playing a role in haemostasis, platelets are also involved in inflammation. However, it is unclear whether current antiplatelet therapies also affect platelet immune functions. In this study, the possible anti-inflammatory effects of antiplatelet medications on chemokine release were investigated using ELISA and on the chemotaxis of THP-1 cells towards platelet releasates. The cause of atherothrombosis is rupture or erosion of atherosclerotic lesions, leading to an increased risk on myocardial infarction or stroke. Here, platelet activation plays a major role, leading to the release of bioactive molecules, e.g. chemokines and coagulation factors, and to platelet clot formation. Several antiplatelet therapies have been developed for secondary prevention of cardiovascular events, in which anticoagulant drugs are often combined. Besides playing a role in haemostasis, platelets are also involved in inflammation. However, it is unclear whether current antiplatelet therapies also affect platelet immune functions. In this study, the possible anti-inflammatory effects of antiplatelet medications on chemokine release were investigated using ELISA and on the chemotaxis of THP-1 cells towards platelet releasates. We found that antiplatelet medication acetylsalicylic acid (ASA) led to reduced chemokine (C-C motif) ligand 5 (CCL5) and chemokine (C-X-C motif) ligand 4 (CXCL4) release from platelets, while leukocyte chemotaxis was not affected. Depending on the agonist, αIIbβ3- and P2Y12-inhibitors also affected CCL5 or CXCL4 release. The combination of ASA with a P2Y12 inhibitor or a phosphodiesterase inhibitor did not lead to an additive reduction on CCL5 or CXCL4 release. Interestingly, these combinations did reduce leukocyte chemotaxis. This study provides evidence that combined therapy of ASA and a P2Y12 or PDE3 inhibitor can decrease the inflammatory leukocyte recruiting potential of the releasate of activated platelets.

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Dual Antiplatelet Therapy in Coronary Artery Disease: Comparison Between ACC/AHA 2016 and ESC 2017 Guidelines

Cited by 8 publications

References 22 publications

Secondary Prevention of Cardiovascular Disease in Women: Closing the Gap

Secondary Prevention of Cardiovascular Disease in Women: Closing the Gap

Co-prescription of Dual-Antiplatelet Therapy and Proton Pump Inhibitors: Current Guidelines

Combined Antiplatelet Therapy Reduces the Proinflammatory Properties of Activated Platelets

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