Effectiveness of Clopidogrel and Aspirin Versus Ticlopidine and Aspirin in Preventing Stent Thrombosis After Coronary Stent Implantation

Moussa, Issam; Oetgen, Mathew; Roubin, Gary S.; Colombo, Antonio; Wang, Xangdong; Iyer, Sriram S.; Maida, Roberta; Collins, Michael J.; Kreps, Edward M.; Moses, Jeffrey W.

doi:10.1161/01.cir.99.18.2364

Cited by 316 publications

(154 citation statements)

References 10 publications

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“…14,17) Medication with aspirin and ticlopidine after coronary artery stenting prevents thrombus formation more effectively than medication with only heparin or with aspirin and warfarin. 16) Therefore, combination antiplatelet therapy is currently recommended as the standard periprocedural medication to prevent thrombosis.…”

Section: Discussionmentioning

confidence: 99%

Recurrent Subacute In-stent Restenosis After Carotid Artery Stenting due to Plaque Protrusion -Case Report-

Takigawa

Matsumaru

Kubo

et al. 2009

Neurol. Med. Chir.(Tokyo)

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A 70-year-old male presented with transient ischemic attacks manifesting as right hemiparesis and motor aphasia due to severe left cervical internal carotid artery stenosis. Carotid artery stenting (CAS) using a flow-reversal system was performed without complications. However, the patient exhibited transient right hemiparesis and motor aphasia 10 days after CAS. Emergent angiography demonstrated in-stent restenosis. In-stent percutaneous transluminal angioplasty and CAS were performed successfully using a distal protection system. However, duplex ultrasound scanning revealed progressive in-stent restenosis, 3 and 6 days after the re-treatment. Emergent angiography again demonstrated in-stent restenosis. Urgent stent removal and carotid endarterectomy were performed. Plaque had prolapsed through the stent. Histological examination revealed that the specimen was mainly plaque consisting of cholesterol crystals and macrophages. The patient was able to return to independent life without neurological deficit. Repeated endovascular surgery with appropriate antiplatelet and anticoagulation therapy should be attempted initially to treat in-stent restenosis. Endarterectomy with stent removal should be considered as a rescue option, especially if plaque protrusion is identified.

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Section: Discussionmentioning

confidence: 99%

Recurrent Subacute In-stent Restenosis After Carotid Artery Stenting due to Plaque Protrusion -Case Report-

Takigawa

Matsumaru

Kubo

et al. 2009

Neurol. Med. Chir.(Tokyo)

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“…Dual antiplatelet therapy has reduced the incidence of cardiac ischemic events and stent thrombosis after coronary stenting (5,6,18).…”

Section: Safety and Feasibility Of Outpatient Transradial Pcimentioning

confidence: 99%

“…However, overnight observation may not be necessary in all patients. Dual antiplatelet therapy has markedly decreased the incidence of stent thrombosis (5,6).…”

Section: Introductionmentioning

confidence: 99%

Ambulatory transradial percutaneous coronary intervention: A safe, effective, and cost‐saving strategy

Corvoisier

Gellen

Lesault

et al. 2012

Cathet Cardio Intervent

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Objectives: The aim of this prospective, multicenter study was to assess the safety, feasibility, acceptance, and cost of ambulatory transradial percutaneous coronary intervention (PCI) under the conditions of everyday practice. Background: Major advances in PCI techniques have considerably reduced the incidence of post‐procedure complications. However, overnight admission still constitutes the standard of care in most interventional cardiology centers. Methods: Eligibility for ambulatory management was assessed in 370 patients with stable angina referred to three high‐volume angioplasty centers. On the basis of pre‐specified clinical and PCI‐linked criteria, 220 patients were selected for ambulatory PCI. Results: The study population included a substantial proportion of patients with complex procedures: 115 (52.3%) patients with multivessel coronary artery disease, 50 (22.7%) patients with multilesion procedures, and 60 (21.5%) bifurcation lesions. After 4‐6 hr observation period, 213 of the 220 patients (96.8%) were cleared for discharge. The remaining seven (3.2%) patients were kept overnight for unstable angina (n = 1), atypical chest discomfort (n = 2), puncture site hematoma (n = 1), or non‐cardiovascular reasons (n = 3). Within 24 hr after discharge, no patients experienced readmission, stent occlusion, recurrent ischemia, or local complications. Furthermore, 99% of patients were satisfied with ambulatory management and 85% reported no anxiety. The average non‐procedural cost was lower for ambulatory PCI than conventional PCI (1,230 ± 98 Euros vs. 2,304 ± 1814 Euros, P < 10−6). Conclusions: Ambulatory PCI in patients with stable coronary artery disease is safe, effective, and well accepted by the patients. It may both significantly reduce costs and optimize hospital resource utilization. © 2012 Wiley Periodicals, Inc.

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“…31 The combination of clopidogrel and aspirin seems to be at least as effective as the combination of aspirin and ticlopidine. 32 The CURE study showed that the addition of clopidogrel to aspirin reduced by 20% the incidence of vascular end points in patients with unstable angina or non-ST segment elevation MI. 33 The PCI-CURE substudy showed also that patients undergoing percutaneous revascularization benefit from dual antiplatelet therapy.…”

Section: Thienopyridinesmentioning

confidence: 99%

Aspirin and Clopidogrel

Cattaneo

2004

ATVB

368

133

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Abstract-Aspirin and the thienopyridines ticlopidine and clopidogrel are antiplatelet agents that display good antithrombotic activity. In the past few years, the concept of aspirin resistance has been largely emphasized in the medical literature, although its definition is still uncertain. I suggest that "aspirin-resistant" should be considered as a description for those individuals in whom aspirin fails to inhibit thromboxane A 2 production, irrespective of the results of unspecific tests of platelet function, such as the bleeding time, platelet aggregation, or the PFA-100 system. Less well known than aspirin resistance, but certainly better characterized, is the issue of "clopidogrel resistance," which is probably mostly caused by inefficient metabolism of the prodrug clopidogrel to its active metabolite. At present, aspirin and clopidogrel resistance should not be looked for in the clinical setting, because there is no definite demonstration of an association with clinical events conditioning cost-effective changes in patient management. Key Words: aspirin resistance Ⅲ clopidogrel resistance Ⅲ antiplatelet agents Ⅲ cardiovascular diseases Ⅲ cerebrovascular diseases A spirin and the thienopyridines ticlopidine and clopidogrel are inhibitors of platelet aggregation that display good antithrombotic activity. They are used in the prophylaxis of patients undergoing vascular grafting or percutaneous angioplasty, in the medical management of acute coronary syndromes, and in long-term prevention of cardiovascular and cerebrovascular events.Both aspirin and the thienopyridines selectively inhibit a single pathway of platelet activation: aspirin affects the arachidonate-thromboxane A 2 (TxA 2 ) pathway by irreversibly inhibiting cyclo-oxygenase-1 (COX-1) (Figure 1). 1 The thienopyridines affect the adenosine diphosphate (ADP) pathway, by irreversibly blocking the ADP receptor P2Y 12 ( Figure 1). 2 Despite their selective mechanism of action, which does not counteract the many alternative pathways for platelet activation, aspirin and thienopyridines display a good antithrombotic activity. This is explained by the fact that both the arachidonate-TxA 2 pathway and the ADP pathway contribute to the amplification of platelet activation and are essential for the full aggregation and secretion response of platelets to agonists. 2

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Effectiveness of Clopidogrel and Aspirin Versus Ticlopidine and Aspirin in Preventing Stent Thrombosis After Coronary Stent Implantation

Abstract: These data suggest that clopidogrel may be an effective pharmacological regimen after coronary stent implantation. Furthermore, the simpler dosing regimen, the absence of neutropenia, and the lower frequency of other side effects make it a safe alternative to ticlopidine.

Cited by 316 publications

References 10 publications

Recurrent Subacute In-stent Restenosis After Carotid Artery Stenting due to Plaque Protrusion -Case Report-

Recurrent Subacute In-stent Restenosis After Carotid Artery Stenting due to Plaque Protrusion -Case Report-

Ambulatory transradial percutaneous coronary intervention: A safe, effective, and cost‐saving strategy

Aspirin and Clopidogrel

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