Extended dual antiplatelet therapy after acute myocardial infarction. Current evidence and future perspectives

Cosentino, Nicola; Campodonico, Jeness; Milazzo, Valentina; Celentano, Katia; Moltrasio, Marco; Faggiano, Pompilio; Marenzi, Giancarlo

doi:10.4081/monaldi.2019.1046

Cited by 3 publications

(3 citation statements)

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“…Moreover, they often had lower platelet counts and anemia [ 24 ]. Notably, in ACS patients, both thrombocytopenia and anemia have been demonstrated to be associated with a higher bleeding risk and with a poorer prognosis, independently of the presence of cancer [ 26 , 27 ].…”

Section: Prevalence and Clinical Characteristics Of Acs In Cancer mentioning

confidence: 99%

Characteristics, Management, and Outcomes of Acute Coronary Syndrome Patients with Cancer

Milazzo

Cosentino

Campodonico

et al. 2020

JCM

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Patients with cancer are at increased risk of cardiovascular disease, with a reported prevalence of acute coronary syndrome (ACS) ranging from 3% to 17%. The increased risk of ACS in these patients seems to be due to the complex interaction of shared cardiovascular risk factors, cancer type and stage, and chemotherapeutic and radiotherapy regimens. The management of ACS in patients with cancer is a clinical challenge, particularly due to cancer’s unique pathophysiology, which makes it difficult to balance thrombotic and bleeding risks in this specific patient population. In addition, patients with cancer have largely been excluded from ACS trials. Hence, an evidence-based treatment for ACS in this group of patients is unknown and only a limited proportion of them is treated with antiplatelets or invasive revascularization, despite initial reports suggesting their beneficial prognostic effects in cancer patients. Finally, cancer patients experiencing ACS are also at higher risk of in-hospital and long-term mortality as compared to non-cancer patients. In this review, we will provide an overview on the available evidence of the relationship between ACS and cancer, in terms of clinical manifestations, possible underlying mechanisms, and therapeutic and prognostic implications.

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Section: Prevalence and Clinical Characteristics Of Acs In Cancer mentioning

confidence: 99%

Characteristics, Management, and Outcomes of Acute Coronary Syndrome Patients with Cancer

Milazzo

Cosentino

Campodonico

et al. 2020

JCM

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“…Cardiovascular diseases and their prevention in subjects at high risk of cardiovascular events remain the main reasons for the administration of antiplatelet therapy [6]. Dual antiplatelet therapy with aspirin and P 2 Y 12 receptor antagonists is standard for patients with acute myocardial infarction and ischemic stroke [7,8]. Nevertheless, the following development of drug resistance, hypersensitivity [9][10][11][12], and serious adverse effects, among which are peptic ulcers, gastrointestinal bleeding, and aspirin-induced asthma, are associated with the application of this therapy [13][14][15][16].…”

Section: Introductionmentioning

confidence: 99%

Antiplatelet Effects of Flavonoid Aglycones Are Mediated by Activation of Cyclic Nucleotide-Dependent Protein Kinases

Balykina,

Naida,

Kirkgöz

et al. 2024

IJMS

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Flavonoid aglycones are secondary plant metabolites that exhibit a broad spectrum of pharmacological activities, including anti-inflammatory, antioxidant, anticancer, and antiplatelet effects. However, the precise molecular mechanisms underlying their inhibitory effect on platelet activation remain poorly understood. In this study, we applied flow cytometry to analyze the effects of six flavonoid aglycones (luteolin, myricetin, quercetin, eriodictyol, kaempferol, and apigenin) on platelet activation, phosphatidylserine externalization, formation of reactive oxygen species, and intracellular esterase activity. We found that these compounds significantly inhibit thrombin-induced platelet activation and decrease formation of reactive oxygen species in activated platelets. The tested aglycones did not affect platelet viability, apoptosis induction, or procoagulant platelet formation. Notably, luteolin, myricetin, quercetin, and apigenin increased thrombin-induced thromboxane synthase activity, which was analyzed by a spectrofluorimetric method. Our results obtained from Western blot analysis and liquid chromatography–tandem mass spectrometry demonstrated that the antiplatelet properties of the studied phytochemicals are mediated by activation of cyclic nucleotide-dependent signaling pathways. Specifically, we established by using Förster resonance energy transfer that the molecular mechanisms are, at least partly, associated with the inhibition of phosphodiesterases 2 and/or 5. These findings underscore the therapeutic potential of flavonoid aglycones for clinical application as antiplatelet agents.

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“…Patients were also excluded if they had an acute myocardial infarction (AMI), received stenting procedures, switched from one to another antiplatelet, were prescribed with other antiplatelets, were aged under 20, or died during the index admission. We excluded patients with intermittent claudication, AMI, or receiving stenting procedures to ensure that all patients were treated with dual antiplatelet only for the prevention of ischemic events following acute minor ischemic stroke or TIA without other possible purposes [21][22][23][24] . Fig.…”

Section: Introductionmentioning

confidence: 99%

Cilostazol plus Aspirin vs. Clopidogrel plus Aspirin in Acute Minor Stroke or Transient Ischemic Attack

Huang,

Chen,

Chi

et al. 2024

JAT

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Aim: This study compared the effectiveness, safety, and mortality risks between cilostazol plus aspirin and clopidogrel plus aspirin treatment for patients with acute minor ischemic stroke or transient ischemic attack (TIA). Methods: This retrospective cohort study employed a new-user design and utilized data from the nationwide Health and Welfare Database in Taiwan. Patients were included if they were discharged with newly initiated cilostazol plus aspirin or clopidogrel plus aspirin after primary acute minor ischemic stroke or TIA hospitalization between 2009 and 2018. Inverse probability of treatment weighting was applied to balance covariats between study groups. Effectiveness outcomes were the risks of acute ischemic stroke, acute myocardial infarction (AMI), TIA, and composite cardiovascular events; Safety outcomes were the risks of intracranial hemorrhage (ICH), gastrointestinal bleeding, and composite bleeding events; Mortality outcomes were the risks of fatal stroke, cardiovascular mortality, and all-cause mortality. Results: A total of 3,403 patients were included, of which 578 were treated with cilostazol plus aspirin and 2,825 were treated with clopidogrel plus aspirin. Cilostazol plus aspirin was associated with a higher risk of ICH (HR: 1.82; 95% CI: 1.16-2.84) compared to clopidogrel plus aspirin. No significant differences in the risks of effectiveness or mortality outcomes between the two groups were found. Conclusions: The effectiveness and mortality of the two groups were similar for patients with acute minor ischemic stroke or TIA. However, cilostazol plus aspirin was associated with a higher risk of ICH compared to clopidogrel plus aspirin. Patients treated with cilostazol plus aspirin among this population should be monitored carefully to ensure their safety.

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Extended dual antiplatelet therapy after acute myocardial infarction. Current evidence and future perspectives

Cited by 3 publications

References 0 publications

Characteristics, Management, and Outcomes of Acute Coronary Syndrome Patients with Cancer

Characteristics, Management, and Outcomes of Acute Coronary Syndrome Patients with Cancer

Antiplatelet Effects of Flavonoid Aglycones Are Mediated by Activation of Cyclic Nucleotide-Dependent Protein Kinases

Cilostazol plus Aspirin vs. Clopidogrel plus Aspirin in Acute Minor Stroke or Transient Ischemic Attack

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