Recurrent cardiac ischemic events early after discontinuation of short-term heparin treatment in acute coronary syndromes

Bijsterveld, Nick R.; Peters, Ron J.G.; Murphy, Sabina A.; Bernink, P. J. L. M.; Tijssen, Jan G.P.; Cohen, Marc

doi:10.1016/j.jacc.2003.05.014

Cited by 32 publications

(4 citation statements)

References 22 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…The TIMI risk score is a simple, well-validated score for which prediction of cardiac ischemic events and cardiovascular death has been shown in patients with unstable angina or NSTEMI [26], [27], and in patients presenting with acute chest pain to the emergency department [28]. The TIMI risk score offers clinical applications as it categorizes patients with a wide, about 5- to 10-fold, range of major adverse clinical events risk into different risk groups [23].…”

Section: Discussionmentioning

confidence: 99%

Clinical Criteria Replenish High-Sensitive Troponin and Inflammatory Markers in the Stratification of Patients with Suspected Acute Coronary Syndrome

et al. 2014

View full text Add to dashboard Cite

ObjectivesIn patients with suspected acute coronary syndrome (ACS), rapid triage is essential. The aim of this study was to establish a tool for risk prediction of 30-day cardiac events (CE) on admission. 30-day cardiac events (CE) were defined as early coronary revascularization, subsequent myocardial infarction, or cardiovascular death within 30 days.Methods and ResultsThis single-centre, prospective cohort study included 377 consecutive patients presenting to the emergency department with suspected ACS and for whom troponin T measurements were requested on clinical grounds. Fifteen biomarkers were analyzed in the admission sample, and clinical parameters were assessed by the TIMI risk score for unstable angina/Non-ST myocardial infarction and the GRACE risk score. Sixty-nine (18%) patients presented with and 308 (82%) without ST-elevations, respectively. Coronary angiography was performed in 165 (44%) patients with subsequent percutaneous coronary intervention – accounting for the majority of CE – in 123 (33%) patients, respectively. Eleven out of 15 biomarkers were elevated in patients with CE compared to those without. High-sensitive troponin T (hs-cTnT) was the best univariate biomarker to predict CE in Non-ST-elevation patients (AUC 0.80), but did not yield incremental information above clinical TIMI risk score (AUC 0.80 vs 0.82, p = 0.69). Equivalence testing of AUCs of risk models and non-inferiority testing demonstrated that the clinical TIMI risk score alone was non-inferior to its combination with hs-cTnT in predicting CE.ConclusionsIn patients presenting without ST-elevations, identification of those prone to CE is best based on clinical assessment based on TIMI risk score criteria and hs-cTnT.

show abstract

Section: Discussionmentioning

confidence: 99%

Clinical Criteria Replenish High-Sensitive Troponin and Inflammatory Markers in the Stratification of Patients with Suspected Acute Coronary Syndrome

et al. 2014

View full text Add to dashboard Cite

show abstract

“…Placebo patients on heparin at baseline also experienced more cardiac events (myocardial infarction and atrial fibrillation), more gastrointestinal events, and more thrombotic events than heparin patients. It is not conclusive whether this increase in serious events was related to discontinuation of commercial heparin, but rebound thrombosis after heparin cessation has been described for both UFH [19,20] and LMWH [21,22]. Furthermore, the rebound effect has been linked to a rise in coagulation markers (e.g., thrombin generation) [23].…”

Section: Discussionmentioning

confidence: 99%

Comprehensive safety analysis of concomitant drotrecogin alfa (activated) and prophylactic heparin use in patients with severe sepsis

et al. 2009

View full text Add to dashboard Cite

show abstract

“…An increased risk of recurrent ischaemic events after discontinuation of unfractionated heparin or low-molecular weight heparin has been noted in ACS patients [15,16]. Following the observation that increased levels of prothrombin fragments persist up to six months after a coronary ischaemic event [14], several trials investigated the possibility that long-term anti-coagulation with vitamin K antagonists (e.g.…”

Section: Oral Anti-thrombotics In Acsmentioning

confidence: 99%

Novel anti-thrombotic therapy in acute coronary syndromes

Aziz¹,

Aziz²,

Wheatcroft³

2013

Cor Vasa

View full text Add to dashboard Cite

Despite recent developments in revascularisation, anti-platelet and anti-thrombotic therapies, patients with acute coronary syndromes (ACS) remain at increased risk of recurrent atherothrombotic events. Dual anti-platelet therapy comprising aspirin and platelet P2Y 12 receptor inhibition has become the cornerstone of therapy in ACS. However, thrombin-mediated pathways, which contribute to platelet activation and are responsible for the formation of fi brin clot, remain active following initial plaque rupture. Recently, orally administered drugs which directly target thrombin, factor Xa or thrombin-mediated platelet activation have been developed. Effi cacy outcomes in trials of these novel anti-thrombotic agents in ACS have yielded mixed results and their adoption in clinical practice is currently hampered due to a penalty of increased bleeding. To date, the direct Xa inhibitor rivaroxaban and the protease-activated receptor-1 antagonist atopaxar have shown most promise and require further evaluation to determine their role in ACS management. SOUHRNPřes pokrok v oblasti revaskularizačních výkonů i protidestičkových léků a antitrombotik přetrvává u pacientů s akutními koronárními syndromy (AKS) zvýšené riziko recidivy aterotrombotických příhod. Hlavním prvkem léčby AKS se stala duální antiagregační léčba založená na podávání kyseliny acetylsalicylové a inhibici destičkového receptoru typu P2Y 12 . Trombinem zprostředkované dráhy, které přispívají k aktivaci destiček a jsou odpovědné za tvorbu fibrinové sraženiny, však přetrvávají i po ruptuře plátu. V poslední době byly vyvinuty perorálně podávané léky přímo cíleně působící na trombin, faktor Xa nebo trombinem zprostředkovanou aktivaci destiček. Hodnocení účinnosti ve studiích s těmito novými antitrombotiky u AKS zatím přineslo smíšené výsledky a jejich zavedení do klinické praxe v současné době ztěžuje problém zvýšené krvácivosti. Zatím se jako nejslibnější jeví přímý inhibitor faktoru Xa rivaroxaban a proteázou aktivovaný antagonista receptoru-1 atopaxar; u nich je však nutno ještě podrobněji posoudit jejich možnou úlohu v léčbě AKS.

show abstract

Recurrent cardiac ischemic events early after discontinuation of short-term heparin treatment in acute coronary syndromes

Abstract: There is significant clustering of recurrent ischemic events within 24 h after cessation of both short-term UFH and enoxaparin treatment, and patients should be carefully monitored during that period. This early rebound may be prevented by continuation of a fixed dose of enoxaparin.

Cited by 32 publications

References 22 publications

Clinical Criteria Replenish High-Sensitive Troponin and Inflammatory Markers in the Stratification of Patients with Suspected Acute Coronary Syndrome

Clinical Criteria Replenish High-Sensitive Troponin and Inflammatory Markers in the Stratification of Patients with Suspected Acute Coronary Syndrome

Comprehensive safety analysis of concomitant drotrecogin alfa (activated) and prophylactic heparin use in patients with severe sepsis

Novel anti-thrombotic therapy in acute coronary syndromes

Contact Info

Product

Resources

About