The Clopidogrel in Unstable angina to prevent Recurrent Events (CURE) trial programme. Rationale, design and baseline characteristics including a meta-analysis of the effects of thienopyridines in vascular disease

Yusuf, Salim; Mehta, Shamir R.; Anand, Sonia S.; Avezum, Álvaro; Awan, Najam A.; Bertrand, Michel E.; Blumenthal, Mel; Bouthier, J.; Budaj, Andrzej; Ceremuźyński, L; Chrolavicius, Susan; Col, Jacques; Commerford, Patrick; Dı́az, Rafael; Flather, Marcus; Fox, Kim; Franzosi, MariaGrazia; Gaudin, Christophe; Gersh, Bernard J.; Grossman, William; Halon, David A.; Hess, Timothy; Hunt, David; Joyner, C.; Karatzas, N. B.; Keltai, Mátyás; Khurmi, Nardev S.; Kopecky, Steven L.; Lewis, Basil S.; Maggioni, A P; Malmberg, Klas; Mocceti, T.; Morais, João; Paolasso, Ernesto; Piegas, Leopoldo Soares; Pipilis, Athanasios; Ramos-Corrales, Marco Antonio; Rupprecht, Hans‐Jürgen; Rydén, L; Sitkei, É.; Sotty, Marc; Tognoni, Gianni; Valentín, Vicent; Varigos, John; Widimský, Petr; Wittlinger, Thomas; Pogue, Janice; Copland, Ingrid; Cracknell, B.; Demers, Catherine; Eikelboom, John W.; Hall, Karl Victor; Keys, J.; McQueen, Matthew; Montague, Patricia; Morris, Beth; Ôunpuu, Stephanie; Wright, Christine; Yacyshyn, Vincent; Zhao, Feng; Wyse, George; Cairns, J.; Hart, Robert G.; Hirsh, Jack; Gent, Michael; Ryan, Thomas J.; Wittes, Janet; Auger, Pierre; Basart, D.C.G.; Chan, Ying; Raedt, Herbert De; Hartoog, M. Den; Galli, Mattía; García-Guerrero, J; Marquis, Jean-François; Mauri, Francesco; Mayosi, Bongani M.; Natarajan, Madhu K.; Nieminen, M.; Norris, John W.; Panju, Akbar; Peters, Ron J.G.; Renkin, Jean; Rihal, Charanjit S.; Szymański, Paweł; Wąsek, Wojciech; Allende, Guillermo Einer; Bono, J. O.; Caccavo, Alberto; Fernandez, Andres; Fuselli, Juan J.; Gambarte, A. J.; Guerrero, R. A. Ahuad; Hasbani, E. G.; Liprandi, Álvaro Sosa

doi:10.1053/euhj.2000.2474

Cited by 241 publications

(35 citation statements)

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“…17 Thienopyridines act through irreversible inhibition of the platelet P2Y 12 receptor, inhibiting platelet aggregation. 70 This class of therapy was initially explored in patients with PAD in the Swedish Ticlopidine Multicenter Study, in which the first generation thienopyridine reduced major cardiovascular events in 687 patients with symptomatic PAD, however, with significant adverse events, including thrombotic thrombocytopenic purpura and neutropenia. 71,72 The second generation thienopyridine, clopidogrel, is better tolerated than its predecessor ticlodipine 73 and has been most broadly evaluated in the setting of stable atherosclerosis and PAD.…”

Section: Antiplatelet Therapymentioning

confidence: 99%

Pharmacological Treatment and Current Management of Peripheral Artery Disease

Bonaca

Creager

2015

Circulation Research

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Abstract:Patients with peripheral artery disease (PAD) are at heightened risk of both systemic cardiovascular adverse events, as well as limb-related morbidity. The optimal management of patients with PAD requires a comprehensive treatment strategy incorporating both lifestyle changes, including smoking cessation and exercise, as well as optimal medical therapy. Pharmacological therapies for patients with PAD are targeted both at modifying broad risk factors for major adverse cardiovascular events, as well as reducing limb-related morbidity. Observational data suggest that indicated pharmacological treatments are greatly underutilized in PAD, underscoring the need for improvements in patient identification and care delivery. Ongoing trials of novel therapies in patients with PAD will further inform pharmacological strategies to reduce both systemic cardiovascular risk and limb-related morbidity. (Circ Res.

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Section: Antiplatelet Therapymentioning

confidence: 99%

Pharmacological Treatment and Current Management of Peripheral Artery Disease

Bonaca

Creager

2015

Circulation Research

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“…These recommendations are mainly based on evidence from the Percutaneous Coronary Intervention‐Clopidogrel in Unstable angina to prevent Recurrent Events (PCI‐CURE)5 and the Clopidogrel for the Reduction of Events During Observation (CREDO) trials,25 which were conducted more than a decade ago and may not represent contemporary practice trends. In these studies, most of the patients had their PCIs postponed for up to several days after pretreatment, whereas current practice often leads to invasive treatment within hours of first medical contact.…”

Section: Discussionmentioning

confidence: 99%

“…Many clinical considerations might support not using DAPT pretreatment, such as concerns for increased bleeding risk (eg, patients with low baseline hemoglobin, with low platelet counts, or taking long‐term anticoagulants) or the expectation that the patients with NSTEMI might have underlying severe coronary vessel disease requiring coronary artery bypass graft surgery (CABG) 4, 5, 6, 7, 8, 9. Prediction models to detect the risk of bleeding after percutaneous coronary intervention (PCI), as well as to estimate the probability of undergoing CABG after a NSTEMI,10, 11, 12, 13 have been developed to support such decisions, but whether avoiding DAPT pretreatment is associated with patient‐centered risks is unknown.…”

Section: Introductionmentioning

confidence: 99%

Variation in Practice Regarding Pretreatment With Dual Antiplatelet Therapy for Patients With Non–ST Elevation Myocardial Infarction

Shafiq

Valle

Jang

et al. 2016

JAHA

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BackgroundDespite guideline recommendations, a significant number of patients with non–ST elevation myocardial infarction (NSTEMI) do not receive dual antiplatelet therapy (DAPT) before angiography “pretreatment.” While there may be valid clinical reasons to not pretreat, such as concern for bleeding or multivessel disease warranting coronary artery bypass graft surgery, the degree of variability and factors associated with DAPT pretreatment are unknown.Methods and ResultsFrom the multicenter TRIUMPH registry, 1632 NSTEMI patients were not taking DAPT on admission and were included in the study cohort. Among the study patients, only 22% patients received DAPT pretreatment. A multivariable logistic regression model showed that race other than white or black (odds ratio [OR] 0.41, 95% CI 0.21–0.83), hemoglobin level (OR 1.18, 95% CI 1.08–1.29), patients’ bleeding risk (assessed with NCDR CathPCI Bleeding Risk Score) (OR 0.85, 95% CI 0.74–0.99), and severe left ventricular dysfunction (OR 0.3, 95% CI 0.13–0.65) were the main predictors of pretreatment with DAPT, whereas likelihood of needing coronary artery bypass graft surgery (GRACE prediction model) was not (OR 1.09, 95% CI 0.88–1.35). Median ORs were calculated to assess variability of receiving DAPT pretreatment across sites after adjustment for patient characteristics. Receiving DAPT pretreatment varied substantially across sites (range 0–100%, mean OR 3.94, P<0.0001).ConclusionsWhile deviating from guideline‐recommended DAPT pretreatment in patients with NSTEMI was associated with patient factors (eg, bleeding risk), marked variation was present across sites after accounting for patient‐level characteristics. This suggests that site‐level interventions are needed to improve concordance with current guidelines.

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“…Therefore, an early and reversible stage of TTP or hemolytic uremic syndrome, a disorder similar to TTP but without neurological symptoms, needs to be considered for both cases. Further trials using clopidogrel should be analyzed concerning these potential life-threatening side effects [6]. …”

Section: Discussionmentioning

confidence: 99%