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Qu J, Zhang D, Zhang H, Rao C, Chen S, Zhao Y, Zheng Z. Preoperative clopidogrel and outcomes in patients with acute coronary syndrome undergoing coronary artery bypass surgery. J Thorac Cardiovasc Surg 2020; 163:1044-1052.e15. [DOI: 10.1016/j.jtcvs.2020.03.118] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/06/2019] [Revised: 03/20/2020] [Accepted: 03/29/2020] [Indexed: 11/15/2022]
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Siller-Matula JM, Petre A, Delle-Karth G, Huber K, Ay C, Lordkipanidzé M, De Caterina R, Kolh P, Mahla E, Gersh BJ. Impact of preoperative use of P2Y12 receptor inhibitors on clinical outcomes in cardiac and non-cardiac surgery: A systematic review and meta-analysis. EUROPEAN HEART JOURNAL-ACUTE CARDIOVASCULAR CARE 2015; 6:753-770. [DOI: 10.1177/2048872615585516] [Citation(s) in RCA: 43] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Affiliation(s)
| | - Alexandra Petre
- Department of Cardiology, Medical University of Vienna, Austria
| | | | - Kurt Huber
- 3rd Medical Department of Cardiology and Emergency Medicine, Wilhelminen Hospital, Vienna, Austria
| | - Cihan Ay
- Division of Haematology and Haemostaseology, Department of Medicine I, Medical University of Vienna, Austria
| | - Marie Lordkipanidzé
- Faculty of Pharmacy, University of Montreal; Research Center, Montreal Heart Institute, Canada
| | - Raffaele De Caterina
- Institute of Cardiology, ‘G d’Annunzio’ University – Chieti-Pescara, Chieti, Italy
| | - Philippe Kolh
- Department of Cardiothoracic Surgery, University Hospital of Liege, Belgium
| | - Elisabeth Mahla
- Department of Anaesthesiology and Intensive Care Medicine, Medical University of Graz, Austria
| | - Bernard J Gersh
- Division of Cardiovascular Diseases, Department of Internal Medicine, Mayo Clinic, College of Medicine Rochester, USA
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Power RF, Hynes BG, Moran D, Yagoub H, Kiernan G, Ruggiero NJ, Kiernan TJ. Modern antiplatelet agents in coronary artery disease. Expert Rev Cardiovasc Ther 2014. [DOI: 10.1586/erc.12.127] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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Hechler B, Ohlmann P, Chafey P, Ravanat C, Eckly A, Maurer E, Mangin P, Isola H, Cazenave JP, Gachet C. Preserved functional and biochemical characteristics of platelet components prepared with amotosalen and ultraviolet A for pathogen inactivation. Transfusion 2013; 53:1187-200. [PMID: 23067365 DOI: 10.1111/j.1537-2995.2012.03923.x] [Citation(s) in RCA: 51] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2012] [Revised: 07/23/2012] [Accepted: 08/15/2012] [Indexed: 01/28/2023]
Abstract
BACKGROUND Platelet concentrate (PC) functionality decreases during storage. This is referred to as the storage lesion. Pathogen inactivation may accelerate or induce lesions, potentially accounting for reduced viability. Our aim was to characterize functional and biochemical properties of platelets (PLTs) from photochemically treated buffy-coat PCs (PCT-PCs) compared to those from conventional PCs. STUDY DESIGN AND METHODS Four PCT-PCs and four conventional PCs were stored for 6.5 days and PLT function and proteomic profiles were examined at various time points during storage. To evaluate their intrinsic properties, samples of stored PLTs were taken, washed, and suspended in Tyrode's buffer before testing. RESULTS PLT counts and morphology were conserved although a slight increase in the PLT volume was observed after PCT. Glycoprotein (GP) IIbIIIa, IaIIa, and VI expression remained stable while GPIbα declined similarly in both types of PCs. A steep decrease (50%) in GPV occurred on Day 1.5 in PCT-PCs and Day 2.5 in control PCs. For both PCT- and control PCs, P-selectin expression and activated GPIIbIIIa remained low during storage. PCT- and control PCs were fully responsive to aggregation agonists up to Day 4.5 and exhibited similar perfusion functionality. Mitochondrial membrane potential and annexin A5 binding of PCT-PCs and control PCs were comparable. Two-dimensional differential in-gel electrophoresis and mass spectrometry profiles for 1882 protein spots revealed only three proteins selectively changed in PCT-PCs compared to control-PCs. CONCLUSION Washed treated and untreated PCs have similar functional, morphologic, and proteomic characteristics provided that PLTs are suspended in an appropriate medium during testing.
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Affiliation(s)
- Béatrice Hechler
- INSERM, UMR_S949, Université de Strasbourg, Etablissement Français du Sang-Alsace (EFS-Alsace), Strasbourg, France
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Tan GM, Lam YY, Yan BP. Novel Platelet ADP P2Y12 Inhibitors in the Treatment of Acute Coronary Syndrome. Cardiovasc Ther 2011; 30:e167-73. [DOI: 10.1111/j.1755-5922.2011.00262.x] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/24/2023] Open
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Nijjer SS, Watson G, Athanasiou T, Malik IS. Safety of clopidogrel being continued until the time of coronary artery bypass grafting in patients with acute coronary syndrome: a meta-analysis of 34 studies. Eur Heart J 2011; 32:2970-88. [DOI: 10.1093/eurheartj/ehr151] [Citation(s) in RCA: 78] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/11/2023] Open
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Early clopidogrel use in non-ST elevation acute coronary syndrome and subsequent coronary artery bypass grafting. Am Heart J 2011; 161:832-41. [PMID: 21570511 DOI: 10.1016/j.ahj.2011.01.020] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/18/2010] [Accepted: 01/21/2011] [Indexed: 11/21/2022]
Abstract
Clopidogrel use is associated with a significant decrease in major adverse cardiac events when used in patients with non-ST elevation acute coronary syndromes (NSTE-ACS), and guidelines give a class I level of evidence A recommendation for the use of clopidogrel in these patients. The optimal timing of clopidogrel use has not been conclusively determined, but nearly all data available support early use in patients with NSTE-ACS. Despite this, clopidogrel usage is far less than expected based on current guidelines because of concern for bleeding at the time of possible subsequent coronary artery bypass grafting (CABG). Clopidogrel use has been associated with increased perioperative bleeding at the time of CABG, but data are mixed. Numerous studies have conclusively shown that this bleeding risk is confined to those patients receiving clopidogrel within 5 days of CABG. The absolute number of patients exposed to this possible bleeding risk is very small relative to the >1 million patients who present annually with NSTE-ACS and is estimated to be <0.8% of these patients. Recent data have shown that (1) holding clopidogrel for 5 days before CABG is safe in patients with NSTE-ACS and (2) clopidogrel use in patients with NSTE-ACS decreases ischemic events in patients referred for CABG compared to patients who are not given clopidogrel. These data strongly challenge the notion that clopidogrel should be withheld until it is determined if the patient will be referred for CABG.
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Platelet function recovery after cessation of aspirin: preliminary study of volunteers and surgical patients. Eur J Anaesthesiol 2010; 27:617-23. [PMID: 20035230 DOI: 10.1097/eja.0b013e328335b354] [Citation(s) in RCA: 44] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND AND OBJECTIVE Recent evidence indicates that platelet function may recover more rapidly after cessation of aspirin therapy than previously thought. The present study evaluated the effect of aspirin on platelet function using platelet aggregometry in healthy individuals and in aspirin-treated patients scheduled for surgery. METHODS Platelet aggregation in response to arachidonic acid, epinephrine, and adenosine diphosphate was determined in 14 male volunteers during and after 10 days' aspirin administration (100 mg) and in 58 aspirin-treated patients during intake, on days 3, 4 or 6 after drug cessation, and on day 10 after drug cessation, prior to elective surgery. Urine thromboxane (11-dehydro-thromboxane B2) concentrations were also measured. RESULTS Platelet aggregation in response to arachidonic acid and epinephrine was significantly decreased in both volunteers and patients during aspirin administration. The aggregation normalized within 3 days of aspirin cessation in the volunteers and within 4-6 days in the patients. Urine concentration of 11-dehydro-thromboxane B2 was about three times lower with aspirin treatment than without, although in two patients concentrations were higher with aspirin. CONCLUSION Platelet aggregometry with arachidonic acid is a sensitive test for the evaluation of the effects of aspirin on platelet function. In most aspirin-treated patients, platelet function recovers 4 days after drug cessation, although the process is sometimes prolonged. Therefore, the time of aspirin cessation before scheduled surgery should be determined individually.
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Controversies in Oral Antiplatelet Therapy in Patients Undergoing Aortocoronary Bypass Surgery. Ann Thorac Surg 2010; 90:1040-51. [DOI: 10.1016/j.athoracsur.2010.04.041] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/22/2010] [Revised: 04/08/2010] [Accepted: 04/09/2010] [Indexed: 11/20/2022]
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Abstract
Antiplatelet agents like aspirin and clopidogrel are treatment cornerstones for acute coronary syndromes (ACS). Drawbacks of dual therapy with these agents include slow onset and offset of effect and wide response variability. Clopidogrel may provide little benefit if administered too close to percutaneous coronary intervention (PCI) and increase major bleeding risk if given too close to coronary artery bypass grafting (CABG) or other surgery. It may not provide sufficient antiplatelet coverage prior to CABG if stopped too long before intervention and leave patients without antiplatelet coverage due to hyporesponsiveness. Prasugrel has made steps towards addressing these limitations by exhibiting more efficient metabolism, more rapid onset of effect, and greater and more consistent platelet inhibition than clopidogrel. The TRITON-TIMI38 trial in ACS patients undergoing PCI showed prasugrel produced greater ischemic event protection than clopidogrel but significantly increased major bleeding risk. AZD6140, the first reversible oral P2Y(12) inhibitor, provides more rapid onset of effect and greater and more consistent platelet inhibition than clopidogrel. In DISPERSE2, a phase II trial in ACS patients, AZD6140 did not increase bleeding risk, reduced bleeding risk among CABG patients, and produced numerical reductions in myocardial infarction risk. AZD6140 is being compared with clopidogrel in PLATO, a phase III trial in approximately 18000 ACS patients.
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Affiliation(s)
- Steen Husted
- Department of Medicine and Cardiology, Arhus University Hospital, DK-8000 Arhus C, Arhus, Denmark.
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Movahed MR. Regarding Comparison of Percutaneous Coronary Intervention With Bare-Metal and Drug-Eluting Stents for Cardiac Allograft Vasculopathy. JACC Cardiovasc Interv 2009; 2:474; author reply 474-5. [DOI: 10.1016/j.jcin.2009.02.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/02/2009] [Accepted: 02/18/2009] [Indexed: 10/20/2022]
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Kulik A, Chan V, Ruel M. Antiplatelet therapy and coronary artery bypass graft surgery: perioperative safety and efficacy. Expert Opin Drug Saf 2009; 8:169-82. [DOI: 10.1517/14740330902797081] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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Becker RC. Biological and pharmacological aspects of perioperative hemorrhagic complications associated with oral platelet-directed antithrombotic agents. Focus on isolated coronary artery bypass grafting and oral irreversible P2Y(12) receptor antagonists. Thromb Res 2008; 123:419-28. [PMID: 18937965 DOI: 10.1016/j.thromres.2008.05.007] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2008] [Revised: 05/09/2008] [Accepted: 05/13/2008] [Indexed: 10/21/2022]
Abstract
Coronary arterial bypass grafting (CABG)-the most common heart surgery performed worldwide-is an effective procedure for treating patients with advanced, obstructive atherothrombotic coronary artery disease, prolonging survival in selected high-risk patients. However, CABG is also associated with hemorrhagic complications, which can impact outcome measures such as perioperative morbidity, mortality, length of hospital stay, and health care expenditures. Recent observations have expanded our understanding of the complex process of hemostasis, fostering a more informed view of CABG-associated bleeding complications. Additional research is warranted to determine whether new antithrombotic drug treatment options, such as reversible P2Y12 receptor antagonists among patients with acute coronary syndromes, will favorably impact these clinically relevant complications.
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Affiliation(s)
- Richard C Becker
- Duke University School of Medicine, Durham, North Carolina, USA.
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Snyder-Ramos SA, Mhnle P, Weng YS, Bttiger BW, Kulier A, Levin J, Mangano DT. The ongoing variability in blood transfusion practices in cardiac surgery. Transfusion 2008; 48:1284-99. [DOI: 10.1111/j.1537-2995.2008.01666.x] [Citation(s) in RCA: 111] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Tumialán LM, Zhang YJ, Cawley CM, Dion JE, Tong FC, Barrow DL. Intracranial hemorrhage associated with stent-assisted coil embolization of cerebral aneurysms: a cautionary report. J Neurosurg 2008; 108:1122-9. [PMID: 18518714 DOI: 10.3171/jns/2008/108/6/1122] [Citation(s) in RCA: 84] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Object
The introduction of the Neuroform microstent has facilitated the embolization of complex cerebral aneurysms, which were previously not amenable to endovascular therapy. Typically, the use of this stent necessitates the administration of dual antiplatelet therapy to minimize thromboembolic complications. Such therapy may increase the risk of hemorrhage in patients who require concurrent external ventricular drainage and/or subsequent permanent cerebrospinal fluid diversion.
Methods
The authors' neurosurgical database was queried for all patients who underwent stent-assisted coil embolization for cerebral aneurysms and who required an external ventricular drain (EVD) or ventriculoperitoneal (VP) shunt placement for management of hydrocephalus.
Results
Thirty-seven patients underwent stent-assisted coil embolization for intracranial aneurysms at the authors' institution over a recent 2-year period. Seven of these patients required placement of an EVD and/or a VP shunt. Three of the 7 patients suffered an immediate intraventricular hemorrhage (IVH) associated with placement or manipulation of an EVD; 1 experienced a delayed intraparenchymal hemorrhage and an IVH; 1 suffered an aneurysmal rehemorrhage; and the last patient had a subdural hematoma (SDH) that resulted from placement of a VP shunt. This patient required drainage of the SDH and exchange of the valve.
Conclusions
The necessity of dual antiplatelet therapy in the use of stent-assisted coil embolization increases the risk of intracranial hemorrhage and possibly rebleeding from a ruptured aneurysm. This heightened risk must be recognized when contemplating the appropriate therapy for a cerebral aneurysm and when considering the placement or manipulation of a ventricular catheter in a patient receiving dual antiplatelet therapy. Further study of intracranial procedures in patients receiving dual antiplatelet therapy is indicated.
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Affiliation(s)
| | - Y. Jonathan Zhang
- 1Department of Neurosurgery and
- 2Division of Interventional Neuroradiology, Department of Radiology, Emory University School of Medicine, Atlanta, Georgia
| | - C. Michael Cawley
- 1Department of Neurosurgery and
- 2Division of Interventional Neuroradiology, Department of Radiology, Emory University School of Medicine, Atlanta, Georgia
| | - Jacques E. Dion
- 2Division of Interventional Neuroradiology, Department of Radiology, Emory University School of Medicine, Atlanta, Georgia
| | - Frank C. Tong
- 2Division of Interventional Neuroradiology, Department of Radiology, Emory University School of Medicine, Atlanta, Georgia
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Becker RC. Emerging constructs to maintain safety among patients with acute coronary syndromes requiring surgical coronary revascularization. Eur Heart J Suppl 2008. [DOI: 10.1093/eurheartj/sun006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
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Abstract
BACKGROUND Many older adults (ie, those aged >65 years) drink alcohol and use medications that may be harmful when consumed together. OBJECTIVE This article reviews the literature on alcohol and medication interactions, with a focus on older adults. METHODS Relevant articles were identified through a search of MEDLINE and International Pharmaceutical Abstracts (1966-August 2006) for English-language articles. The following medical subject headings and key words were used: alcohol medication interactions, diseases worsened by alcohol use, and alcohol metabolism, absorption, and distribution. Additional articles were identified by a manual search of the reference lists of the identified articles, review articles, textbooks, and personal reference sources. RESULTS Many older adults drink alcohol and take medications that may interact negatively with alcohol. Some of these interactions are due to age-related changes in the absorption, distribution, and metabolism of alcohol an medications. Others are due to disulfiram-like reactions observed with some medications, exacerbation of therapeutic effects and adverse effects of medications when combined with alcohol, and alcohol's interference with the effectiveness of some medications. CONCLUSIONS Older adults who drink alcohol and who take medications are at risk for a variety of adverse consequences depending on the amount of alcohol and the type of medications consumed. It is important for clinicians to know how much alcohol their older patients are drinking to be able to effectively assess their risks and to counsel them about the safe use of alcohol and medications. Similarly, it is important for older adults to understand the potential risks of their combined alcohol and medication use to avoid the myriad of problems possible with unsafe use of these substances..
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Affiliation(s)
- Alison A Moore
- UCLA Integrated Substance Abuse Programs, Semel Institute for Neuroscience and Human Behavior, Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine at UCLA, Los Angeles, California 90095-1687, USA.
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