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Ueng KC, Chiang CE, Chao TH, Wu YW, Lee WL, Li YH, Ting KH, Su CH, Lin HJ, Su TC, Liu TJ, Lin TH, Hsu PC, Wang YC, Chen ZC, Jen HL, Lin PL, Ko FY, Yen HW, Chen WJ, Hou CJY. 2023 Guidelines of the Taiwan Society of Cardiology on the Diagnosis and Management of Chronic Coronary Syndrome. Acta Cardiol Sin 2023; 39:4-96. [PMID: 36685161 PMCID: PMC9829849 DOI: 10.6515/acs.202301_39(1).20221103a] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 10/26/2022] [Accepted: 11/03/2022] [Indexed: 01/24/2023]
Abstract
Coronary artery disease (CAD) covers a wide spectrum from persons who are asymptomatic to those presenting with acute coronary syndromes (ACS) and sudden cardiac death. Coronary atherosclerotic disease is a chronic, progressive process that leads to atherosclerotic plaque development and progression within the epicardial coronary arteries. Being a dynamic process, CAD generally presents with a prolonged stable phase, which may then suddenly become unstable and lead to an acute coronary event. Thus, the concept of "stable CAD" may be misleading, as the risk for acute events continues to exist, despite the use of pharmacological therapies and revascularization. Many advances in coronary care have been made, and guidelines from other international societies have been updated. The 2023 guidelines of the Taiwan Society of Cardiology for CAD introduce a new concept that categorizes the disease entity according to its clinical presentation into acute or chronic coronary syndromes (ACS and CCS, respectively). Previously defined as stable CAD, CCS include a heterogeneous population with or without chest pain, with or without prior ACS, and with or without previous coronary revascularization procedures. As cardiologists, we now face the complexity of CAD, which involves not only the epicardial but also the microcirculatory domains of the coronary circulation and the myocardium. New findings about the development and progression of coronary atherosclerosis have changed the clinical landscape. After a nearly 50-year ischemia-centric paradigm of coronary stenosis, growing evidence indicates that coronary atherosclerosis and its features are both diagnostic and therapeutic targets beyond obstructive CAD. Taken together, these factors have shifted the clinicians' focus from the functional evaluation of coronary ischemia to the anatomic burden of disease. Research over the past decades has strengthened the case for prevention and optimal medical therapy as central interventions in patients with CCS. Even though functional capacity has clear prognostic implications, it does not include the evaluation of non-obstructive lesions, plaque burden or additional risk-modifying factors beyond epicardial coronary stenosis-driven ischemia. The recommended first-line diagnostic tests for CCS now include coronary computed tomographic angiography, an increasingly used anatomic imaging modality capable of detecting not only obstructive but also non-obstructive coronary plaques that may be missed with stress testing. This non-invasive anatomical modality improves risk assessment and potentially allows for the appropriate allocation of preventive therapies. Initial invasive strategies cannot improve mortality or the risk of myocardial infarction. Emphasis should be placed on optimizing the control of risk factors through preventive measures, and invasive strategies should be reserved for highly selected patients with refractory symptoms, high ischemic burden, high-risk anatomies, and hemodynamically significant lesions. These guidelines provide current evidence-based diagnosis and treatment recommendations. However, the guidelines are not mandatory, and members of the Task Force fully realize that the treatment of CCS should be individualized to address each patient's circumstances. Ultimately, the decision of healthcare professionals is most important in clinical practice.
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Affiliation(s)
- Kwo-Chang Ueng
- Division of Cardiology, Department of Internal Medicine, Chung Shan Medical University Hospital; School of Medicine, Chung Shan Medical University, Taichung
| | - Chern-En Chiang
- General Clinical Research Center and Division of Cardiology, Department of Medicine, Taipei Veterans General Hospital, Taipei
- School of Medicine, National Yang Ming Chiao Tung University, Taipei
| | - Ting-Hsing Chao
- Department of Internal Medicine, National Cheng Kung University Hospital; College of Medicine, National Cheng Kung University, Tainan
| | - Yen-Wen Wu
- School of Medicine, National Yang Ming Chiao Tung University, Taipei
- Division of Cardiology, Cardiovascular Medical Center, Far Eastern Memorial Hospital, New Taipei City
| | - Wen-Lieng Lee
- School of Medicine, National Yang Ming Chiao Tung University, Taipei
- Cardiovascular Center, Taichung Veterans General Hospital, Taichung
| | - Yi-Heng Li
- Department of Internal Medicine, National Cheng Kung University Hospital; College of Medicine, National Cheng Kung University, Tainan
| | - Ke-Hsin Ting
- Division of Cardiology, Department of Internal Medicine, Yunlin Christian Hospital, Yunlin
| | - Chun-Hung Su
- Division of Cardiology, Department of Internal Medicine, Chung Shan Medical University Hospital; School of Medicine, Chung Shan Medical University, Taichung
| | - Hung-Ju Lin
- Cardiovascular Center, Department of Internal Medicine, National Taiwan University Hospital
| | - Ta-Chen Su
- Cardiovascular Center, Department of Internal Medicine, National Taiwan University Hospital
- Department of Environmental and Occupational Medicine, National Taiwan University College of Medicine, Taipei
| | - Tsun-Jui Liu
- Cardiovascular Center, Taichung Veterans General Hospital, Taichung
| | - Tsung-Hsien Lin
- Division of Cardiology, Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung
| | - Po-Chao Hsu
- Division of Cardiology, Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung
| | - Yu-Chen Wang
- Division of Cardiology, Asia University Hospital, Department of Medical Laboratory Science and Biotechnology, Asia University, Taichung
| | - Zhih-Cherng Chen
- Division of Cardiology, Department of Internal Medicine, Chi-Mei Medical Center, Tainan
| | - Hsu-Lung Jen
- Division of Cardiology, Cheng Hsin Rehabilitation Medical Center, Taipei
| | - Po-Lin Lin
- Division of Cardiology, Hsinchu MacKay Memorial Hospital, Hsinchu
| | - Feng-You Ko
- Cardiovascular Center, Kaohsiung Veterans General Hospital, Kaohsiung
| | - Hsueh-Wei Yen
- Division of Cardiology, Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung
| | - Wen-Jone Chen
- Division of Cardiology, Department of Internal Medicine, Min Sheng General Hospital, Taoyuan
| | - Charles Jia-Yin Hou
- Cardiovascular Center, Department of Internal Medicine, MacKay Memorial Hospital; Department of Medicine, Mackay Medical College, New Taipei City, Taiwan
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Yandrapalli S, Andries G, Gupta S, Dajani AR, Aronow WS. Investigational drugs for the treatment of acute myocardial infarction: focus on antiplatelet and anticoagulant agents. Expert Opin Investig Drugs 2018; 28:223-234. [PMID: 30580647 DOI: 10.1080/13543784.2019.1559814] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Affiliation(s)
- Srikanth Yandrapalli
- Division of Cardiology, Department of Medicine, Westchester Medical Center and New York Medical College, Valhalla,
NY, USA
| | - Gabriela Andries
- Department of Medicine, Westchester Medical Center and New York Medical College, Valhalla,
NY, USA
| | - Shashvat Gupta
- Department of Medicine, Westchester Medical Center and New York Medical College, Valhalla,
NY, USA
| | - Abdel Rahman Dajani
- Department of Medicine, Norwalk Hospital affiliated to Yale University, Norwalk,
CT, USA
| | - Wilbert S. Aronow
- Division of Cardiology, Department of Medicine, Westchester Medical Center and New York Medical College, Valhalla,
NY, USA
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Moon JY, Nagaraju D, Franchi F, Rollini F, Angiolillo DJ. The role of oral anticoagulant therapy in patients with acute coronary syndrome. Ther Adv Hematol 2017; 8:353-366. [PMID: 29204262 DOI: 10.1177/2040620717733691] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2017] [Accepted: 09/04/2017] [Indexed: 12/16/2022] Open
Abstract
Dual antiplatelet therapy (DAPT) with aspirin and a P2Y12 receptor antagonist represents the current standard of care to prevent atherothrombotic recurrences in patients with acute coronary syndrome (ACS). However, despite the use of DAPT, the recurrence rate of cardiovascular ischemic events still remains high. This persistent risk may be in part attributed to the sustained activation of the coagulation cascade leading to generation of thrombin, which may continue to play a key role in thrombus formation. The use of vitamin K antagonists (VKAs) as a strategy to reduce atherothrombotic recurrences after an ACS has been previously tested, leading to overall unfavorable outcomes due to the high risk of bleeding complications. The recent introduction of non-VKA oral anticoagulants (NOACs), characterized by a better safety profile and ease of use compared with VKA, has led to a reappraisal of the use of oral anticoagulant therapy for secondary prevention in ACS patients. The present article provides an overview of the rationale and prognostic role of oral anticoagulant therapy in ACS patients as well as recent updated clinical data, in particular with NOACs, in the field and future perspectives on this topic.
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Affiliation(s)
- Jae Youn Moon
- Division of Cardiology, University of Florida College of Medicine - Jacksonville, FL, USA Department of Cardiology, CHA Bundang Medical Center, CHA University, Seongnam, Korea
| | - Deepa Nagaraju
- Division of Cardiology, University of Florida College of Medicine - Jacksonville, FL, USA
| | - Francesco Franchi
- Division of Cardiology, University of Florida College of Medicine - Jacksonville, FL, USA
| | - Fabiana Rollini
- Division of Cardiology, University of Florida College of Medicine - Jacksonville, FL, USA
| | - Dominick J Angiolillo
- University of Florida College of Medicine - Jacksonville, 655 West 8th Street, Jacksonville, FL 32209, USA
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Chen P, Song H, Yao S, Tu X, Su M, Zhou L. Magnetic targeted nanoparticles based on β-cyclodextrin and chitosan for hydrophobic drug delivery and a study of their mechanism. RSC Adv 2017. [DOI: 10.1039/c7ra02398g] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Magnetic nanoparticles double coated with β-cyclodextrin and chitosan were prepared for hydrophobic drug delivery, and its related mechanism was discussed.
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Affiliation(s)
- Pengfei Chen
- School of Chemical Engineering
- Sichuan University
- Chengdu 610065
- China
| | - Hang Song
- School of Chemical Engineering
- Sichuan University
- Chengdu 610065
- China
| | - Shun Yao
- School of Chemical Engineering
- Sichuan University
- Chengdu 610065
- China
| | - Xianyu Tu
- School of Chemical Engineering
- Sichuan University
- Chengdu 610065
- China
| | - Miao Su
- School of Chemical Engineering
- Sichuan University
- Chengdu 610065
- China
| | - Lu Zhou
- School of Chemical Engineering
- Sichuan University
- Chengdu 610065
- China
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Shchegol'kov E, Shchur I, Burgart Y, Saloutin V, Trefilova A, Ljushina G, Solodnikov S, Markova L, Maslova V, Krasnykh O, Borisevich S, Khursan S. Polyfluorinated salicylic acid derivatives as analogs of known drugs: Synthesis, molecular docking and biological evaluation. Bioorg Med Chem 2017; 25:91-99. [DOI: 10.1016/j.bmc.2016.10.014] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2016] [Revised: 10/07/2016] [Accepted: 10/10/2016] [Indexed: 01/05/2023]
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Soleimanpour M, Imani F, Safari S, Sanaie S, Soleimanpour H, Ameli H, Alavian SM. The Role of Non-Steroidal Anti-Inflammatory Drugs (NSAIDs) in the Treatment of Patients With Hepatic Disease: A Review Article. Anesth Pain Med 2016; 6:e37822. [PMID: 27843779 PMCID: PMC5100664 DOI: 10.5812/aapm.37822] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2016] [Revised: 06/11/2016] [Accepted: 06/27/2016] [Indexed: 12/29/2022] Open
Abstract
CONTEXT Patients with hepatic dysfunction suffer from many problems and associated complications in organs other than the liver. Therefore, it is very important to investigate the effects of different drugs in the treatment of these patients. Due to the high consumption of non-steroidal anti-inflammatory drugs (NSAIDs), studying the effects of these drugs in patients with hepatic dysfunction is particularly important. EVIDENCE ACQUISITION Research studies published from 1958 to 2014 were investigated in the present study. The literature search was conducted based on the following keywords: non-steroidal anti-inflammatory drugs (NSAIDs), liver dysfunction, cirrhosis, pharmaceutical complications, drug-induced liver injury (DILI), and similar words from reliable resources. In total, 63 articles and two books (out of 179 initially identified resources) were included in the study. RESULTS In addition to significant hemostatic disorders and cardiovascular disorders, disorders of the renal, respiratory, and gastrointestinal systems, as well as disorders of the central nervous system, occur in patients with hepatic dysfunction. The various NSAIDs have different effects on different bodily systems. Therefore, the appropriate drug should be chosen based on both the condition of the disease and the severity of the dysfunction. CONCLUSIONS Due to the potential adverse effects of NSAIDs in patients with hepatic disease, their impact on all bodily systems should be emphasized when determining whether their use is necessary. Further, the appropriate medication should be selected after a careful assessment of the severity of the disease and any associated complications. It is logical that medicines should only be prescribed by a qualified physician.
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Affiliation(s)
- Maryam Soleimanpour
- Road Traffic Injury Research Center, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Farnad Imani
- Pain Research Center, Iran University of Medical Sciences, Tehran, Iran
| | - Saeid Safari
- Pain Research Center, Iran University of Medical Sciences, Tehran, Iran
| | - Sarvin Sanaie
- Tuberculosis and Lung Research Center, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Hassan Soleimanpour
- Road Traffic Injury Research Center, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Hoorolnesa Ameli
- Students’ Research Committee, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Seyed Moayed Alavian
- Baqiyatallah Research Center for Gastroenterology and Liver Diseases, Baqiyatallah University of Medical Sciences, Tehran, Iran
- Tehran Hepatitis Center, Tehran, Iran
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Li Y, Xie Y, Wang L, Zhang Y, Gu H, Chai Y. Significant Modules and Biological Processes between Active Components of Salvia miltiorrhiza Depside Salt and Aspirin. Evid Based Complement Alternat Med 2016; 2016:3439521. [PMID: 27069488 DOI: 10.1155/2016/3439521] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/16/2015] [Revised: 12/08/2015] [Accepted: 01/12/2016] [Indexed: 12/22/2022]
Abstract
The aim of this study is to examine and compare the similarities and differences between active components of S. miltiorrhiza depside salt and aspirin using perspective of pharmacological molecular networks. Active components of S. miltiorrhiza depside salt and aspirin's related genes were identified via the STITCH4.0 and GeneCards Database. A text search engine (Agilent Literature Search 2.71) and MCODE software were applied to construct network and divide modules, respectively. Finally, 32, 2, and 28 overlapping genes, modules, and pathways were identified between active components of S. miltiorrhiza depside salt and aspirin. A multidimensional framework of drug network showed that two networks reflected commonly in human aortic endothelial cells and atherosclerosis process. Aspirin plays a more important role in metabolism, such as the well-known AA metabolism pathway and other lipid or carbohydrate metabolism pathways. S. miltiorrhiza depside salt still plays a regulatory role in type II diabetes mellitus, insulin resistance, and adipocytokine signaling pathway. Therefore, this study suggests that aspirin combined with S. miltiorrhiza depside salt may be more efficient in treatment of CHD patients, especially those with diabetes mellitus or hyperlipidemia. Further clinical trials to confirm this hypothesis are still needed.
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De Caterina R, Husted S, Wallentin L, Andreotti F, Arnesen H, Bachmann F, Baigent C, Collet JP, Halvorsen S, Huber K, Jespersen J, Kristensen SD, Lip GYH, Morais J, Rasmussen LH, Ricci F, Sibbing D, Siegbahn A, Storey RF, Ten Berg J, Verheugt FWA, Weitz JI. Oral anticoagulants in coronary heart disease (Section IV). Position paper of the ESC Working Group on Thrombosis - Task Force on Anticoagulants in Heart Disease. Thromb Haemost 2016; 115:685-711. [PMID: 26952877 DOI: 10.1160/th15-09-0703] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2015] [Accepted: 01/29/2016] [Indexed: 11/05/2022]
Abstract
Until recently, vitamin K antagonists (VKAs) were the only available oral anticoagulants evaluated for long-term treatment of patients with coronary heart disease (CHD), particularly after an acute coronary syndrome (ACS). Despite efficacy in this setting, VKAs are rarely used because they are cumbersome to administer. Instead, the more readily manageable antiplatelet agents are the mainstay of prevention in ACS patients. This situation has the potential to change with the introduction of non-VKA oral anticoagulants (NOACs), which are easier to administer than VKAs because they can be given in fixed doses without routine coagulation monitoring. The NOACs include dabigatran, which inhibits thrombin, and apixaban, rivaroxaban and edoxaban, which inhibit factor Xa. Apixaban and rivaroxaban were evaluated in phase III trials for prevention of recurrent ischaemia in ACS patients, most of whom were also receiving dual antiplatelet therapy with aspirin and clopidogrel. Although at the doses tested rivaroxaban was effective and apixaban was not, both agents increased major bleeding. The role for the NOACs in ACS management, although promising, is therefore complicated, because it is uncertain how they compare with newer antiplatelet agents, such as prasugrel, ticagrelor or vorapaxar, and because their safety in combination with these other drugs is unknown. Ongoing studies are also now evaluating the use of NOACs in non-valvular atrial fibrillation patients, where their role is established, with coexistent ACS or coronary stenting. Focusing on CHD, we review the results of clinical trials with the NOACs and provide a perspective on their future incorporation into clinical practice.
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Affiliation(s)
- Raffaele De Caterina
- Raffaele De Caterina, MD, PhD, Institute of Cardiology, "G. d'Annunzio" University - Chieti, Ospedale SS. Annunziata, Via dei Vestini, 66013 Chieti, Italy, E-mail:
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Vazquez FJ, Gonzalez JP, LeGal G, Carrier M, Gándara E. Risk of major bleeding in patients receiving vitamin K antagonists or low doses of aspirin. A systematic review and meta-analysis. Thromb Res 2016; 138:1-6. [DOI: 10.1016/j.thromres.2015.12.013] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2015] [Revised: 12/08/2015] [Accepted: 12/13/2015] [Indexed: 11/25/2022]
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Abdollahpour N, Soheili V, Saberi MR, Chamani J. Investigation of the Interaction Between Human Serum Albumin and Two Drugs as Binary and Ternary Systems. Eur J Drug Metab Pharmacokinet 2016; 41:705-21. [DOI: 10.1007/s13318-015-0297-y] [Citation(s) in RCA: 44] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
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Ding Y, Shen SZ, Sun H, Sun K, Liu F, Qi Y, Yan J. Design and construction of polymerized-chitosan coated Fe3O4 magnetic nanoparticles and its application for hydrophobic drug delivery. Materials Science and Engineering: C 2015; 48:487-98. [DOI: 10.1016/j.msec.2014.12.036] [Citation(s) in RCA: 133] [Impact Index Per Article: 14.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/05/2014] [Revised: 11/05/2014] [Accepted: 12/05/2014] [Indexed: 11/22/2022]
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Sharma A, Garg A, Borer JS, Krishnamoorthy P, Garg J, Lavie CJ, Arbab-Zadeh A, Mukherjee D, Ahmad H, Lichstein E. Role of oral factor Xa inhibitors after acute coronary syndrome. Cardiology 2014; 129:224-32. [PMID: 25402219 DOI: 10.1159/000368747] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/16/2014] [Accepted: 09/26/2014] [Indexed: 11/19/2022]
Abstract
Despite an early invasive strategy and the use of dual antiplatelet therapy, patients with acute coronary syndrome (ACS) continue to be at substantial risk for recurrent ischemic events. It is believed that this risk is, at least in part, due to an intrinsic coagulation pathway that remains activated for a prolonged period after ACS. Earlier studies using warfarin showed a reduction in ischemic events, but the overall benefits were offset by increased bleeding complications. Recently, there has been increased interest in the potential role of new oral anticoagulants, some of which target factor Xa, after ACS. Factor Xa is important for the coagulation pathway and also plays a role in cellular proliferation and inflammation. It may thus be an attractive target for therapeutic intervention in ACS. Recently, various oral factor Xa inhibitors have been studied as potential treatment options for ACS. This review will focus on currently available data to evaluate the possible role of factor Xa inhibitors in the management of patients with ACS.
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Affiliation(s)
- Abhishek Sharma
- Division of Cardiovascular Medicine, State University of New York Downstate Medical Center, New York, N.Y., USA
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Refat MS, Sharshar T, Elsabawy KM, Heiba ZK. Physicochemical impact studies of gamma rays on “aspirin” analgesics drug and its metal complexes in solid form: Synthesis, spectroscopic and biological assessment of Ca(II), Mg(II), Sr(II) and Ba(II) aspirinate complexes. J Mol Struct 2013. [DOI: 10.1016/j.molstruc.2013.04.031] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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Chen C, Jiang X, Kaneti YV, Yu A. Design and construction of polymerized-glucose coated Fe3O4 magnetic nanoparticles for delivery of aspirin. POWDER TECHNOL 2013; 236:157-63. [DOI: 10.1016/j.powtec.2012.03.008] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
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Vijaya Bharathi D, Hotha KK, Kolagatla PRR, Venkateswarlu V. Low dose aspirin estimation: an application to a human pharmacokinetic study. Biomed Chromatogr 2012; 27:589-98. [DOI: 10.1002/bmc.2832] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2012] [Accepted: 09/19/2012] [Indexed: 11/05/2022]
Affiliation(s)
- D. Vijaya Bharathi
- Bioanalytical Department, Integrated Product Development; Dr Reddy's Laboratories Ltd, Bachupalli; Hyderabad-500 072; India
| | - Kishore Kumar Hotha
- Bioanalytical Department, Integrated Product Development; Dr Reddy's Laboratories Ltd, Bachupalli; Hyderabad-500 072; India
| | - Pandu Ranga Reddy Kolagatla
- Bioanalytical Department, Integrated Product Development; Dr Reddy's Laboratories Ltd, Bachupalli; Hyderabad-500 072; India
| | - V. Venkateswarlu
- Bioanalytical Department, Integrated Product Development; Dr Reddy's Laboratories Ltd, Bachupalli; Hyderabad-500 072; India
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Park JY, Rha S, Poddar KL, Ramasamy S, Chen K, Li Y, Choi BG, Ryu SK, Choi JW, Park SH, Park S, Elnagar A, Im SI, Kim SW, Na JO, Choi CU, Lim HE, Kim JW, Kim EJ, Han SW, Park CG, Seo HS, Oh DJ. Impact of low-dose aspirin on coronary artery spasm as assessed by intracoronary acetylcholine provocation test in Korean patients. J Cardiol 2012; 60:187-91. [DOI: 10.1016/j.jjcc.2012.02.007] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/27/2011] [Revised: 02/14/2012] [Accepted: 02/16/2012] [Indexed: 12/21/2022]
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Ghosh C, Upadhayay A, Singh A, Bahadur S, Jain P, Chakraborty BS. SIMULTANEOUS DETERMINATION OF ASPIRIN AND ITS METABOLITE FROM HUMAN PLASMA BY UPLC-UV DETECTION: APPLICATION TO PHARMACOKINETIC STUDY. J LIQ CHROMATOGR R T 2011. [DOI: 10.1080/10826076.2011.589092] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/15/2022]
Affiliation(s)
| | | | - Ajay Singh
- a Cadila Pharmaceuticals Limited , Gujarat, India
| | | | - Priya Jain
- a Cadila Pharmaceuticals Limited , Gujarat, India
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Affiliation(s)
- Marc Fisher
- From the Department of Medicine (J.L.), Brigham and Women's Hospital, Harvard Medical School, Boston, MA, and UMass/Memorial Healthcare (M.F.), Worcester, MA
| | - Joseph Loscalzo
- From the Department of Medicine (J.L.), Brigham and Women's Hospital, Harvard Medical School, Boston, MA, and UMass/Memorial Healthcare (M.F.), Worcester, MA
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Ren Y, Patel K, Crane T. A review of antiplatelet drugs, coronary artery diseases and cardiopulmonary bypass. J Extra Corpor Technol 2010; 42:103-113. [PMID: 20648894 PMCID: PMC4680033] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 05/12/2009] [Accepted: 01/16/2010] [Indexed: 05/29/2023]
Abstract
UNLABELLED Platelets play a major role in the thromboembolic diseases and upon vascular injury, especially arterial vascular injury. These platelets rapidly adhere to the exposed subendothelial area, where they become activated by contacting with stimulants. Antiplatelet therapy remains extremely important in treatment and prophylaxis of arterial thromboembolic disorders such as coronary arterial diseases and stroke. The antiplatelet drugs (APDs) are among the most widely used in the world. Based on the molecular targets, APDs are classified as Thromboxane A2 pathway blockers, ADP receptor antagonists, GPIIa/IIIb antagonists, adenosine reuptake inhibitors, phosphodiesterase inhibitors, thrombin receptor inhibitors, and others. Coronary artery bypass graft (CABG) surgery is an important therapeutic approach to treat coronary artery disease. Long-term success after CABG depends on the patency of the bypass vessels. Since platelets play a crucial role in the pathogenesis of thrombosis in the blood vessels, APDs are broadly used to reduce serious cardiovascular events. Platelets also are an integral part of inflammation and APDs have demonstrated to reduce the inflammation mediators in the healthy volunteers and coronary artery disease patients; it will be an interesting topic to determine if platelet inhibition will attenuate CPB-induced systemic inflammatory response syndrome. Due to concerns of post-op bleeding with use of APDs, it is a common practice to withhold APDs prior to surgery; however, recent studies have demonstrated that continuation of APDs prior to surgery (even until the day of surgery) does not increase the risk of post-op bleeding. With extensive use of APDs in cardiovascular thromboembolic events, APD resistance becomes problematic in clinical antiplatelet therapy. Since there is no standardized or universal definition available to quantify APDs resistance, a clinically meaningful definition of APD resistance needs to be developed based on data linking laboratory tests to clinical outcomes in patients. KEYWORDS antiplatelet drug, coronary artery diseases, cardiopulmonary bypass, clinical trials, drug resistance, platelet mapping.
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Affiliation(s)
- Yajun Ren
- *Hospital Clinical Services Group, Lakeland Regional Medical Center, St. Joseph, Michigan 49085, USA.
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Haq SA, Heitner JF, Sacchi TJ, Brener SJ. Long-term effect of chronic oral anticoagulation with warfarin after acute myocardial infarction. Am J Med 2010; 123:250-8. [PMID: 20193834 DOI: 10.1016/j.amjmed.2009.08.016] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/15/2009] [Revised: 07/13/2009] [Accepted: 08/17/2009] [Indexed: 10/19/2022]
Abstract
BACKGROUND Antiplatelet therapy is the principal component of the antithrombotic regimen after acute myocardial infarction. It remains unclear whether additional chronic oral anticoagulation (OAC) improves outcomes. We set out to evaluate the risk and benefit of long-term OAC after myocardial infarction. METHODS We pooled 10 randomized clinical trials comparing warfarin-containing regimens (OAC) with or without aspirin with non-OAC regimens with or without aspirin (No OAC) for patients with recent infarction. The primary endpoint was all-cause mortality. Other endpoints included recurrent infarction, stroke, and major bleeding. We calculated the odds ratio (OR) (fixed effect, OR <1 indicates benefit for OAC) for death and other ischemic and hemorrhagic complications at the longest interval of follow-up available. RESULTS Among 24,542 patients, 14,062 were assigned to OAC and 10,480 to no OAC. The patients were followed for 3-63 months, for 89,562 patient-years. Death occurred in 2424 patients (9.9%), 1279 OAC patients, and 1145 in the no OAC group, OR 0.97 (95% confidence interval [CI], 0.88-1.05), P=.43. Similarly, there was no effect on recurrent infarction. Stroke occurred in 578 patients (2.4%), 271 in the OAC group and 307 in the no OAC group, OR 0.75 (95% CI, 0.63-0.89), P=.001. There was substantially more major bleeding (OR 1.83 [95% CI, 1.50-2.23], P <.001) in the OAC group. Separate analyses, performed for patients (n=11,920) randomized to aspirin versus aspirin and OAC yielded very similar results. CONCLUSION As compared with placebo or aspirin, OAC with or without aspirin does not reduce mortality or reinfarction, reduces stroke, but is associated with significantly more major bleeding.
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Affiliation(s)
- Salman A Haq
- New York Methodist Hospital, Brooklyn, 11215, USA
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Choi JI, Raghavendran HR, Sung NY, Kim JH, Chun BS, Ahn DH, Choi HS, Kang KW, Lee JW. Effect of fucoidan on aspirin-induced stomach ulceration in rats. Chem Biol Interact. 2010;183:249-254. [PMID: 19788892 DOI: 10.1016/j.cbi.2009.09.015] [Citation(s) in RCA: 76] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2009] [Revised: 09/21/2009] [Accepted: 09/21/2009] [Indexed: 11/20/2022]
Abstract
In this study, the effects of fucoidan on aspirin-induced ulcers in rats were evaluated: both biochemical and immunological parameters were taken into consideration. The status of stomach tissue glycogen storage and histological changes were also examined. Examination of basic biochemical parameters showed significant (p<0.01) alterations in aspartate (AST) and alanine (ALT) transaminases in ulcer-induced rats. Also, moderate alterations (p<0.05) were observed in the levels of cholesterol and blood urea nitrogen (BUN). Histopathological examination showed neutrophil infiltration and inflammation in oxyntic cells with altered glycogen storage. Analysis of serum cytokines of aspirin-induced rats showed a moderate decrease in interleukin-10 (IL-10) with considerable increase of interleukin-6 (IL-6) and interferon-gamma (INF-gamma) when compared with control. Administration of fucoidan showed considerable (p<0.05) protection against ulceration by inhibiting the acute alterations of AST, ALT, cytokines and stomach glycogen. However, aggravated serum INF-gamma was observed in the fucoidan-pretreated group. These findings suggest that the anti-ulcer property of fucoidan might contribute in protecting the inflammatory cytokine-mediated oxidative damage to gastric mucosa.
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Becker RC, Meade TW, Berger PB, Ezekowitz M, O'Connor CM, Vorchheimer DA, Guyatt GH, Mark DB, Harrington RA. The primary and secondary prevention of coronary artery disease: American College of Chest Physicians Evidence-Based Clinical Practice Guidelines (8th Edition). Chest 2008; 133:776S-814S. [PMID: 18574278 DOI: 10.1378/chest.08-0685] [Citation(s) in RCA: 163] [Impact Index Per Article: 10.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
The following chapter devoted to antithrombotic therapy for chronic coronary artery disease (CAD) is part of the Antithrombotic and Thrombolytic Therapy: American College of Chest Physicians Evidence-Based Clinical Practice Guidelines (8th Edition). Grade 1 recommendations are strong and indicate that the benefits do or do not outweigh risks, burden, and costs. Grade 2 suggests that individual patient values may lead to different choices (for a full understanding of the grading see the "Grades of Recommendation" chapter by Guyatt et al in this supplement, CHEST 2008; 133[suppl]:123S-131S). Among the key recommendations in this chapter are the following: for patients with non-ST-segment elevation (NSTE)-acute coronary syndrome (ACS) we recommend daily oral aspirin (75-100 mg) [Grade 1A]. For patients with an aspirin allergy, we recommend clopidogrel, 75 mg/d (Grade 1A). For patients who have received clopidogrel and are scheduled for coronary bypass surgery, we suggest discontinuing clopidogrel for 5 days prior to the scheduled surgery (Grade 2A). For patients after myocardial infarction, after ACS, and those with stable CAD and patients after percutaneous coronary intervention (PCI), we recommend daily aspirin (75-100 mg) as indefinite therapy (Grade 1A). We recommend clopidogrel in combination with aspirin for patients experiencing ST-segment elevation (STE) and NSTE-ACS (Grade 1A). For patients with contraindications to aspirin, we recommend clopidogrel as monotherapy (Grade 1A). For long-term treatment after PCI in patients who receive antithrombotic agents such as clopidogrel or warfarin, we recommend aspirin (75 to 100 mg/d) [Grade 1B]. For patients who undergo bare metal stent placement, we recommend the combination of aspirin and clopidogrel for at least 4 weeks (Grade 1A). We recommend that patients receiving drug-eluting stents (DES) receive aspirin (325 mg/d for 3 months followed by 75-100 mg/d) and clopidogrel 75 mg/d for a minimum of 12 months (Grade 2B). For primary prevention in patients with moderate risk for a coronary event, we recommend aspirin, 75-100 mg/d, over either no antithrombotic therapy or vitamin K antagonist (Grade 1A).
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Affiliation(s)
- Richard C Becker
- Duke Clinical Research Institute, Duke University Medical Center, Durham, NC.
| | - Thomas W Meade
- Non Comm Disease Epidemiology, London School of Hygiene Tropical, London, UK
| | | | | | | | | | - Gordon H Guyatt
- McMaster University Health Sciences Centre, Hamilton, ON, Canada
| | | | - Robert A Harrington
- Duke Clinical Research Institute, Duke University Medical Center, Durham, NC
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McQuaid KR, Laine L. Systematic review and meta-analysis of adverse events of low-dose aspirin and clopidogrel in randomized controlled trials. Am J Med 2006; 119:624-38. [PMID: 16887404 DOI: 10.1016/j.amjmed.2005.10.039] [Citation(s) in RCA: 249] [Impact Index Per Article: 13.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/07/2005] [Revised: 10/20/2005] [Accepted: 10/22/2005] [Indexed: 12/11/2022]
Abstract
PURPOSE We performed a systematic review to define the relative and absolute risk of clinically relevant adverse events with the antiplatelet agents, aspirin and clopidogrel. MATERIALS AND METHODS Databases were searched for randomized controlled trials of low-dose aspirin (75-325 mg/day) or clopidogrel administered for cardiovascular prophylaxis. Relative risks (RR) were determined by meta-analysis of 22 trials for aspirin versus placebo and from single studies for aspirin versus clopidogrel, aspirin versus aspirin/clopidogrel, and clopidogrel versus aspirin/clopidogrel. Absolute risk increase was calculated by multiplying RR increase by the pooled weighted incidence of the control. RESULTS Aspirin increased the risk of major bleeding (RR=1.71; 95% confidence interval [CI], 1.41-2.08), major gastrointestinal (GI) bleeding (RR=2.07; 95% CI, 1.61-2.66), and intracranial bleeding (RR=1.65; 95% CI, 1.06-5.99) versus placebo. No difference between 75-162.5 mg/day and >162.5-325 mg/day aspirin versus placebo was seen. The absolute annual increases attributable to aspirin were major bleeding: 0.13% (95% CI, 0.08-0.20); major GI bleeding: 0.12% (95% CI, 0.07-0.19), intracranial bleeding: 0.03% (95% CI, 0.01-0.08). No study compared clopidogrel with placebo. One study showed increased major GI bleeding (but not non-GI bleeding endpoints) with aspirin versus clopidogrel (RR=1.45; 95% CI, 1.00-2.10). The absolute annual increase was 0.12% (95% CI, 0.00-0.28). CONCLUSIONS Low-dose aspirin increases the risk of major bleeding by approximately 70%, but the absolute increase is modest: 769 patients (95% CI, 500-1250) need to be treated with aspirin to cause one additional major bleeding episode annually. Compared with clopidogrel, aspirin increases the risk of GI bleeding but not other bleeding; however, 883 patients (95% CI, 357-infinity) would need to be treated with clopidogrel versus aspirin to prevent one major GI bleeding episode annually at a cost of over 1 million dollars.
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Abstract
Secondary prevention of coronary events in coronary artery disease (CAD) patients with aspirin is generally accepted because of ease of administration, predictable safety, and proven efficacy. The use of long-term anticoagulant therapy with heparins, vitamin-K antagonists (VKAs), or thrombin inhibitors is, however, more controversial. During the last 40 years, several trials have been conducted in order to evaluate the role of anticoagulant therapy in patients with CAD as a protection against subsequent death and thrombo-embolic complications. The conducted trials are heterogeneous in many ways, concerning comparative medications, patient populations, endpoints and follow-up, which makes a standardized recommendation on the basis of these studies difficult. This review is an overview of the largest and best studies on this topic and discusses the scientific background for a possible use of VKA or an alternative anticoagulant treatment in CAD patients, looking at both the beneficial effects and the risk of bleeding.
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Affiliation(s)
- S E Husted
- Department of Medicine and Cardiology, University Hospital of Aarhus, Tage Hansens Gade 2, DK-8000 Aarhus C, Denmark.
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27
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Eikelboom JW, Quinlan DJ, Mehta SR, Turpie AG, Menown IB, Yusuf S. Unfractionated and low-molecular-weight heparin as adjuncts to thrombolysis in aspirin-treated patients with ST-elevation acute myocardial infarction: a meta-analysis of the randomized trials. Circulation 2005; 112:3855-67. [PMID: 16344381 DOI: 10.1161/circulationaha.105.573550] [Citation(s) in RCA: 102] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND There is uncertainty about the role of intravenous unfractionated heparin (UFH) and low-molecular-weight heparin (LMWH) in patients with ST-elevation myocardial infarction (STEMI) treated with aspirin and thrombolysis. METHODS AND RESULTS We performed a meta-analysis of the randomized trials to assess the effect of UFH and LMWH on reinfarction, death, stroke, and bleeding. Fourteen trials involving a total of 25,280 patients were included (1239 comparing intravenous UFH versus placebo or no heparin; 16,943 comparing LMWH versus placebo; and 7098 comparing LMWH versus intravenous UFH). Intravenous UFH during hospitalization did not reduce reinfarction (3.5% versus 3.3%; odds ratio [OR], 1.08; 95% CI, 0.58 to 1.99) or death (4.8% versus 4.6%; OR, 1.04; 95% CI, 0.62 to 1.78) and did not increase major bleeding (4.2% versus 3.4%; OR, 1.21; 95% CI, 0.67 to 2.18) but increased minor bleeding (19.6% versus 12.5%; OR, 1.72; 95% CI, 1.22 to 2.43). During hospitalization/at 7 days, LMWH compared with placebo reduced the risk of reinfarction by approximately one quarter (1.6% versus 2.2%; OR, 0.72; 95% CI, 0.58 to 0.90; number needed to treat [NNT]=167) and death by &10% (7.8% versus 8.7%; OR, 0.90; 95% CI, 0.80 to 0.99; NNT=111) but increased major bleeding (1.1% versus 0.4%; OR, 2.70; 95% CI, 1.83 to 3.99; number needed to harm [NNH]=143) and intracranial bleeding (0.3% versus 0.1%; OR, 2.18; 95% CI, 1.07 to 4.52; NNH=500). The reduction in death with LMWH remained evident at 30 days. LMWH compared with UFH during hospitalization/at 7 days reduced reinfarction by &45% (3.0% versus 5.2%; OR, 0.57; 95% CI, 0.45 to 0.73; NNT=45), did not reduce death (4.8% versus 5.3%; OR, 0.92; 95% CI, 0.74 to 1.13) or increase major bleeding (3.3% versus 2.5%; OR, 1.30; 95% CI, 0.98 to 1.72), but increased minor bleeding (22.8% vs 19.4%; OR, 1.26; 95% CI, 1.12 to 1.43). The reduction in reinfarction remained evident at 30 days. CONCLUSIONS In aspirin-treated patients with STEMI who are treated with thrombolysis, intravenous UFH has not been shown to prevent reinfarction or death. LMWH given for 4 to 8 days compared with placebo reduces reinfarction by approximately one quarter and death by &10% and when directly compared with UFH reduces reinfarction by almost one half. These data suggest that LMWH should be the preferred antithrombin in this setting.
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Affiliation(s)
- John W Eikelboom
- General Division, Hamilton Health Sciences, Hamilton, Ontario, Canada
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Harrington RA, Becker RC, Ezekowitz M, Meade TW, O'Connor CM, Vorchheimer DA, Guyatt GH. Antithrombotic therapy for coronary artery disease: the Seventh ACCP Conference on Antithrombotic and Thrombolytic Therapy. Chest 2004; 126:513S-548S. [PMID: 15383483 DOI: 10.1378/chest.126.3_suppl.513s] [Citation(s) in RCA: 159] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
This chapter about antithrombotic therapy for coronary artery disease (CAD) is part of the Seventh ACCP Conference on Antithrombotic and Thrombolytic Therapy: Evidence Based Guidelines. Grade 1 recommendations are strong and indicate that the benefits do, or do not, outweigh risks, burden, and costs. Grade 2 suggests that individual patients' values may lead to different choices (for a full understanding of the grading see Guyatt et al, CHEST 2004; 126:179S-187S). Among the key recommendations in this chapter are the following: For patients presenting with non-ST-segment elevation (NSTE) acute coronary syndrome (ACS), we recommend immediate and then daily oral aspirin (Grade 1A). For patients with an aspirin allergy, we recommend immediate treatment with clopidogrel, 300-mg bolus po, followed by 75 mg/d indefinitely (Grade 1A). In all NSTE ACS patients in whom diagnostic catheterization will be delayed or when coronary bypass surgery will not occur until > 5 days, we recommend clopidogrel as bolus therapy (300 mg), followed by 75 mg/d for 9 to 12 months in addition to aspirin (Grade 1A). In NSTE ACS patients in whom angiography will take place within 24 h, we suggest beginning clopidogrel after the coronary anatomy has been determined (Grade 2A). For patients who have received clopidogrel and are scheduled for coronary bypass surgery, we recommend discontinuing clopidogrel for 5 days prior to the scheduled surgery (Grade 2A). In moderate- to high-risk patients presenting with NSTE ACS, we recommend either eptifibatide or tirofiban for initial (early) treatment in addition to treatment with aspirin and heparin (Grade 1A). For the acute treatment of NSTE ACS, we recommend low molecular weight heparins over unfractionated heparin (UFH) [Grade 1B] and UFH over no heparin therapy use with antiplatelet therapies (Grade 1A). We recommend against the direct thrombin inhibitors as routine initial antithrombin therapy (Grade 1B). For patients after myocardial infarction, after ACS, and with stable CAD, we recommend aspirin in doses from 75 to 325 mg as initial therapy and in doses of 75 to 162 mg as indefinite therapy (Grade 1A). For patients with contraindications to aspirin, we recommend long-term clopidogrel (Grade 1A). For primary prevention in patients with at least moderate risk for a coronary event, we recommend aspirin, 75 to 162 mg/d, over either no antithrombotic therapy or vitamin K antagonist (VKA) [Grade 2A]; for patients at particularly high risk of events in whom the international normalized ratio (INR) can be monitored without difficulty, we suggest low-dose VKA (target INR, 1.5) [Grade 2A].
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Abstract
The anticoagulant, warfarin, and the antiplatelet agent, aspirin, have been shown to have similar benefits after myocardial infarction. As these agents have different mechanisms of action, the beneficial effects of warfarin and aspirin may be additive after myocardial infarction. In the Warfarin, Aspirin, Reinfarction Study (WARIS II), the main outcome was a composite of death, non-fatal reinfarction or thromboembolic stroke, whichever came first over 4 years. Compared to aspirin alone (160 mg/day), the risk reduction was 19% (p = 0.03) with warfarin alone (INR of 2.8 IU) and 29% (p = 0.001) with the combination of aspirin and warfarin (aspirin, 75 mg/day; warfarin, INR of 2.2 IU). This difference in the first event with warfarin alone or the combination, represented a reduction in reinfarction and thromboembolic stroke rather than death. For reinfarction, compared to aspirin alone (117 of 1206), there was a reduction with warfarin alone (90 of 1216) and a further reduction with the combination (69 of 1208). For thromboembolic stroke, compared to aspirin (32 of 1206), there were similar reductions with warfarin and the combination. There were more major and minor bleeding in the warfarin groups than the aspirin group, with major bleeding occurring in 8, 33 and 28 patients taking aspirin, warfarin and aspirin and warfarin, respectively. In conclusion, as compared with aspirin alone, therapy with moderate-intensity warfarin combined with aspirin and high-intensity warfarin alone, resulted in a reduced risk of reinfarction and ischemic stroke but a higher risk of bleeding.
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Affiliation(s)
- Sheila A Doggrell
- School of Biomedical Sciences, The University of Queensland, QLD 4072, Australia.
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Mosquera Pérez I, Muñiz García J, Freire Castroseiros E, García Castelo A, Castro-Beiras A. Uso de anticoagulación al alta hospitalaria en pacientes con insuficiencia cardíaca y fibrilación auricular. Rev Esp Cardiol 2003; 56:880-7. [PMID: 14519275 DOI: 10.1016/s0300-8932(03)76976-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
INTRODUCTION AND OBJECTIVES To assess the degree of compliance with current guidelines for chronic anticoagulation in patients with heart failure and atrial fibrillation. PATIENTS AND METHOD From the INCARGAL Study database, we analyzed data from 195 consecutive patients (88 men; mean age 76 10 years) with both conditions, admitted to three Galician hospitals between January and March 1999. It was assumed that these patients should have received anticoagulant therapy at discharge, unless contraindicated. We studied the association of treatment at discharge (anticoagulation or not) with the presence or absence of contraindications. RESULTS 152 patients (78%) had no contraindication for anticoagulation and 43 had at least one (absolute: 11, relative: 32). Only 50% of patients without contraindications received anticoagulation at the time of discharge. No patient with an absolute contraindication and 3 with a relative one received anticoagulation. Factors related with the less frequent prescription of anticoagulation therapy in patients without a formal contraindication were: age, a previous history of coronary heart disease, absence of valvular heart disease, prior myocardial infarction, treatment with beta-blocking agents, non performance of an echocardiogram, and admission to a department other than cardiology. On multivariate analysis, age, prior myocardial infarction, and non-valvular disease were found to be independent predictors of less use of anticoagulation. CONCLUSIONS Anticoagulant therapy is used less often than recommended at discharge in patients with heart failure and atrial fibrillation for whom there were no contraindications. Advanced age reduces its use. The presence of other indications for antiplatelet or anticoagulation therapy appears to determine the choice of one or the other. Noncompliance with the guidelines due to overprescription was not found.
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Affiliation(s)
- Ignacio Mosquera Pérez
- Servicio de Cardiología. Area del Corazón. Complejo Hospitalario Universitario Juan Canalejo. A Coruña. España
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Fortuny J, Agustí A. ¿Está indicado el tratamiento combinado con anticoagulantes orales y antiagregantes en la prevención secundaria del infarto agudo de miocardio? Med Clin (Barc) 2003; 121:433-5. [PMID: 14563277 DOI: 10.1016/s0025-7753(03)73977-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Affiliation(s)
- Joan Fortuny
- Fundació Institut Català de Farmacologia, Servei de Farmacologia Clínica, Hospital Universitari Vall d'Hebron, Barcelona, España
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Abstract
BACKGROUND The role of antithrombotic therapy in secondary prevention after myocardial infarction is well established. Although the available literature suggests that warfarin is superior to aspirin, aspirin is currently the more widely used drug. We studied the efficacy and safety of warfarin, aspirin, or both after myocardial infarction. METHODS In a randomized, multicenter trial in 3630 patients, 1216 received warfarin (in a dose intended to achieve an international normalized ratio [INR] of 2.8 to 4.2), 1206 received aspirin (160 mg daily), and 1208 received aspirin (75 mg daily) combined with warfarin (in a dose intended to achieve an INR of 2.0 to 2.5). The mean duration of observation was four years. RESULTS The primary outcome, a composite of death, nonfatal reinfarction, or thromboembolic cerebral stroke, occurred in 241 of 1206 patients receiving aspirin (20.0 percent), 203 of 1216 receiving warfarin (16.7 percent; rate ratio as compared with aspirin, 0.81; 95 percent confidence interval, 0.69 to 0.95; P=0.03), and 181 of 1208 receiving warfarin and aspirin (15.0 percent; rate ratio as compared with aspirin, 0.71; 95 percent confidence interval, 0.60 to 0.83; P=0.001). The difference between the two groups receiving warfarin was not statistically significant. Episodes of major, nonfatal bleeding were observed in 0.62 percent of patients per treatment-year in both groups receiving warfarin and in 0.17 percent of patients receiving aspirin (P<0.001). CONCLUSIONS Warfarin, in combination with aspirin or given alone, was superior to aspirin alone in reducing the incidence of composite events after an acute myocardial infarction but was associated with a higher risk of bleeding.
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Affiliation(s)
- Mette Hurlen
- Department of Cardiology, Ullevål University Hospital, Oslo, Norway
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Philpott S, Boynton PM, Feder G, Hemingway H. Gender differences in descriptions of angina symptoms and health problems immediately prior to angiography: the ACRE study. Appropriateness of Coronary Revascularisation study. Soc Sci Med 2001; 52:1565-75. [PMID: 11314852 DOI: 10.1016/s0277-9536(00)00269-0] [Citation(s) in RCA: 68] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Although the prevalence of angina in women is increasing, women are less likely than men to undergo invasive management of coronary disease. Gender differences in language use may contribute to disparities in management, since the diagnosis of angina relies on a patient's description of their symptoms. This study set out to investigate whether gender differences exist in the language used when describing angina symptoms and perceived health problems at the time of angiography, which might influence the rate of subsequent revascularisation. Content analysis was used to analyse written accounts of 'symptoms and health problems' in 200 (96 female) patients randomly selected within age strata who were undergoing coronary angiography for chronic stable angina in the Appropriateness of Coronary Revascularisation (ACRE) study. Written free text was coded into seven categories: pain location (chest or arm and throat, neck or jaw); pain character; breathlessness; other symptoms; effects on lifestyle; symptom attributions; and patient discourses ('story' or 'factual'). Women described more throat, neck or jaw pain than men among those with low physical functioning ( p=0.06), in the presence of coronary artery disease (p = 0.04) and in those who were not subsequently revascularised (p =0.05). Women also gave more accounts than men of breathlessness and other symptoms, but there was little evidence for gender differences in the use of 'factual' discourses. We conclude that from the time of angiography, gender differences in language use do exist and description of angina pain may influence subsequent revascularisation. Further research is necessary to investigate the nature and consequences of gender differences in language use at this and earlier stages in the referral process.
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Affiliation(s)
- S Philpott
- Department of Research and Development, Kensington & Chelsea and Westminster Health Authority, London, UK.
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Affiliation(s)
- J A Cairns
- Faculty of Medicine, University of British Columbia, Vancouver, Canada
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Pothula A, Serebruany VL, Gurbel PA, McKenzie ME, Atar D. Pathophysiology and therapeutic modification of thrombin generation in patients with coronary artery disease. Eur J Pharmacol 2000; 402:1-10. [PMID: 10940351 DOI: 10.1016/s0014-2999(00)00440-4] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
Thrombin plays a central role in thrombogenesis: it activates platelets, converts fibrinogen to fibrin, and activates factor XIII, which then crosslinks and stabilizes the fibrin clot. In addition, thrombin amplifies coagulation by activating factors VIII and V, key cofactors in the generation of activated factor X and thrombin, respectively. Even platelet function is influenced by thrombin. Hence, thrombin generation is most important both in the chronic progression of coronary atherosclerotic disease and in its conversion to acute events. To date, various therapeutic approaches capitalize on this knowledge by targeting specific thrombin-related pathways. Among the successful and carefully documented pharmacologic strategies in acute or chronic coronary heart disease are the use of unfractioned heparin, low-molecular-weight heparin, thrombolysis, hirudin, and/or inhibition of thrombin generation by glycoprotein IIb/IIIa antagonists, most often utilized on top of antiplatelet therapy (e.g., with acetylsalicylic acid) and/or vitamin K antagonism. The present review provides insights into the pathophysiology of thrombin generation in coronary atherosclerosis and gives an overview over the above mentioned therapeutic thrombin modifications.
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Affiliation(s)
- A Pothula
- Sinai Hospital, Center for Thrombosis Research, Baltimore, MD, USA
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Altman R, Rouvier J, Scazziota A. Secondary prevention of myocardial infarction: beneficial effect of combining oral anticoagulant plus aspirin: therapy based on evidence. Clin Appl Thromb Hemost 2000; 6:126-34. [PMID: 10898271 DOI: 10.1177/107602960000600302] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Affiliation(s)
- R Altman
- Centro de Trombosis de Buenos Aires, Argentina
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Abstract
In general, aspirin is indicated to prevent thrombosis in conditions associated with high shear rates (i.e., atherosclerosis) and warfarin is indicated to prevent thrombosis in conditions associated with stasis (i.e., atrial fibrillation). While aspirin and warfarin should generally not be used together, their combined use is beneficial in selected patients (e.g., some patients with mechanical valve prostheses). Aspirin in a dose of 75-150 mg per day is indicated to prevent vascular events in patients with ischaemic heart disease and also in patients at high risk of ischaemic heart disease. All patients with atrial fibrillation should be considered for oral anticoagulant therapy, with the decision for its use based on an assessment of the balance between the risk of thromboembolism and bleeding. The recommended therapeutic INR (international normalised ratio) range in non-valvular atrial fibrillation is 2.0-3.0. Warfarin is contraindicated in pregnancy, particularly during the first trimester; however, it may still need to be used in the second and third trimesters in patients with mechanical valve prostheses.
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Affiliation(s)
- R E Peverill
- Department of Medicine, Monash Medical Centre, and Monash University, Melbourne, VIC.
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Abstract
Three long-term studies on oral anticoagulation, the Sixty Plus trial, the WARIS study, and the ASPECT trial all meet the methodological requirements for modern stand alone clinical trials: large number of patients, double-blinded, placebo-controlled design, and intention to treat analysis. All demonstrate significant reduction in recurrent myocardial infarction, and all show reduction in the risk of total stroke. The WARIS study, however, is the only study demonstrating efficacy in terms of statistically significant reduction of all-cause mortality. These findings are confirmed by a recent meta-analysis. The overall benefit of oral anticoagulation after myocardial infarction suggests avoidance of 4-26 events per 100 patients treated for 2-3 years. Given the results from the trials applying the most adequate control of anticoagulation, avoidance of 10-14 events per 100 patients treated seems to be a realistic benefit. Provided there is sound management of the anticoagulant therapy, especially employment of suitable control methods, the incidence of bleeding may be kept at a low level.
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Affiliation(s)
- P Smith
- Department of Medicine, Baerum Hospital, Norway.
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Affiliation(s)
- J A Cairns
- Faculty of Medicine, University of British Columbia, Vancouver, Canada
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