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The Integrative Coronary Heart Disease (CHD) Prevention Program
Published in Mark C Houston, The Truth About Heart Disease, 2023
Omega-3 fatty acids are safe and have very few adverse effects from the recommended daily dose of 1000–5000 mg per day in divided doses twice per day. Supplementation of less than 4 grams per day when co-prescribed with antiplatelet and anticoagulants are not associated with an increased risk of major or minor bleeding episodes. Ten grams EPA equals 320 mg ASA for bleeding risk. The very low risk of possible atrial fibrillation remains controversial and may be limited to very special populations or poor-quality omega-3 fatty acids. These studies and analyses need more verification. This is not a reason to avoid omega-3 FA.
Coronary Artery Disease
Published in Jahangir Moini, Matthew Adams, Anthony LoGalbo, Complications of Diabetes Mellitus, 2022
Jahangir Moini, Matthew Adams, Anthony LoGalbo
Treatment of CAD is focused on reducing the cardiac workload. This is achieved by decreasing oxygen demand while improving blood flow through the coronary artery. Over time, the goal is to stop and reverse atherosclerosis. Percutaneous coronary intervention (PCI) and coronary artery bypass grafting (CABG) can improve coronary artery blood flow. Fibrinolytic drugs may be used to dissolve an acute coronary thrombosis, for some patients. The medical treatments for CAD are based on cardiac function, present symptoms, and underlying disorders. Antiplatelet drugs are recommended to stop clot formation. Statins are used to lower LDL cholesterol, improving outcomes in part by stabilizing atheromatous plaques and also by causing better endothelial function. Beta-blockers can reduce angina symptoms by decreasing myocardial oxygen demand and reducing heart rate and contractility. Calcium channel blockers are often effective, especially when used with beta-blockers to manage angina and hypertension. Nitrates slightly dilate the coronary arteries to decrease venous return. For patients with CAD and LV dysfunction, the angiotensin-converting enzyme (ACE) inhibitors and angiotensin II receptor blockers (ARBs) are the preferred medications.
Selected topics
Published in Henry J. Woodford, Essential Geriatrics, 2022
Because some medications can promote hyperglycaemia, medication review should consider if discontinuation or switching drug class would be appropriate. As part of vascular risk reduction, those who smoke should be encouraged to stop. Antiplatelets are only recommended for people who also have cardiovascular disease.91 Statin medications may be indicated (see Chapter 3). Blood pressure control is discussed in Chapter 18. Reducing blood pressure can reduce both micro- and macrovascular complications. ACE inhibitors or angiotensin receptor blockers (ARBs) tend to be used in preference for BP control in people with diabetes. ARBs may reduce the risk of developing end-stage renal disease in people with albuminuria but neither drug appears to improve all-cause mortality compared to placebo.97
Delivery of rivaroxaban and chitosan rapamycin microparticle with dual antithrombosis and antiproliferation functions inhibits venous neointimal hyperplasia
Published in Drug Delivery, 2022
Peng Sun, Haoliang Wu, Hao He, Liwei Zhang, Yuanfeng Liu, Cong Zhang, Chunyang Lou, Jingan Li, Hualong Bai
After vascular interventions, antiplatelet and anticoagulation drugs are used to prevent platelet accumulation and thrombus formation (Liu et al., 2019, Haybar et al., 2019). Neointimal cell, especially smooth muscle cells proliferation also plays an important role in the neointimal hyperplasia, so rapamycin or paclitaxel coated grafts are also widely used to inhibit neointimal cell proliferation (Bai et al., 2021). Recent studies showed programmed death-1 antibody or inhibitor coated vascular graft can also inhibit neointimal hyperplasia after patch angioplasty in rat (Sun et al., 2021, Bai et al., 2021). IL-33 antibody absorbed plant leaf patch can be used to inhibit venous neointimal hyperplasia in rat (Xie et al., 2021). But these interventions were all focused on one step in the neointimal hyperplasia; this may be the cause that the treatment of neointimal hyperplasia is not satisfactory in clinic. Although we developed a hierarchical hydrogel releasing system, but this system was complex. In this research, we fabricated this PGA scaffold patch which has dual antithrombosis and antiproliferation functions to decrease neointimal hyperplasia; this dual functional scaffold is much easier to make compared to the hierarchical hydrogel patch.
Comparison of predictive value of risk scores for gastrointestinal bleeding in antiplatelet therapy
Published in Platelets, 2022
Mei-na Lv, Xiao-chun Zheng, Shao-jun Jiang, Hong-qin Zhang, Fang-Da Xu, Ting-Ting Wu, Wen-Jun Chen, Jin-hua Zhang
With the increased aging of the population, the prevalence of cardiovascular and cerebrovascular diseases is increasing year by year. According to the survey, there are currently about 290 million patients with cardiovascular and cerebrovascular diseases in China, accounting for about 21% of the total population [1,2], and the standardized incidence of stroke among residents aged 40–74 has increased by an average of 8.3% per year [3]. Antiplatelet drugs are one of the important drugs for the prevention and treatment of cardiovascular and cerebrovascular diseases. The use of antiplatelet drugs is also increasing year by year in China. For example, the amount of clopidogrel used in 2018 increased by 1.89 times compared with 2013 [4]. Oral antiplatelet drugs mainly include aspirin, clopidogrel, ticagrelor, cilostazol, and prasugrel. These drugs are widely used to prevent or treat thrombosis and reduce the risk of embolism events, including non-cardiogenic stroke, coronary heart disease, and lower extremity arterial embolism [5–7].
Antiplatelet drugs and liver fibrosis
Published in Platelets, 2022
Pamela Czajka, Adam Przybyłkowski, Anna Nowak, Marek Postula, Marta Wolska, Dagmara Mirowska-Guzel, Anna Czlonkowska, Ceren Eyileten
The pathophysiology of liver fibrosis is complex. Platelets play a pivotal role in the mechanisms involved in disease progression. Their inhibition seems to be a promising therapeutic target. The results of previous observational studies show that ASA treatment was correlated with a decrease in liver fibrosis progression as well as HCC development. However, chronic liver diseases are also associated with the increased risk of bleeding which can be aggravated during antiplatelet therapy. Therefore the practical aspects of antiplatelet therapy in liver fibrosis and indications for its implementation should be elucidated. Further research is necessary to; i) define the factors allowing to stratify the risk of bleeding in the group of chronic liver disease patients, ii) find patients who can benefit most from the treatment, iii) assess the real advantages of antiplatelet treatment in chronic liver diseases. Moreover, the safety and efficacy of antiplatelet treatment should be assessed in randomized clinical trials which may be also helpful to exclude other factors which may be the bias of observational studies.