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Coronary Artery Disease
Published in Jahangir Moini, Matthew Adams, Anthony LoGalbo, Complications of Diabetes Mellitus, 2022
Jahangir Moini, Matthew Adams, Anthony LoGalbo
Ischemia is prevented by antiplatelet drugs, beta-blockers, long-acting nitrates, and calcium channel blockers. Antiplatelet drugs inhibit the aggregation of platelets. Aspirin binds to the platelets irreversibly, inhibiting platelet aggregation and cyclooxygenase. Other antiplatelet drugs include clopidogrel, prasugrel, and ticagrelor. These block platelet aggregation induced by adenosine diphosphate. They are able to reduce risks of MI or sudden death, and are most effective when administered together. If a patient cannot tolerate one of them, he or she should receive one of the drugs that can be tolerated.
Acute coronary syndromes
Published in Henry J. Woodford, Essential Geriatrics, 2022
Primary PCI may be offered to people having an NSTEMI, for example, if any of cardiogenic shock, ongoing chest pain despite medical treatment, life-threatening arrhythmias, acute heart failure or dynamic ECG changes are present.2,12 Angiography, with or without PCI, may be performed in high-risk people within 24 hours following initial medical treatment for NSTEMI. Unless there is a plan for early intervention, fondaparinux (2.5 mg subcutaneously daily) is recommended. Alternative anticoagulation strategies are adopted for people having early PCI.2 Antiplatelet drugs are also prescribed seeFigure 20.1. Nitrates (including sublingual) and beta-blockers (when no contraindications) are recommended for control of persisting symptoms.2
The Rational Basis of Thrombosis Models
Published in Josef Hladovec, Antithrombotic Drugs in Thrombosis Models, 2020
Some arterial models deal with coronary arteries. They are often concerned not so much with problems of thrombogenesis but with its consequence, myocardial infarction. Of course, it is possible to stress the differences in the equipment of coronary endothelium in comparison with other arteries, e.g., the strong representation of the adenosine system, in order to justify the much more complicated and cumbersome work with coronaries, particularly in small animals. However, if myocardial infarction is accepted as the end-point indicator, the effectiveness of a drug in similar models may be caused by other mechanisms besides the antithrombotic one, such as antiarrhythmic, metabolic, spasmolytic, etc. It is true that most antiplatelet drugs find their use to be chiefly in the prevention of coronary thrombosis. On the other hand, results of clinical trials do not show any marked tendency to distinguish coronary arteries from those of other regions, e.g., carotid arteries as the main source of TIA.
Are P2Y12 inhibitors superior to aspirin for long-term secondary prevention of cardiovascular disease?
Published in Expert Review of Cardiovascular Therapy, 2023
Stephanie Carlin, John Eikelboom
Based on these data, we suggest that either ticagrelor or clopidogrel should now be preferred over aspirin for long-term secondary prevention in patients with CAD who are treated with single agent antiplatelet therapy, whereas clopidogrel should be the preferred P2Y12 inhibitor in patients with PAD and in those with prior stroke or TIA. Possible additional considerations in the choice of antiplatelet agent include the pharmacological profile of individual antiplatelet drugs and concerns regarding adherence. In patients with CAD, ticagrelor may be preferred over clopidogrel in the highest risk patients and in patients who have experienced breakthrough events during clopidogrel therapy because it is the most potent, as well as in patients with known CYP2C19 polymorphisms associated with reduced response to clopidogrel. Clopidogrel may be favored in patients with heart failure, chronic obstructive pulmonary disease, asthma, anemia, or other conditions associated with breathlessness in whom ticagrelor-associated dyspnea, if it occurs, may be less well tolerated and lead to diagnostic uncertainty. As a once daily medication, clopidogrel may be preferred over twice daily ticagrelor if adherence to more frequent dosing is a concern. As prescription medications, P2Y12 inhibitors may also be perceived by patients as more important than aspirin (which is readily available over the counter) and adherence can typically be more easily monitored through dispensing records.
Tirofiban potentiates agonist-induced platelet activation and degranulation, despite effectively inhibiting aggregation
Published in Platelets, 2022
Martina Aguiar Bucsai, Christian Idel, Barbara Wollenberg, Christine Mannhalter, Admar Verschoor
The platelet response needs to be instantaneous and robust enough to limit blood loss upon vessel injury but at the same time coordinated and carefully controlled. Otherwise, it can lead to pathological consequences such as thrombosis, one of the leading causes of mortality, and as such responsible for one quarter of global deaths [16]. As a result, antiplatelet drugs belong to some of the most commonly prescribed medications [17]. Competitive inhibitors of integrin αIIbβ3 - molecules that mimic integrin-binding fibrin(ogen) sequence RGD- such as tirofiban, bind to the αIIbβ3ʹs fibrin(ogen) binding site, thus preventing the cross-linking of individual platelets by fibrin(ogen) molecules and effectively inhibiting platelet aggregation [18,19]. Clinically, anti-aggregants are primarily indicated during episodes of acute coronary syndrome (ACS) [20,21].
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].