China
Africa
Explore chapters and articles related to this topic
Medicines for CHD
Published in Mark C Houston, The Truth About Heart Disease, 2023
Antithrombotic drugs in routine use includeAntiplatelet drugs (aspirin, clopidogrel, and glycoprotein IIb/IIIa receptor antagonists).Anticoagulants (unfractionated and low molecular weight heparin, warfarin, and direct thrombin inhibitors).Factor X inhibitors.
Dyslipidemia
Published in Jahangir Moini, Matthew Adams, Anthony LoGalbo, Complications of Diabetes Mellitus, 2022
Jahangir Moini, Matthew Adams, Anthony LoGalbo
Since most atherosclerotic complications occur from plaque fissure or rupture, followed by platelet activation and thrombosis, oral antiplatelet drugs are extremely important. Aspirin is widely used, and is indicated for secondary prevention. It may be used for primary prevention if the patient is at very high risk (diabetes, those with 20% or higher risk of cardiac events with low risks of bleeding, and those at intermediate risk of atherosclerosis with 10%–20% risks of cardiac events and low risks of bleeding). Use of aspirin is controversial among clinicians, especially in people at low risk. The lowest dose (81 mg per day) is usually recommended to reduce risks of bleeding, especially if other antithrombotic drugs are used. In patients using aspirin for secondary prevention, there is recurrence of ischemic events. The nonsteroidal anti-inflammatory drugs (NSAIDs) must be used carefully since they appear to increase cardiovascular risks.
Major Adverse Limb Events and Mortality in Patients with Peripheral Artery Disease: The COMPASS Trial
Published in Juan Carlos Jimenez, Samuel Eric Wilson, 50 Landmark Papers Every Vascular and Endovascular Surgeon Should Know, 2020
Juan Carlos Jimenez, Samuel Eric Wilson
The COMPASS trial findings are being recognized as practice changing advancements in the treatment of PAD patients but continue to have clinical applicability concerns. The COMPASS trial group has advocated for clinical implementation of their findings for patients meeting inclusion criteria, namely patients who have a high risk of developing an adverse cardiovascular event with symptomatic PAD or coronary arterial disease and asymptomatic PAD.10 Despite this somewhat narrowed inclusion criteria, the risk of bleeding remains a clinical concern and an important factor when initiating this combination antithrombotic therapy. Given the risk of bleeding and the inclusion of patients with symptomatic and asymptomatic PAD, a stratified analysis of the effect of combined therapy on different subpopulations of patients with PAD would be helpful to determine if the combined therapy results in equally impressive outcomes in symptomatic and asymptomatic patients. However, it is unlikely that this analysis can be meaningfully performed due to the sample size.
Antiplatelet therapy for coronary artery disease in 2023: current status and future prospects
Published in Expert Review of Cardiovascular Therapy, 2023
Rishi Chandiramani, Alessandro Spirito, James W. Johnson, Adhya Mehta, Birgit Vogel, Robert T. Faillace, Roxana Mehran
Antithrombotic therapy remains the cornerstone for prevention and management of ischemic complications among patients with CAD. Over the last four decades, various antithrombotic agents and regimens have been investigated and implemented in clinical practice. Strategies to reduce ischemic risk broadly involve increasing the potency of P2Y12 inhibition and/or prolonging the duration of DAPT. On the other hand, an increased risk of bleeding can be managed by shortening DAPT duration, considering P2Y12 monotherapy or de-escalation of antiplatelet regimens. Individualized clinical judgment by incorporating tools to assess both the above ischemic and bleeding risks, while also taking patient preferences, comorbidities and barriers to care into account are crucial for determining the optimal approach in each clinical scenario.
Evaluation of cold snare polypectomy for small pedunculated (Ip) polyps with thin stalks: a prospective clinical feasibility study
Published in Scandinavian Journal of Gastroenterology, 2022
Jun Arimoto, Hideyuki Chiba, Jun Tachikawa, Kenji Yamaoka, Dai Yamazaki, Airi Higa, Naoya Okada, Takuma Suto, Naoya Kawano, Toshihiro Niikura, Hiroki Kuwabara, Michiko Nakaoka, Tomonori Ida, Taiki Morohashi, Tohru Goto
CSP was performed for 2552 polyps at Omori Red Cross Hospital between January 2019 and February 2021. We excluded 2438 polyps (2412 polyps with other morphology, and 26 Ip polyps larger than 10 mm in diameter and/or Ip polyps showing evidence of submucosal invasion and/or Ip polyps with thick stalks). Therefore, CSP for Ip polyps was performed in 89 patients (including 92 colonoscopies and 114 polyps) during the study period. The clinical characteristics of the patients are presented in Table 1. The total number of patients was 89, with a mean age (± SD) of 70.5 ± 12.6 years. In all, 15 patients were receiving antithrombotic therapy: the indications were ischemic heart disease in 26.7% of patients, atrial fibrillation in 13.3% of patients, cerebrovascular events in 26.7% of patients, and preventive medication in 33.3% of patients.
The effect of ticagrelor on microarterial thrombosis in an experimental model
Published in Journal of Plastic Surgery and Hand Surgery, 2021
Mehmet İhsan Okur, Ahmet Çetinbaş, Serdar Altun, Mehmet Öztan, Aysun Yıldız Altun, İbrahim Özercan
An important factor in antithrombotic therapy is unwanted drug-induced bleeding. Birkeland et al. stated that the rate of unwanted bleeding was higher in patients using clopidogrel than in patients using ticagrelor [22]. In this study, no perivascular hematoma was encountered in any rats in the ticagrelor and control groups. The rate of inflammation and edema in the arterial wall was found to be significantly lower in the ticagrelor group compared with the control group. It is thought that thrombus formation narrows the lumen, reduces blood flow through the anastomosis, and increases edema and inflammation. Weisshar et al. [17] reported that ticagrelor reduced ischemia-reperfusion-induced endothelial dysfunction. Although the high cost of ticagrelor compared with other antithrombotic agents used in microsurgery practice is a disadvantage, the rapid and reversible onset of action of the drug is regarded as an advantage [23].