China 
Africa 
Explore chapters and articles related to this topic
A Randomised, Blinded, Trial of Clopidogrel versus Aspirin in Patients at Risk of Ischaemic Events (CAPRIE)
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
Antiplatelet therapy's role in reducing cardiovascular risk has been long established, first by the Antiplatelet Trialists’ Collaboration meta-analysis study in 1994 and expounded upon by the Antithrombotic Trialists’ Collaboration group's 2002 systemic review—both showing an approximately 20% odds reduction in vascular events in patients on antiplatelet therapy compared to controls.1,2 However, prior to clopidogrel, no safe alternative to aspirin had been approved for the prevention of cardiovascular morbidity. Previously, ticlopidine, an alternate thienopyridine derivative to clopidogrel, had shown a significant decrease in the risk of adverse cardiovascular events compared to placebo but with an unfavorable side effect profile.
Anti-coagulation in acute coronary syndrome
Published in K Sarat Chandra, AJ Swamy, Acute Coronary Syndromes, 2020
Nitin Parashar, Deepti Siddharthan, Sivasubramanian Ramakrishnan
Further safety of low-dose rivaroxaban was assessed in the GEMINI-ACS-1 trial, in which 3037 patients with ACS were randomised to receive aspirin or rivaroxaban in addition to a thienopyridine (clopidogrel or ticagrelor). This trial was different as rivaroxaban was used in place of aspirin, not simultaneously. The primary end point was TIMI clinically significant bleeding; low dose rivaroxaban was found to have similar risk of clinically significant bleeding as aspirin when added to a thienopyridine (p = 0.580). They did not assess the efficacy of rivaroxaban in this trial [32].
Anticoagulation
Published in Harold R. Schumacher, William A. Rock, Sanford A. Stass, Handbook of Hematologic Pathology, 2019
Louis M. Fink, Nicole A. Massoll, Alex A. Pappas
Ticlopidine is a thienopyridine derivative which irreversibly inhibits platelets by inhibiting the adenosine diphosphate (ADP)-induced activation of the platelet fibrinogen receptors. Since ticlopidine works by a different mechanism than aspirin when the two drugs are given in combination, there may be a synergistic effect. Ticlopidine has been observed to produce less gastric irritation and gastrointestinal hemorrhage than aspirin, but diarrhea, nausea, and GI discomfort are not uncommon side effects and ticlopidine should not be given to patients with hepatic impairment. Severe reversible neutropenia occurs in 1% of patients on ticlopidine, which necessitates periodic monitoring of the leukocyte count. Ticlopidine use is contraindicated during pregnancy (88). Thrombocytopenic purpura TTP has been observed in a few patients treated with ticlopidine.
Thrombus remodelling by reversible and irreversible P2Y12 inhibitors
Published in Platelets, 2023
Kjersti Tunströmer, Lars Faxälv, Pia Larsson, Tomas L. Lindahl, Niklas Boknäs
There is an inverse correlation between the fraction of newly formed reticulated platelets and the response to prasugrel in patients with ACS or ST elevation myocardial infarction (STEMI), as measured by multiple electrode aggregometry or the VerifyNow™ P2Y12 platelet function assay [10,11]. This indicates that the presence of a fraction of newly formed, P2Y12+ platelets is enough to markedly reduce the antithrombotic efficacy of thienopyridines. To explore the underlying mechanisms for this finding, Hoefer et al. performed in vitro experiments on platelet aggregates formed after ADP stimulation of washed platelet suspensions containing a 80/20 mixture of P2Y12+/P2Y12- platelets, showing that P2Y12+ platelets were overrepresented in the core of platelet aggregates [9]. In a follow-up study, this finding was corroborated ex vivo using platelets from patients with coronary artery disease (CAD) treated with thienopyridines [7]. These studies suggest that P2Y12+ platelet subpopulations can establish “nuclei” that support ADP-induced platelet aggregation in the face of thienopyridine treatment.
Treatment inequity in antiplatelet therapy for ischaemic heart disease in patients with advanced chronic kidney disease: releasing the evidence vacuum
Published in Platelets, 2023
Frances L. Varian, William A. E. Parker, James Fotheringham, Robert F. Storey
Prasugrel is a newer prodrug, with significantly enhanced potency in reduction of platelet activation compared to clopidogrel. Rapidly hydrolysed by intestinal hydroxyesterases followed by CYP bioactivation, maximum plasma concentration of the active metabolite is reached at 30–60 min [65]. Like clopidogrel, this third-generation thienopyridine blocks ADP binding to the P2Y12 receptor irreversibly and effectively reduces multiple aspects of platelet activation and associated responses [66]. Maximum effect of platelet inhibition after loading with 60 mg prasugrel is seen at 1 h compared to clopidogrel where maximum effects of a 300 mg loading dose are seen at >6 h and 600 mg at 2–4 h [65,67]. Furthermore, small studies suggest that low-dose prasugrel, as well as clopidogrel, demonstrates a reduction in platelet inhibition post-HD (mean P2Y12 reaction units >208), which requires further exploration [63].
Reoperation for bleeding following coronary artery bypass surgery with special focus on long-term outcomes
Published in Scandinavian Cardiovascular Journal, 2020
Steinthor A. Marteinsson, Alexandra A. Heimisdóttir, Tomas A. Axelsson, Hera Johannesdottir, Linda O. Arnadottir, Helga R. Gardarsdottir, Arni Johnsen, Martin I. Sigurdsson, Solveig Helgadottir, Tomas Gudbjartsson
In summary, this nationwide study shows that the rate of complications, length of stay and short-term mortality were significantly higher in patients that required reoperation, underscoring the importance of this complication for the outcome of the patient. Furthermore, our findings show that the long-term effects of reoperation do not seem to affect survival after the first 30 postoperative days or extend to other MACCE. Nonetheless, it is imperative to lower the rates of reoperation by identifying risk factors for excessive bleeding and controlling them when possible. The reoperation rate following CABG in Iceland is in the higher range as compared to previous studies but is decreasing. It is possible that changes in transfusion practice focusing on point of care coagulation assessment and the availability of fibrinogen and coagulation factor concentrates have contributed toward this success, as surgical techniques have remained similar. Our data also suggest that the perioperative use of clopidogrel is an important risk factor for reoperation, stressing the importance of preoperative discontinuation of the medication if possible. Alternatively, thienopyridine agents with a shorter half-life such as ticagrelor or cangrelor could also be used when managing acute coronary syndrome prior to angiography.