Flexible endoscopy
P Ronan O’Connell, Robert D Madoff, Stanley M Goldberg, Michael J Solomon, Norman S Williams in Operative Surgery of the Colon, Rectum and Anus Operative Surgery of the Colon, Rectum and Anus, 2015
Antithrombotic agents include anticoagulants (warfarin and heparin) and antiplatelet agents (aspirin and clopidogrel). They are used to reduce the risks of thromboembolic events in susceptible individuals (e.g. atrial fibrillation with or without valvular heart disease). Before performing colonoscopy in patients on antithrombotic agents, one should consider the risks of: bleeding related to the antithrombotic agents;bleeding related to an endoscopic procedure, such as polypectomy;thromboembolic event arising from withholding the antithrombotic agents.
Role of Naturopathy in Pain Management
Mark V. Boswell, B. Eliot Cole in Weiner's Pain Management, 2005
Those most opposed to naturopathic medicine cite a lack of scientific data to justify deviation from conventional care. However, the Office of Technology Assessment of the U.S. Congress has estimated that fewer than 30% of the procedures currently used in conventional medicine have been rigorously tested (Astin et al., 1998). One reason most naturopathic therapies are not considered “evidence-based” is that the majority were introduced prior to the advent of the randomized, controlled clinical trial (RCT). Such limitations are evident in conventional medicine as well; however, they are often overlooked due to the apparent or established effectiveness of a particular treatment. The common and accepted use of antithrombotic agents for cardiovascular diseases and their complications (myocardial infarction, stroke, pulmonary embolism, and death) is a good example. Three of the agents that had been prescribed by allopathic physicians for millions of patients every day, warfarin, aspirin, and heparin, were introduced prior to the era of randomized clinical trials and had widespread use for many years before they were validated by RCTs (Relman & Weil, 1999). However, few physicians would have argued that these were unconventional treatments simply because they had not yet gone through RCTs. Furthermore, natural substances are not patentable, and there is little financial incentive for corporate funded research. Nonetheless, every year sees and an ever-growing amount of meaningful data demonstrating or refuting safety and efficacy of complementary and alternative modalities.
Outcome assessment in acute venous disease
Peter Gloviczki, Michael C. Dalsing, Bo Eklöf, Fedor Lurie, Thomas W. Wakefield, Monika L. Gloviczki in Handbook of Venous and Lymphatic Disorders, 2017
Bleeding is a serious side effect of antithrombotic drugs. Systemic thrombolytic therapy for PE can lead to severe bleeding complications in up to 14% of patients10; anti-vitamin K anticoagulants also have a high rate of bleeding complications.5 Heparin, even in a prophylactic dosage, causes significant bleeding hazards,13 and on the whole, a bleeding complication is considered more serious than a recurrent thromboembolic event.7 Bleeding complications can include minor bleeding from the site of a venipuncture to massive cerebral hemorrhage and death. Evaluation of risk of bleeding has improved considerably because of the introduction of standardized criteria. The criteria of the European Agency for the Evaluation of Medicinal Products (EMEA) for major bleeding (Table 66.3)21 and the Thrombolysis In Myocardial Infarction (TIMI) criteria for major and minor bleeding of the TIMI studies (Table 66.4)22 are widely used when considering the whole field of anticoagulant therapy. However, regarding VTE, the International Society for Thrombosis and Haemostasis (ISTH) criteria have been used in most recent works (Table 66.5).23
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.
A vaccine targeting blood clot formation: what is the potential?
Published in Expert Review of Vaccines, 2019
Munehisa Shimamura, Hironori Nakagami
Antithrombotic agents are generally classified as anti-platelet agents for non-cardioembolic stroke and anti-coagulants for cardio-embolic stroke. Although several types of anti-platelet and anti-coagulant agents are available in the clinic which targets different molecules in the thrombosis pathway, most agents cause increased the risk of bleeding. For example, aspirin and a P2Y12 receptor antagonist (clopidogrel), commonly used for secondary prevention of ischemic stroke, prasugrel, ticagrelor, and other glycoprotein IIb/IIIa inhibitors (abciximab, tirofiban, and eptifibatide) in heart diseases increase the risk of bleeding [5]. In contrast, protease-activated receptor (PAR)-1 inhibitor is an anti-platelet medication reported to prevent thrombotic formation without affecting coagulation and bleeding time in animal models [6] and a phase 2 clinical trial [6]. However, patients administered the PAR-1 inhibitor in addition to standard of care antiplatelet therapy showed an increased incidence of bleeding events compared to the placebo group in phase 3 trials [7,8]. Thus, we focus on the recently reported novel thrombotic agent S100A9 [9].
Endoloop closure following gastric endoscopic submucosal dissection to prevent delayed bleeding in patients receiving antithrombotic therapy
Published in Scandinavian Journal of Gastroenterology, 2021
Kazuo Shiotsuki, Kohei Takizawa, Akifumi Notsu, Naomi Kakushima, Noboru Kawata, Masao Yoshida, Yohei Yabuuchi, Yoshihiro Kishida, Sayo Ito, Kenichiro Imai, Hirotoshi Ishiwatari, Kinichi Hotta, Hiroyuki Matsubayashi, Hiroyuki Ono
In this retrospective study, we reviewed a chart-based investigation of 1163 consecutive patients who were treated with gastric ESD at Shizuoka Cancer Center from March 2016 to January 2019. Patients who were taking antithrombotic agents were enrolled in the study. Antithrombotic agents were defined as antiplatelet agents (low-dose aspirin, cilostazol, thienopyridine derivatives) or anticoagulants (warfarin, direct oral anticoagulants [DOAC]). The exclusion criteria were as follows: (1) advanced gastric cancer, (2) ESD for multiple lesions, and (3) the use of polyglycolic acid (PGA) sheets or clip closure to prevent post-ESD bleeding. All eligible patients were divided into two groups: the ELC group and control group. The ELC group consisted of patients with a post-ESD ulcer closed using an endoloop and clips, whereas the control group included patients that did not undergo further prophylactic treatment. This study was approved by the ethics committee of Shizuoka Cancer Center (approval no. 30-J114-30-1-3).
Related Knowledge Centers
- Anticoagulant
- Antiplatelet Drug
- Warfarin
- Platelet
- Thrombus
- Blood
- Preventive Healthcare
- Medical Guideline
- Thrombolysis
- Direct Factor Xa Inhibitors