Management of peripheral arterial disease in the elderly
Wilbert S. Aronow, Jerome L. Fleg, Michael W. Rich in Tresch and Aronow’s Cardiovascular Disease in the Elderly, 2019
Antiplatelet drugs that have been shown to decrease the incidence of vascular death, nonfatal myocardial infarction, and nonfatal stroke in persons with PAD are aspirin, ticlopidine, clopidogrel, and ticagrelor (120–122). Aspirin plus dipyridamole has not been shown to be more efficacious than aspirin alone in the treatment of persons with PAD (120). Oral platelet glycoprotein IIb/IIIa inhibitors have been shown to increase mortality in the treatment of persons with CAD and have not been investigated in the treatment of persons with PAD (123). Adverse hematologic effects associated with ticlopidine limit the use of this drug in the treatment of elderly persons with PAD (124). Ticagrelor and clopidogrel are equally effective in reducing cardiovascular events and cause a similar incidence of major bleeding (122).
Nursing care of the cardiac catheterisation patient
John Edward Boland, David W. M. Muller in Interventional Cardiology and Cardiac Catheterisation, 2019
Treatment is almost always emergent PCI with options for restoring perfusion, including thrombectomy (routine thombectomy in PCI is no longer recommended in the 2017 European Society of Cardiology guidelines, however is reasonable practice in cases of large residual thrombus)140 and or balloon angioplasty. Treatment may also include administration of more potent pharmacologic agents such as IV glycoprotein IIb/IIIa inhibitors.18(p197) Understanding the underlying aetiology by using IVUS or OCT to determine presence of stent underexpansion/malapposition or residual dissection is reasonable before further PCI is performed with balloon inflations or stenting. Finally, evaluation for a hypercoagulable state, thrombocytosis or aspirin/clopidogrel resistance with escalation of antiplatelet therapy to prasugrel or ticagrelor is standard.18(p197)
Technical Tips for Carotid Angioplasty and Stenting
Peter A. Schneider, W. Todd Bohannon, Michael B. Silva in Carotid Interventions, 2004
Some reports support the routine use of glycoprotein IIb/IIAa inhibitors to reduce ischemic complications associated with carotid stenting, whereas others have found either no benefit or higher complication rates. Glycoprotein IIb/IIIa inhibitors are likely indicated in certain patients at high risk for thrombotic complications. Preoperative administration of glycoprotein IIb/IIIa inhibitors may be indicated in patients who are actively having carotid territory symptoms or those patients who did not have an appropriate preoperative loading of clopidogrel. Intraoperative administration of glycoprotein IIb/IIIa inhibitors should be considered when the development of thrombus is suspected within the stent.
An update on novel therapies for treating patients with arterial thrombosis
Published in Expert Review of Hematology, 2023
Udaya S Tantry, Sanchit Duhan, Eliano Navarese, Bogumil Ramotowski, Parshotam Kundan, Kevin P Bliden, Paul Gurbel
Symptom onset in the ACS setting is the result of occlusive platelet rich thrombus generation and resultant flow reduction. Efforts to block further progression of this process requires early and effective inhibition by antiplatelet agents. Currently available potent oral P2Y12 receptor inhibitors require nearly 2 hours to achieve maximal platelet inhibition whereas immediate (within minutes) antiplatelet/antithrombotic effects are achieved only with intravenously administered agents (glycoprotein IIb/IIIa inhibitors and cangrelor) [15]. Currently, the symptom onset-to-balloon time in ST-elevation myocardial infarction (STEMI) in the contemporary arena remains unacceptably long. Since myocardial necrosis occurs at an exponential rate early after vessel occlusion [16], efforts have been undertaken to establish potent pre-hospital therapy potentially in the hands of the patient. Delayed onset of effective antiplatelet therapy likely influences the frequency of adverse CV outcomes.
Systemic immune-inflammation index predicts no-reflow phenomenon after primary percutaneous coronary intervention
Published in Acta Cardiologica, 2022
Kerim Esenboğa, Alparslan Kurtul, Yakup Yunus Yamantürk, Türkan Seda Tan, Durmuş Eralp Tutar
Perioperative essential medications followed clinical guidelines [3]. The application of an angiotensin converting enzyme inhibitor or angiotensin II receptor antagonist, beta blockers and statins, and the types and doses were determined by the coronary intensive care cardiologists according to the patient’s condition. The use of glycoprotein IIb/IIIa inhibitors was planned by the operator according to the patient’s clinical condition. The use of other peri-procedural medications such as intracoronary nitroglycerine and adenosine was also left to the discretion of the operator. All echocardiographic measurements were made within 24 h after the procedures, using a GE ViVidE7 ultrasound machine (GE Healthcare, Piscataway, USA) with a 3.5-MHz transducer. Left ventricular ejection fraction (LVEF) was measured using the Simpson method according to the recommendations of the American Society of Echocardiography.
Impact of plaque burden and composition on coronary slow flow in ST-segment elevation myocardial infarction undergoing percutaneous coronary intervention: intravascular ultrasound and virtual histology analysis
Published in Acta Cardiologica, 2021
Sreenivas Reddy, Raghavendra Rao K, Jeet Ram Kashyap, Vikas Kadiyala, Hithesh Reddy, Samir Malhotra, Ramesh Daggubati, Suraj Kumar, Hariom Soni, Naindeep Kaur, Jaspreet Kaur, Vadivelu Ramalingam
Despite maximum utilisation of dual antiplatelet therapy and glycoprotein IIb/IIIa inhibitors in STEMI in this study, coronary SF persists in a significant proportion. This supports the concept that the plaque components and atheroma burden are important contributors towards SF by the mechanical fragmentation during PCI and subsequent distal embolisation. Hibi et al. showed that in patients presenting with ACS and high-risk feature (attenuated plaque ≥5 mm) as identified on IVUS, the usage of distal embolic protection device was not only associated with decreased incidence of SF but also had lesser serious adverse cardiac events [50]. On the basis of our findings in this study, we also suggest that high-risk features as described on IVUS can identify patients who might benefit from embolic protection devices.
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