Anti-platelet Aggregation Treatment Research Articles

An analysis of antithrombotic therapy in elderly patients with atrial fibrillation undergoing percutaneous coronary interventions.

As a result of large, randomized trials and updates to clinical guidelines, antithrombotic therapy following percutaneous coronary intervention (PCI) has changed in recent years for patients with nonvalvular atrial fibrillation (NVAF). The purpose of this study was to investigate the real-world data of antithrombotic regimens at discharge and their evolving trends, as well as compare the effect of different therapies on the incidence of major cardiovascular and cerebrovascular ischemic events (MACCEs) and bleeding events in elderly patients. An analysis of 6298 stent implantation patients from 2016-2018 was carried out retrospectively. AF patients aged 65 and older were divided into two groups according to the antithrombotic regimens prescribed at hospital discharge: dual antiplatelet aggregation treatment group (DAPT) and anticoagulant treatment and antiplatelet aggregation treatment group (ATT). Baseline characteristics, efficacy endpoints (MACCEs/cerebrovascular ischemic events), and safety endpoints (bleeding events) were analyzed and compared between the different antithrombotic regiments. During 2016-2018, the use of oral anticoagulants (OAC) increased from 16.3% to 54.1% (P trend < 0.01). Since the introduction of non-vitamin K antagonist oral anticoagulants (NOACs), warfarin usage has decreased from 100% to 41.7%, and NOACs have rapidly replaced warfarin. The rate of persistent AF in the ATT group was significantly higher than the rate in the DAPT group (79.6% vs. 59.7%, P = 0.01), and the ATT group used more proton pump inhibitors (PPI) than the DAPT group (23.3% vs. 11.8%, P = 0.01). A significant decrease was observed in MACCEs (10.7% vs. 26.0%, P < 0.01) and cerebrovascular ischemic events (2.9% vs. 11.8%, P = 0.01) in the ATT group compared with the DAPT group. According to the ATT subgroup analysis, there was a significant difference in the incidence of overall bleeding between the triple anticoagulant therapy group (TT) and the dual anticoagulant therapy group (DT) (18.0% vs. 2.4%, P = 0.02). MACCEs were predicted independently by ATT and CHA2DS2-VASc scores, whereas bleeding was predicted independently by PPI use and HAS-BLED scores. As a result of NOAC introduction and use, the combination of antithrombotic regimens at discharge for elderly patients with AF after PCI has changed rapidly over the past few years toward a higher use of ATTs, while patients with AF undergoing PCI still rarely receive an appropriate antithrombotic regimen. It is essential to conduct ATT in elderly patients who are undergoing PCI, and further DT may be more appropriate.

Aerobic exercise, cardiac function, heart rate recovery and the quality of life of elderly heart disease patients

Objective To explore the effect of aerobic exercise on cardiac function, heart rate recovery and the quality of life of elderly heart disease patients. Methods One hundred senile heart disease patients were studied. They were randomly divided into a control group and an observation group, with 50 in each group. Both groups were provided with the conventional anti-platelet aggregation treatment, dilation of blood vessels and control of blood pressure. The observation group was also given individualized aerobic exercise training. At the outset and after 3 months the cardiac function and heart rate recovery of both groups were observed, and their quality of life was evaluated using the SF-36 life quality scale. Results After the treatment, the average left ventricular ejection fraction of those in the observation group was significantly better than before the treatment, and significantly better than the average among the controls. The average 6-minute walking test time and average maximum oxygen uptake in the observation group were also significantly better than before the treatment and significantly better than among the controls. The average peak heart rate and HRR1 in the observation group had increased significantly, and significantly more than those of the control group. The average total SF-36 score in the observation group was also significantly higher. Conclusion Individualized aerobic exercise can significantly improve cardiac function and promote heart rate recovery in elderly patients with heart disease, which is of clinical value for improving their quality of life. Key words: Aerobic exercise; Elderly; Heart disease; Cardiac function; Heart rate; Quality of life

Positive clinical response to clopidogrel is independent of paraoxonase 1 Q192R and CYP2C19 genetic variants

There is increasing controversy about the influence of serum paraoxonase type 1 and cytochrome CYP2C19 in the conversion of clopidogrel to its pharmaceutically active metabolite. The effect of concomitant medication with the proton pump inhibitor omeprazole has been also subject of intense scrutiny. We present a cohort of 263 patients receiving anti-platelet aggregation treatment with clopidogrel and aspirin for 1 year. The paraoxonase 1 gene Q192R variant along with the presence of CYP2C19*2 and *3 loss of function alleles, concomitant medication with proton pump inhibitors and known cardiovascular risk factors were examined to determine their influence in disease relapse due to an ischaemic event during the 12 month treatment period. The low number of patients suffering a relapse (20 out of 263), indicates that double anti-aggregation therapy with aspirin and clopidogrel was very effective in our patients. Among the relapsers, evidence of coronary heart disease was the most influencial factor affecting response to therapy, while the presence of the paraoxonase 1 Q192R variant, loss of function of CYP2C19, and concomitant medication with omeprazole were non-significant.

Evaluation of therapeutic efficacy on combined use of clopidogrel and ozagrel sodium in the treatment of acute ischemic stroke

Background Antiplatelet aggregation treatment has become a regular treatment of ischemic stroke. The affirmation of antiplatelet therapy is mainly derived from patients with clinical use, which can not provide the laboratory indexes for evaluation of a recognized accuracy. Studies have confirmed that the degree of platelet activation is associated with atherosclerosis and ischemic stroke, and recognized that both CD62p (α-platelet granule membrane glycoprotein) and CD63 (lysosomal membrane glycoprotein) were important indexes of platelet activation. This study aims to explore the differences of efficacy between combined use of clopidogrel and ozagrel sodium and monotherapy by aspirin in the treatment of acute ischemic stroke by investigating the expression of CD62p and CD63. Methods Flow cytometry was employed to detect CD62p and CD63 expression on circulating platelet in patients with ischemic stroke and normal control group. The positive rate of CD62p and CD63 was detected in patients with ischemic stroke who were treated with aspirin 0.15 g (single drug therapy) and clopidogrel 75 mg + ozagrel sodium 80 mg (combination therapy) before and after one and two weeks' treatment. National Institute of Health Stroke Scale (NIHSS) scores were measured in patients with ischemic stroke at the same time in three periods respectively to evaluate the improvement of neural function. Results Platelet CD62p and CD63 positive expression rate in ischemic stroke group were higher than normal control group before treatment (P = 0.001, 0.032). CD62p and CD63 positive expression rate and NIHSS score were measured at different times, and the differences were statistically significant (F = 56.693, P = 0.000; F = 21.544, P = 0.000; F = 216.271, P = 0.000, respectively). Compared with before treatment, CD62p and CD63 positive expression rate and NIHSS score decreased significantly after treatment (P = 0.000, for all), but the differences between aspirin group and combination group were not statistically significant (P > 0.05, for all). There was no interaction between the treatment groups and measuring time with CD62p and CD63 positive expression rate (F = 1.403, P = 0.250; F = 2.830, P = 0.063), while there was interaction between treatment groups and measuring time with NIHSS score (F = 4.518, P = 0.013). Conclusion Antiplatelet drug treatment of acute ischemic stroke is effective. The curative effect of combined treatment (clopidogrel and ozagrel sodium) is not superior to aspirin alone. CD62p positive expression rate in acute stage of ischemic stroke can measure the effect of antiplatelet therapy, while the determination of CD63 needs further research.

A unilateral brachiocephalic vein thrombosis: cause of a rare, transient ischemic attack, a case report and review of the literature

The purpose of this report is to inform medical professionals of a case in which brachiocephalic vein thrombosis caused a transient ischemic attack (TIA). A brain computerized tomography (CT) scan, magnetic resonance imaging, digital subtraction angiography, head and lung CT angiography, jugular venography, cardiac color Doppler ultrasound scan, color Doppler ultrasound scan of the neck and lower vascular extremities and 24-hour, continuous electrocardiogram monitoring were performed. A 50-year-old male experienced a total of 31 onsets of weakness in the right side of his body, speech impairment and numbness in the right side of his body during a period of 20 days. Imaging results did not reveal evidence of a cerebral infarction. The potential of a TIA with an arterial origin and other causes were ruled out, and a left brachiocephalic vein thrombosis and left jugular vein congestion were discovered. Thus, the brachiocephalic vein thrombosis was considered to be the cause of the TIA. The patient received anticoagulant and antiplatelet aggregation treatment. On the following day after the termination of the TIA, a color Doppler ultrasound scan detected the opening of the jugular venous arch, but the blood flow that returned to the superior vena cava via the left brachiocephalic vein did not significantly increase. A brachiocephalic vein thrombosis can be the cause of a TIA. In addition to the anticoagulant and antiplatelet aggregation treatment, the opening of the collateral of veins, including that of the jugular venous arch, may play an important role in reducing venous congestion and in terminating TIAs.

Le syndrome du marteau hypothénarien : analyse de la littérature et cas clinique

Hypothenar hammer syndrome is a rare disease first described by Conn et al. in 1970. It groups together symptoms of chronic microtraumatism to the ulnar artery or its superficial palmar branch against the hamate. Manual workers using vibrating tools are the most affected by this. Diagnosis is made by echodoppler, while arteriography is the gold standard for establishing the treatment plan. Hypothenar hammer syndrome may lead to severe complications secondary to ischemia and to embolic events resulting from delayed diagnosis or maltreatment. There is no real consensus as to the place of medical or surgical treatments. Medical treatment consists of eliminating favorizing factors and long-term antiplatelet aggregation treatment. Surgical treatment depends on the vascular lesions: simple arterial ligation, resection of the thrombosed arterial segment and end-to-end anastomosis, or revascularization using a pontage venous or arterial graft. Some authors suggested an associated thoracic sympathectomy. The diagnosis must be made early; the choice of treatment must be targeted at preventing serious embolic complications.

Interventional catheter treatment of bypass graft stenosis: comparison of intracoronary stent implantation and balloon angioplasty

Balloon angioplasty of a stenosed bypass graft has a much higher risk of recurrent stenosis than dilatation of a stenosed native coronary artery. Intracoronary stent implantation has established itself as the better treatment of native coronary artery stenosis than conventional balloon angioplasty. However, there is still uncertainty whether intracoronary stent implantation in stenosed bypass vessels gives better long-term results than conventional balloon angioplasty. Results were retrospectively analyzed of unrandomized 224 primarily successful interventions--122 balloon dilatations and 102 stent implantations--performed between January 1996 and June 1998 on stenosed coronary bypass grafts, re-examined by coronary angiography an average of 6 months later. All but 11 patients were on combined aspirin and ticlopidine antiplatelet aggregation treatment. There was a significantly lower 6-month restenosis rate (30.4%) after stent implantation than after balloon dilatation (51.6%). The re-intervention rate was also significantly lower after stent implantation. These data suggest that stent implantation of stenosed coronary bypass grafts under cover of platelet-aggregation inhibition with aspirin and ticlopidine provides a lower restenosis and thus higher revascularization rate than conventional balloon dilatation.

Zukunftsaspekte der Therapie der pulmonalarteriellen Hypertonie

In addition to combination treatment of pulmonary artery hypertension (PHT) with currently available drug options (endothelin-receptor inhibitors, phosphodiesterase-5 inhibitors, prostanoids). Numerous new drugs of other substance groups are being tested in preclinical and clinical studies. Most of the newly tried drugs use previously identified mechanisms of action that are involved in the development and progression of the underlying vascular disease. This has led to a certain paradigm shift which, in addition to vasodilatation and anti-platelet aggregation treatment, increasingly focuses on antiproliferative effects with the aim of preventing or regressing vascular remodelling. Of particular interest in this connection are tyrosine kinase inhibitors, which inhibit the action of such peptide growth factors as platelet-derived growth factor. Imatinib, one of this class of action, has given promising results in experimental studies and several case reports. Another greatly promising approach in the treatment of PHT are activators and simulators of soluble guanylyl cyclase, which are also currently being investigated in clinical trials.

Duale antiaggregatorische Therapie nach Implantation von Koronarstents

Dual antiplatelet-aggregation treatment with aspirin and clopidogrel after coronary stent implantation is nowadays standard peri-interventional practice, although its use is not yet licensed for this indication in many European countries. Clopidogrel administration is initiated before PCI with a loading dose of 300 mg when given at least 6 hours before PCI, otherwise 600 mg. The required duration of combined (aspirin + clopidogrel) antiplatelet-aggregation treatment after coronary stent implantation depends on the type of stent and the pre-existing disease. After bare-metal stent implantation dual antiplatelet medication is needed for at least 3-4 weeks, after drug-eluting stent implantation 6 months, after coronary brachytherapy 12 months, and 9 months after an acute coronary syndrome. These time intervals should also be respected before any elective surgical intervention. Early operations, because postponement is impossible, should be performed under antiplatelet-aggregation treatment after assessment of bleeding risk in the individual case. Premature termination of this treatment carries an increased risk of serious cardiovascular events, especially stent thrombosis and myocardial infarction. Prolonged antiplatelet-aggregation treatment is of benefit especially in patients with a high risk of serious cardiovascular events. Patients with an indication for long-term anticoagulation may require, during the period of highest risk of stent thrombosis after stent implantation, administration of combined aspirin, clopidogrel and anticoagulants with an INR target value in the lower therapeutic range. The increased risk of bleeding must be weighed up against the potential benefit.