Clopidogrel For Prevention Research Articles

Ticagrelor versus Clopidogrel in Prevention of No Reflow after 1ry PCI in Diabetic Patients with STEMI

Abstract Background Adequacy of coronary flow can be judged upon using several methods like TIMI Grade and myocardial blush grade. No-reflow phenomenon, defined as incomplete reperfusion at the microvascular level despite adequate patency of the occluded artery, remains an important limitation of primary percutaneous intervention in STEMI patients nowadays. We aim in this study to investigate the relationship between the antiplatelet loading dose whether to be Ticagrelor or Clopidogrel and post intervention coronary flow, bleeding risk in these patients. Aim of the Work To compare between the effects of preoperative loading dose of Ticagrelor and clopidogrel in Diabetic STEMI patients undergoing primary percutaneous coronary intervention regarding prevention of no reflow, Instent thrombosis and short term bleeding risk. Myocardial reperfusion was judged upon using TIMI Grade and myocardial blush grade. Patients and Methods a single center prospective randomized controlled trial based at the coronary care units in Ain shams university hospitals. The study included Three hundred Diabetic patients presenting to Ain shams university hospitals diagnosed with STEMI in the ER fulfilling the inclusion criteria were randomized to receive Ticagrelor (150 patients) or receiving clopidogrel (150 patients) Results As regard TIMI flow there was statistically highly significant highly significant difference between two studied groups with P value 0.000 where in group A 64 % of patients developed TIMI III flow, 22.7 % with TIMI II flow, 12.7% with TIMI I and 0.7% with TIMI 0 While in group B 86% of patients developed TIMI III flow, 9.3% of them developed TIMI II, 3.3 % developed TIMI I flow and 1.3 % developed TIMI 0. As regard MBG there was statistically highly significant difference between two groups with P value 0.00 where in group A where percentage of patients with MBG grades 0,1,2 and 3 were 4%, 16 %,18 % and 62 % respectively while in group B percentage of patients with MBG grades 0,1,2 and 3 were 1.3 %, 3.3 %, 9.3 % and 86 % respectively. As regard echo EF, there was statistically significant difference between two groups with P value 0.036 where mean EF in patients with group A was 40.50 ± 7.93 while the mean EF in patients with group B was 42.55 ± 8.88 . Conclusion Ticagrelor loading before primary PCI resulted in improved post-procedural TIMI flow. It also increased the post-procedural MBG. This resulted in a significant increase in the number of patients having more post-procedural Ejection fraction as measured by modified Simpson’s method. However, it did not decrease incidence of in-hospital MACE. Also there was no significant increase in risk of major nor minor bleeding in both young and elderly patients.

Ticagrelor versus Clopidogrel in Prevention of No Reflow after 1ry PCI in Diabetic Patients with STEMI

Abstract Background Adequacy of coronary flow can be judged upon using several methods like TIMI Grade and myocardial blush grade. No-reflow phenomenon, defined as incomplete reperfusion at the microvascular level despite adequate patency of the occluded artery, remains an important limitation of primary percutaneous intervention in STEMI patients nowadays. We aim in this study to investigate the relationship between the antiplatelet loading dose whether to be Ticagrelor or Clopidogrel and post intervention coronary flow, bleeding risk in these patients. Aim of the Work To compare between the effects of preoperative loading dose of Ticagrelor and clopidogrel in Diabetic STEMI patients undergoing primary percutaneous coronary intervention regarding prevention of no reflow, Instent thrombosis and short term bleeding risk. Myocardial reperfusion was judged upon using TIMI Grade and myocardial blush grade. Patients and Methods a single center prospective randomized controlled trial based at the coronary care units in Ain shams university hospitals. The study included Three hundred Diabetic patients presenting to Ain shams university hospitals diagnosed with STEMI in the ER fulfilling the inclusion criteria were randomized to receive Ticagrelor (150 patients) or receiving clopidogrel (150 patients) Results As regard TIMI flow there was statistically highly significant highly significant difference between two studied groups with P value 0.000 where in group A 64 % of patients developed TIMI III flow, 22.7 % with TIMI II flow, 12.7% with TIMI I and 0.7% with TIMI 0 While in group B 86% of patients developed TIMI III flow, 9.3% of them developed TIMI II, 3.3 % developed TIMI I flow and 1.3 % developed TIMI 0. As regard MBG there was statistically highly significant difference between two groups with P value 0.00 where in group A where percentage of patients with MBG grades 0,1,2 and 3 were 4%, 16 %,18 % and 62 % respectively while in group B percentage of patients with MBG grades 0,1,2 and 3 were 1.3 %, 3.3 %, 9.3 % and 86 % respectively. As regard echo EF, there was statistically significant difference between two groups with P value 0.036 where mean EF in patients with group A was 40.50 ± 7.93 while the mean EF in patients with group B was 42.55 ± 8.88 . Conclusion Ticagrelor loading before primary PCI resulted in improved post-procedural TIMI flow. It also increased the post-procedural MBG. This resulted in a significant increase in the number of patients having more post-procedural Ejection fraction as measured by modified Simpson’s method. However, it did not decrease incidence of in-hospital MACE. Also there was no significant increase in risk of major nor minor bleeding in both young and elderly patients.

New Findings Suggest Ticagrelor and Aspirin as an Alternative to Clopidogrel for Prevention of Recurrent Stroke

New Findings Suggest Ticagrelor and Aspirin as an Alternative to Clopidogrel for Prevention of Recurrent Stroke

Ticagrelor: A safe option as part of triple therapy?

Patients with atrial fibrillation who have concurrent coronary artery disease requiring percutaneous coronary intervention are subsequently prescribed dual antiplatelet therapy and anticoagulation resulting in triple therapy (TT). Ticagrelor, a reversibly binding P2Y12 antiplatelet agent, has shown superiority to clopidogrel in prevention of ischemic events and death, but is also associated with a small increase in the incidence of intracranial bleeding. This bleeding risk may be enhanced in the setting of TT. The objective of this report is to describe a case of a 70-year-old male prescribed TT with ticagrelor and to review the current literature on the safety of ticagrelor as a part of TT.

The correlation between recurrent risk and CYP2C19 gene polymorphisms in patients with ischemic stroke treated with clopidogrel for prevention.

Background:To explore the correlation between recurrent risk and CYP2C19 gene polymorphisms in patients with ischemic stroke (IS) treated with clopidogrel for prevention.Methods:A total of 289 patients with IS treated with clopidogrel regularly were enrolled in this study, and stroke recurrence of all patients were recorded by follow-up. The correlation between CYP2C19 gene polymorphism and stroke recurrence in patients taking clopidogrel regularly was analyzed.Results:After a mean follow-up period of 6 months, there were 289 patients who took clopidogrel regularly, and 41 of which occurred recurrent stroke. Patients of poor metabolizer and intermediate metabolizer had higher risk of recurrent stroke comparing with patients of extensive metabolize, and the odds ratios were 2.88 (95% confidence interval [CI] 1.31–6.33, P = .068) and 3.00 (95% CI 1.09–8.22, P = .027), respectively. The recurrence risk of ∗2 (G681A)A allele carriers was 3.30 times that of G allele carriers (P = .0065). The recurrence rate of stroke in patients carrying heterozygous and homozygous ∗2 allele mutant was 1.96 times (P = .071) and 3.30 times (P = .012) that of patients with wild-type genes. Multifactor logistic regression analysis result indicated carrying loss of function (LOF) allele was an independent risk factor of stroke recurrence.Conclusion:For patients with IS treated with clopidogrel regularly for secondary prevention, poor metabolizer, and intermediate metabolizer patients had higher risk of recurrent stroke comparing with extensive metabolize ones. Carrying CYP2C19 LOF allele is an independent risk factor of stroke recurrence in patients with IS.

Role of clopidogrel in addition to aspirin in the prevention of recurrent ischaemic events in acute coronary syndrome with ST-segment elevation

Background: Studies regarding the efficacy of Aspirin alone versus combination of Aspirin and Clopidogrel in patients with Unstable Angina are many. But, studies on the comparative role of Aspirin alone versus Aspirin plus Clopidogrel in the background of Acute Coronary Syndrome (ACS) with ST segment elevation myocardial infarction (STEMI) were very few, at the time of starting of this study. Keeping this in mind present study was conducted to compare the efficacy and safety of Aspirin alone with combination of aspirin plus Clopidogrel in prevention of events in Acute Coronary Syndrome with ST segment elevation myocardial infarction.Methods: Patients who are admitted to intensive coronary care unit within 12hrs after the onset of symptoms and whose diagnosis as ACS with ST segment elevation has been established were included in this study. Patients in group 1 received 325 mg of aspirin as loading dose, followed by 150 mg once daily. Patients in group 2 received a combination of aspirin and Clopidogrel 325 and 300 mg, respectively, as loading dose, followed by 150 mg of aspirin and 75 mg of Clopidogrel daily. All the patients received a fibrinolytic agent. Treatment response was weighed against the primary and secondary expected outcomes.Results: Addition of Clopidogrel to Aspirin resulted in significant reduction in severe ischaemia not requiring urgent revascularisation i.e.; 32% in Aspirin alone group versus 10% in Aspirin plus Clopidogrel group and recurrent angina with no ECG changes i.e.; 42% in aspirin alone group versus 20% in Aspirin plus Clopidogrel group. Similarly, there was an improvement in ejection fraction at the end of one month i.e.; 0.3% in Aspirin alone group versus 1.85% in Aspirin plus Clopidogrel group.Conclusions: This study demonstrates the benefit of adding Clopidogrel to Aspirin for myocardial infarction with ST-segment elevation. Treatment with a loading dose of 300mg of Clopidogrel followed by a daily dose of 75mg, in addition to aspirin, resulted in significant improvement in the secondary efficacy related outcomes in patients with acute coronary syndrome with ST-segment elevation.

PCV10 - Aspirin Versus Clopidogrel in Prevention of Ischemic Stroke Recurrence: An Evaluation of Effectiveness and Safety from Beijing Medical Insurance Database

PCV10 - Aspirin Versus Clopidogrel in Prevention of Ischemic Stroke Recurrence: An Evaluation of Effectiveness and Safety from Beijing Medical Insurance Database

Safety of low-dose aspirin in endovascular treatment for intracranial atherosclerotic stenosis.

ObjectivesTo evaluate the safety of low-dose aspirin plus clopidogrel versus high-dose aspirin plus clopidogrel in prevention of vascular risk within 90 days of duration of dual antiplatelet therapy in patients treated with intracranial endovascular treatment.MethodsFrom January 2012 to December 2013, this prospective and observational study enrolled 370 patients with symptomatic intracranial atherosclerotic stenosis of ≥70% with poor collateral undergoing intracranial endovascular treatment. Antiplatelet therapy consists of aspirin, at a low-dose of 100 mg or high-dose of 300 mg daily; clopidogrel, at a dose of 75 mg daily for 5 days before endovascular treatment. The dual antiplatelet therapy continued for 90 days after intervention. The study endpoints include acute thrombosis, subacute thrombosis, stroke or death within 90 days after intervention.ResultsTwo hundred and seventy three patients received low-dose aspirin plus clopidogrel and 97 patients received high-dose aspirin plus clopidogrel before intracranial endovascular treatment. Within 90 days after intervention, there were 4 patients (1.5%) with acute thrombosis, 5 patients (1.8%) with subacute thrombosis, 17 patients (6.2%) with stroke, and 2 death (0.7%) in low-dose aspirin group, compared with no patient (0%) with acute thrombosis, 2 patient (2.1%) with subacute thrombosis, 6 patients (6.2%) with stroke, and 2 death (2.1%) in high-dose aspirin group, and there were no significant difference in all study endpoints between two groups.ConclusionLow-dose aspirin plus clopidogrel is comparative in safety with high-dose aspirin plus clopidogrel within 90 days of duration of dual antiplatelet therapy in patients treated with intracranial endovascular treatment.

Advances in Our Understanding of “Resistance” to Antiplatelet Agents for Prevention of Ischemic Stroke

We review the role of aspirin and clopidogrel for prevention of ischemic stroke and explore the concept of antiplatelet therapy resistance both from a laboratory and clinical perspective and genetic polymorphisms that might influence platelet reactivity with clopidogrel administration. Debates have raged over the years about the application of platelet function tests in clinical practice. We conclude that platelet function testing is not indicated in routine clinical practice. This recommendation is supported by clinical guideline statements, a lack of a global platelet function measure, and limitations of current platelet function test methods as applied in practice. We discuss a recently hypothesized hierarchy of patient characteristics in relation to which patients are most likely to benefit from platelet function studies based on acuity (i.e., risk) of cardiovascular disease. A focus of antiplatelet therapy administration should include emphasis on compliance/adherence and in the example of aspirin, use of well-absorbed forms of aspirin and avoidance of drugs that may interact with aspirin to inhibit its mechanism of action (e.g., certain nonsteroidal anti-inflammatory drugs).

Clopidogrel hydrogen sulphate for atrial fibrillation

Introduction: Atrial fibrillation is a common cardiac rhythm abnormality with a considerable cardiovascular disease burden worldwide. It is an independent major risk factor for stroke. Stroke prevention with anticoagulation or antiplatelet agents has been an important area of clinical research. Warfarin is the most widely used antithrombotic therapy for stroke prophylaxis for last several years, and now dabigatran (150 mg b.i.d.) is more effective than warfarin in stroke prevention in individuals at increased of stroke. In addition, several studies have evaluated the efficacy of clopidogrel for stroke prophylaxis either alone or in combination with aspirin.Areas covered: This review summarizes the key findings of the trials looking at the efficacy of clopidogrel in stroke prevention. A literature search was performed using PubMed and Google Scholar. The trials that evaluated the efficacy of clopidogrel in preventing atherothrombotic events or stroke were also included.Expert opinion: Clopidogrel prevents more vascular events, including stroke, in patients with a recent myocardial infarction, stroke or peripheral vascular disease than aspirin. Combination of clopidogrel and aspirin provides a greater reduction of stroke than aspirin or clopidogrel monotherapy, but at an increased risk of bleeding. Dual antiplatelet therapy (clopidogrel and aspirin) is inferior to warfarin in primary stroke prevention for patient with atrial fibrillation and thus should be considered for stroke prophylaxis only in patients ineligible for warfarin. However, with the advent of newer agents, like direct thrombin inhibitors and Factor Xa inhibitors, the role of antiplatelet therapy for stroke prevention in atrial fibrillation remains unclear.

Catheter ablation for atrial fibrillation: Should it be first-line therapy?

Although much has changed in the management of atrial fibrillation (AF) over the past 20 years, pharmacologic therapy still remains the principal means of treatment. h-Adrenergic blockers, calcium-channel blockers, and digoxin are used to slow the ventricular rate during AF. Warfarin and aspirin are used to decrease the stroke risk associated with AF. Class I (eg, propafenone, flecainide, disopyramide) and class III (eg, sotalol, dofetilide, amiodarone) antiarrhythmic drugs are used to decrease the frequency of recurrences of AF. Although these pharmacologic approaches are all relatively effective, there are significant limitations and risks of side effects. Rate control drugs frequently have associated nuisance side effects, such as fatigue, decreased exercise capacity, and sexual dysfunction, and may exacerbate bradyarrhythmias, heart failure, and obstructive lung disease. Pharmacologic approaches for rate control may also be ineffective for controlling rate during AF in up to 25% of patients. Warfarin is substantially more effective than either aspirin alone or the combination of aspirin and clopidogrel for prevention of strokes in patients with AF. Nonetheless, pooled data from prospective trials with warfarin demonstrate only a 65% reduction in stroke risk by intention-to-treat analysis. This lower than expected risk reduction is primarily related to the frequent discontinuation of warfarin because of concerns about bleeding risks and the difficulties maintaining patients in the relatively narrow therapeutic international normalized ratio range of 2 to 3. Based on pooled data from clinical trials, warfarin is associated with a 1% per patient-year risk of major bleeding and a 0.3% per patientyear risk of intracerebral hemorrhage. Accumulated over time; this represents a substantial risk to patients. The risks of anticoagulation therapy are even worse under more typical clinical circumstances (ie, outside of controlled clinical studies), where the risk of major bleeding may be as high as 12%. Perhaps most controversial is the use of class I or III antiarrhythmic drugs for suppression of AF recurrences.

Esomeprazole With Aspirin Versus Clopidogrel for Prevention of Recurrent Gastrointestinal Ulcer Complications

Esomeprazole With Aspirin Versus Clopidogrel for Prevention of Recurrent Gastrointestinal Ulcer Complications

Wrist 12 versus wrist plus: twelve versus six months of clopidogrel for prevention of late total occlusion after gamma radiation therapy for in-stent restenosis

Wrist 12 versus wrist plus: twelve versus six months of clopidogrel for prevention of late total occlusion after gamma radiation therapy for in-stent restenosis