Platelet Therapy Research Articles

Clinical Outcomes of Antithrombotic Strategies for Patients with Atrial Fibrillation After Percutaneous Coronary Intervention.

Antithrombotic strategies for patients with atrial fibrillation (AF) undergoing percutaneous coronary intervention (PCI) remain challenging. This study aims to explore the best antithrombotic strategy for AF patients after PCI based on a network meta-analysis. This study was registered in PROSPERO (CRD42018093928). The PubMed, Cochrane, and EMBASE databases were searched to identify clinical trials concerning antithrombotic therapy for AF patients with PCI from inception to April 2018. Pairwise and network meta-analysis were conducted to compare clinical outcomes of different antithrombotic therapy. The primary endpoint was major bleeding. Fifteen studies including 16,382 patients were identified with follow-up ranging from 3 to 12 months. Non-vitamin K oral anticoagulants (NOAC) plus P2Y12 inhibitor ranked first with a reduced risk of major bleeding compared with vitamin K antagonist (VKA) plus dual antiplatelet therapy (OR: 0.57, 95% CI: 0.43-0.75) but with no significant difference compared with VKA plus single platelet therapy (OR: 0.85, 95% CI: 0.62-1.16). Similar thrombotic events were evident among these groups. Subgroup analysis showed that VKA plus aspirin exhibited a similar risk of major bleeding compared with VKA plus clopidogrel (OR: 0.94, 95% CI: 0.73-1.23) but was associated with increased risks of ischaemic stroke (OR: 2.10, 95% CI: 1.33-3.32) and all-cause death (OR: 1.77, 95% CI: 1.15-2.74) versus VKA plus clopidogrel. In AF patients undergoing PCI, NOAC plus P2Y12 inhibitor and VKA plus clopidogrel, but not VKA plus aspirin, were associated with reduced risk of major bleeding compared with the recommended VKA-based triple therapy, while thrombotic events were similar among these treatments.

Strategies for treatment of childhood primary angiitis of the central nervous system.

ObjectiveChildhood primary angiitis of the CNS (cPACNS) is a devastating neurologic disease. No standardized treatment protocols exist, and evidence is limited to open-label cohort studies and case reports. The aim of this review is to summarize the literature and provide informed treatment recommendations.MethodsA scoping review of cPACNS literature from January 2000 to December 2018 was conducted using Ovid, MEDLINE, PubMed, Embase, Cochrane Database of Systematic Reviews, Cochrane Central Register of Controlled Trials, ClinicalTrials.gov, Vasculitis Foundation, European Vasculitis Society, CanVasc, Google Scholar, and Web of Science. Potentially relevant articles were selected for full-text review using the STROBE checklist if they met the following inclusion criteria: (1) reported treatment, (2) addressed pediatrics, (3) focused on the disease of interest, (4) included ≥5 patients, (5) original research, and (6) full-length articles. Reviews, expert opinions, editorials, case reports with <5 patients, articles lacking treatment information, or non-English articles were excluded. A standardized assessment tool measured study quality. Treatment and outcomes were summarized.ResultsOf 2,597 articles screened, 7 studies were deemed high quality. No trials were available so no meta-analysis was possible. Overall, treatment strategies recommended are induction with acute antithrombotic therapy subsequently followed by high-dose oral prednisone taper over 3–12 months and long-term platelet therapy. In angiography-positive progressive–cPACNS and angiography-negative–cPACNS, we also recommend 6 months of IV cyclophosphamide therapy, with trimethoprim/sulfamethoxazole as part of induction, and maintenance therapy with mycophenolate mofetil/mycophenolic acid.ConclusionNo grade-A evidence exists; however, this review provides recommendations for treatment of cPACNS.

EFFICACY OF DUAL ANTI-PLATELET THERAPY IN CORONARY ARTERY BYPASS GRAFT PATIENTS WITH STABLE ISCHEMIC HEART DISEASE

Role of post-operative dual anti platelet therapy (DAPT) in patients undergoing coronary artery bypass grafting (CABG) with stable ischemic heart disease(SIHD) is equivocal. There is a weak (II b) recommendation in support of use of DAPT, for graft patency. We compared Incidence proportions of all-

The Incidence of Non-Variceal Upper Gastrointestinal Hemorrhage After Percutaneous Coronary Intervention Among Patients Without Acute Myocardial Infarction Is Low: A National Analysis over 11 Months

Introduction: Dual anti—platelet therapy is standard of care after percutaneous coronary intervention (PCI). Non—variceal upper gastrointestinal hemorrhage (NVUGIH) is a potential complication in patients on dual anti—platelet therapy. Despite this known risk, there continues to be paucity of literature on the exact incidence and impact of NVUGIH after PCI. We sought to determine the incidence of NVUGIH after PCI for patients without acute myocardial infarction over an 11—month follow—up period, and its impact on mortality, morbidity and healthcare resource utilization using the largest national readmission database in the United States. Methods: This is a retrospective cohort study using the 2014 National Readmission Database. Inclusion criteria were in—hospital PCI and admissions during January. Exclusion criteria were principal diagnosis of non—ST or ST—elevation myocardial infarction and age less than 18 years. Primary outcome was incidence of NVUGIH during index admission and on 11 month follow—up. Secondary outcomes were: in—hospital and 11—month mortality, morbidity (hemorrhagic shock) and healthcare resource utilization (length of stay (LOS), mean total hospitalization costs and charges). Confounders were adjusted for using multivariate regression analysis. Results: 15,421 patients were included in the analysis. Only 0.3% and 2.7% of patients developed NVUGIH during index admission and 11 months follow, respectively. However, patients who developed NVUGIH during the index admission had higher in—hospital mortality, longer mean LOS, and higher mean total hospitalization costs and charges compared with those who did not (Table 1). Similarly, patients who experienced NVUGIH during the 11—month follow—up period had a higher 1—month mortality compared with those who did not. The NVUGIH associated additional resource utilization were also significant (Table 1). Conclusion: The incidence of non—variceal upper gastrointestinal hemorrhage after a percutaneous coronary intervention among patients without acute myocardial infarction is low both during the index admission and over an 11—month follow—up period. However, patients who develop NVUGIH after PCI have higher mortality, morbidity and healthcare resource utilization compared with those who do not.1187 Figure 1 No Caption available.

P4569Duration of dual anti platelet therapy in elective drug coated balloon angioplasty

P4569Duration of dual anti platelet therapy in elective drug coated balloon angioplasty

Is there a Role for Oral Triple Therapy in Patients with Acute Coronary Syndromes Without Atrial Fibrillation?

Acute Coronary Syndrome (ACS) patients, despite treatment with Dual Anti- Platelet Therapy (DAPT), have up to 10% risk of recurrent Major Adverse Cardiac Events (MACE) in the short term. Here we review studies using more potent antithrombotic agent combinations to reduce this risk, namely Triple Therapy (TT) with the addition of an oral anticoagulant, PAR-1 antagonist, or cilostazol to DAPT (mainly aspirin and clopidogrel), and discuss the limitations of trials to date. Generally speaking, TT leads to an increase in bleeding. Vorapaxar showed a signal for reducing ischaemic events, but increased intracranial haemorrhage 3-fold in the subacute phase of ACS, although remains an option for secondary prevention beyond the immediate subacute phase, particularly if prasugrel or ticagrelor are not available. Non-Vitamin K Oral Anticoagulants (NOACs) all increased bleeding, with only modest reduction in MACE noted with low dose rivaroxaban. Rivaroxaban can be considered combined with aspirin and clopidogrel in ACS patients at high ischaemic and low bleeding risk, without prior stroke/TIA. The combination of P2Y12 inhibitor and NOAC, without aspirin, looks promising. DAPT may be replaced, not by TT, but by dual therapy comprising a NOAC with a P2Y12 inhibitor. More potent antithrombotic regimens increase bleeding and should only be considered on an individual basis, after careful risk stratification. Accurate risk stratification of ACS patients, for both ischaemic and bleeding risk, is essential to allow individualised treatment.

DYNAMICS OF THE CYTOLOGICAL PICTURE OF THE RAS PROCESS IN PATIENTS WITH CHRONIC RANES IN APPLICATION OF PRP-THERAPY

Wound healing is one of the most ancient surgical problems that has not lost its relevance. In the treatment of wounds, surgeons often deal with defects in the covering tissues, which are characterized by signs of chronic inflammation, high bacterial contamination. The aim of the work was to improve the regenerative processes of chronic wounds, using a combination of therapeutic PRP-therapy. Materials and methods. In the period from 2011 to 2017, on the basis of a surgical department, a comprehensive examination and treatment with the proposed and substantiated method was performed for 99 patients with HW, which, in addition to the comprehensive treatment of HW, received local platelet-rich platelet therapy (PRP). The comparison group (Group II) was 101 patients with HW who were treated according to traditional approaches. Patients in the main group used PRP in the form of daily subcutaneous and intradermal injections and applications. The generated plasma was recruited into two insulin syringes of 1 ml each and injected along the periphery of the wound (approximately 20 injections of 0.1 ml). The cytological picture of the wound process was determined with the allocation of 6 types of cytological picture of smears-reflections for Steinberg. The study was performed 4 and 10 days after the start of treatment. Results and discussion. The analysis showed that at day 4, type IV of the cytogram predominated in patients of the (main) group of patients, and therefore the relative "readiness" to further plastic closure of the wound defect was found in only 3 (3,03%) patients. In the second group, 1 (0.99%) patient. On the 10th day of the wound process there is a statistically significant displacement of the cytological picture in the subgroups receiving PRP-therapy in the direction of regenerator types IV, V, VI type of cytogram, and hence relative "readiness" to further plastic closure of the wound defect. Conclusions The use of PRP therapy in the complex of treatment of chronic wounds is clinically effective, which is confirmed by the data of dynamic cytological research, the method allows to accelerate the processes of wound repair.

Variants of PEAR1 Are Associated With Outcome in Patients With ACS and Stable CAD Undergoing PCI.

Introduction: Platelet endothelial aggregation receptor 1 (PEAR1) triggers platelet aggregation and is expressed in platelets and endothelial cells. Genome-wide association studies (GWAS) showed an association between platelet function and single-nucleotide polymorphisms (SNPs) in PEAR1.Methods: In 582 consecutive patients with stable coronary artery disease (CAD) or acute coronary syndrome (ACS) scheduled for PCI and treated with ASA and Clopidogrel, Prasugrel, or Ticagrelor, SNP analysis for rs12566888, rs2768759, rs41273215, rs3737224, and rs822442 was performed. During a follow-up period of 365 days after initial PCI, all patients were tracked for a primary endpoint, defined as a combined endpoint consisting of either time to death, myocardial infarction (MI) or ischemic stroke. All cause mortality, MI and ischemic stroke were defined as secondary endpoints.Results: Multivariable Cox model analysis for the primary endpoint revealed a significantly increased risk in homozygous PEAR1 rs2768759 minor allele carriers (hazard ratio, 3.16; 95% confidence interval, 1.4–7.13, p = 0.006). Moreover, PEAR1 rs12566888 minor allele carriers also showed an increased risk in all patients (hazard ratio, 1.69; 95% confidence interval, 0.87–3.27, p = 0.122), which was marginally significant in male patients (hazard ratio, 2.12; 95% confidence interval, 1.02–4.43, p = 0.045; n = 425).Conclusions: To the best of our knowledge, this is the first study showing that distinct genetic variants of PEAR1 are associated with cardiovascular prognosis in high risk patients undergoing PCI and treated with dual anti platelet therapy.

Did Prasugrel and Ticagrelor Offer the Same Benefit in Patients with Acute Coronary Syndromes after Percutaneous Coronary Interventions Compared to Clopidogrel? Insights from Randomized Clinical Trials, Registries and Meta-analysis.

According to ACC/ AHA guidelines, a minimum of 1 year of dual anti- platelet therapy (DAPT) consisting of aspirin and a platelet ADP-receptor antagonist (P2Y12 inhibitor) is recommended for patients presenting acute coronary syndromes (ACS), regardless of which type of revascularization is performed during the acute event. The purpose of this presentation was to review the present data either from a direct randomized comparison among the three compounds and also large prospective observational registries and meta-analysis were analyzed in detail. With this aim, we performed an extensive large search from PubMed/Medline Journals identifying studies comparing fashion the new P2Y12 inhibitors in patients with ACS including ST elevation myocardial infarction (STEMI) in direct and indirect manner. Pivotal large randomized clinical trials (RCT) in patients with ACS including STEMI, comparing clopidogrel, a first generation P2Y12 inhibitor against the newer prasugrel and ticagrelor showed major efficacy advantages of the latters although both drugs had more bleeding risk than clopidogrel. Direct comparisons of prasugrel and ticagrelor from large RCT are not yet available, however, several observational registries and metaanalysis reported results from an indirect comparison between both compounds. Major findings and limitations of each of these studies were identified, highlighted and discussed. Prasugrel and ticagrelor are both more effective than clopidogrel to prevent adverse cardiac events in patients with ACS. Compared to ticagrelor, prasugrel appears to be more effective in patients with STEMI, although lack of randomized data didn't allow to draw definitive conclusions.

Anti-platelet therapy does not influence the outcome of patients undergoing hepatic resection for colorectal liver metastases, an observational study

AimTo evaluate the impact of anti-platelet therapy on the outcomes of patients undergoing liver resection for CRLM. Secondary aim was to determine whether anti-platelet therapy influenced histo-pathological changes in CRLM. MethodsPatients treated with liver resection for CRLM were identified from a prospectively maintained hepatobiliary database during an 11-year period. Collated data included demographics, primary tumour treatment, surgical data, histopathology analysis and clinical outcome. Results454 patients that underwent primary hepatic resections for CRLM were included. 60 patients were on anti-platelet therapy. 241 patients developed recurrent disease and 131 patients have died. Multi-variate analysis identified 4 independent predictors of disease-free survival: tumour number; tumour size; peri-neural invasion; and resection margin. The presence of peri-neural invasion and multiple hepatic metastases were independent predictors of poorer overall survival on multi-variate analysis. Uni-variate analysis showed that the use of anti-platelet therapy was associated with larger tumour size (p=0.031) and vascular invasion (p=0.023). ConclusionAnti-platelet therapy does not affect the survival outcome in patients with CRLM following liver resection. Anti-platelet therapy is associated with larger liver metastases and vascular invasion on histo-pathological analysis. SynopsisA large retrospective study looking at outcomes of patients taking pre operative anti platelet therapy who have undergone liver resection for colorectal liver metastases.

ASSOCIATION OF PERIOPERATIVE ANTIPLATELET THERAPY AND OUTCOMES IN PATIENTS WITH DRUG-ELUTING STENT PLACEMENT UNDERGOING NONCARDIAC SURGERY

We evaluated whether discontinuation of platelet therapy (APT) before noncardiac surgery (NCS) was associated with higher net adverse clinical event (NACE) in patients with DES. Among 23358 DES-treated patients, 2269 patients were required NCS after DES implantation. NACE was compared with use of

Efficacy of carotid thrombus penetration with a balloon guiding catheter to fast recanalization of acute extra- and intra-cranial carotid artery tandem occlusion - a preliminary report

Abstract Acute ischemic stroke with ipsilateral Internal carotid artery (ICA) stenosis presents a great management dilemma. We present our preliminary report of retrograde retrieval of clot from middle cerebral artery (MCA) followed by delayed carotid artery stenting (CAS) with dual anti platelet therapy (DAPT).

ВЛИЯНИЕ ГЕЛИОГЕОФИЗИЧЕСКИХ ФАКТОРОВ НА СВЕРТЫВАЮЩУЮ СИСТЕМУ КРОВИ БЕРЕМЕННЫХ С ПЛАЦЕНТАРНЫМИ НАРУШЕНИЯМИ

Geomagnetic storms are one of the natural abiotic risk factors for human health. The response of the organism to their impact depends on the individual adaptive abilities, which were formed during the evolution, but can change in the conditions of pathological processes. Evaluation of the effect of a weak magnetic storm (G4v (22 < Ar < 39 nTl) on hemorheological parameters of blood of pregnant women with placental insufficiency compared to healthy pregnant women showed an increase in platelet count (p = 0.05), fibrinogen content (p = 0.02), thrombocyte (p = 0.03), erythrocyte sedimentation rate (p = 0.004). At the same time, a decrease in the number of red blood cells (p = 0.04), hemoglobin concentration (p = 0.001), hematocrit value (p = 0.0009) was registered. We found a strong direct correlation between subpopulations of platelets, which are characterized by different functional activity. Heterogeneity of platelets, their multidirectional correlations with indicators of blood coagulation system of healthy pregnant women can be considered as a response to the change in the disturbance of the earth's magnetic field. For pregnant women with placental disorders, the magnetic storm was associated with increased activity of the blood coagulation system and a significant increase in its components in the blood of patients. Despite the fact that changes in the blood coagulation system occur from the beginning of pregnancy and are often adaptive, in pregnant women with placental disorders, the additional impact of a weak magnetic storm can be a risk of hemostasis disorders and the development of platelet thrombosis, timely diagnosis and therapy of which is important.

Long Term Cardiovascular Outcome Based on Aspirin and Clopidogrel Responsiveness Status in Young ST-Elevated Myocardial Infarction Patients.

BackgroundA subset of patients who take antiplatelet therapy continues to have recurrent cardiovascular events which may be due to antiplatelet resistance. The effect of low response to aspirin or clopidogrel on prognosis was examined in different patient populations.ObjectiveWe aimed to investigate the prevalence of poor response to dual antiplatelet therapy and its relationship with major adverse cardiovascular events (MACE) in young patients with ST-elevation myocardial infarction (STEMI).MethodsIn our study, we included 123 patients under the age of 45 with STEMI who underwent primary percutaneous intervention. A screening procedure to determine both aspirin and clopidogrel responsiveness was performed on the fifth day of admission. We followed a 2x2 factorial design and patients were allocated to one of four groups, according to the presence of aspirin and/or clopidogrel resistance. Patients were followed for a three-year period. A p-value less than 0.05 was considered statistically significant.ResultsWe identified 48% of resistance against one or more antiplatelet in young patients with STEMI. More MACE was observed in patients with poor response to dual platelet therapy or to clopidogrel compared those with adequate response to the dual therapy (OR: 1.875, 1.144-3.073, p < 0.001; OR: 1.198, 0.957-1.499, p = 0.036, respectively). After adjustment for potential confounders, we found that poor responders to dual therapy had 3.3 times increased odds for three-year MACE than those with adequate response to the dual therapy.ConclusionAttention should be paid to dual antiplatelet therapy in terms of increased risk for cardiovascular adverse events especially in young patients with STEMI.

Trends, Characteristics, and Clinical Outcomes of Patients Undergoing Percutaneous Coronary Intervention in Korea between 2011 and 2015.

Background and ObjectivesWe sought to evaluate nationwide trends, characteristics, and clinical outcomes in patients undergoing percutaneous coronary intervention (PCI) in Korea.MethodsFrom National Health Insurance claims data in Korea, 81,115 patients, who underwent PCI for the first episode of coronary artery disease between 2011 and 2015, were enrolled. Patients were categorized into angina (n=49,288) or acute myocardial infarction (AMI, n=31,887) groups and analyzed.ResultsThe mean age of patients was 64.4±12.2 years and 56,576 (69.7%) were men. Diabetes, hyperlipidemia, and hypertension were observed in 27,086 (33.4%), 30,675 (37.8%), and 45,389 (56.0%) patients, respectively. There was a 10% increase in the number of patients undergoing PCI for angina between 2011–2012 and 2014–2015 (11,105 vs. 13,261; p=0.021). However, the number of patients undergoing PCI for AMI marginally decreased between 2011–2012 and 2014–2015 (8,068 vs. 7,823; p=0.052). In procedures, drug-eluting stent was the most frequently used device (93.2%), followed by balloon angioplasty (5.5%) and bare metal stents (1.3%). The mean number of stents per patient was 1.39±0.64. At discharge, dual-anti platelet therapy, statin, beta-blockers, and angiotensin converting enzyme inhibitor or angiotensin receptor blocker were provided to 76,292 (94.1%), 71,411 (88.0%), 57,429 (70.8%), and 54,418 (67.1%) patients, respectively. The mean in-hospital and 1-year total medical costs were 8,628,768±4,832,075 and 13,128,158±9,758,753 Korean Won, respectively. In-hospital mortality occurred in 2,094 patients (2.6%).ConclusionsAppropriate healthcare strategies reflecting trends, characteristics, and clinical outcomes of PCI are needed in Korea.

Which is the best antiaggregant or anticoagulant therapy after TAVI? A propensity-matched analysis from the ITER registry. The management of DAPT after TAVI

The safety and efficacy of single vs. dual antiplatelet therapy (DAPT) in patients undergoing TAVI remain to be addressed. The aim of our study was to evaluate the usefulness of a DAPT compared to a single platelet therapy in patients undergoing TAVI with a balloon-expandable prosthesis. All consecutive patients enrolled in the ITER registry were included. Patients undergoing TAVI discharged with aspirin alone were compared to those taking DAPT before and after selection using propensity score with matching. Subgroup analysis was performed for those on OAT. Prosthetic heart valve dysfunction at follow-up was the primary endpoint, whereas all-cause death, cardiovascular death, bleedings, vascular complications and cerebrovascular accidents were the secondary ones. From 1,364 patients, after propensity score with matching, 605 were selected for each group (aspirin alone vs. DAPT). At 30 days, rates of VARC mortality were lower in patients with aspirin alone (1.5% vs. 4.1%, p=0.003), mainly driven by a reduction of major vascular complications (5.3% vs. 10.7%, p<0.001) and of major bleedings (6.6% vs. 11.5%, p<0.001), without a difference in prosthetic heart valve dysfunction after 45±14 months (2.8% vs. 3.0%, p=0.50). These results were confirmed on multivariable analysis. After TAVI with a balloon-expandable prosthesis, aspirin alone does not increase the risk of prosthetic valve dysfunction, and reduces the risk of periprocedural complications and of 30-day all-cause death.

TCT-731 Nine-month clinical outcomes in patients with diabetes treated with polymer free sirolimus-eluting stents and dual-anti platelet therapy (DAPT) for 6 months versus DAPT for 12 months

TCT-731 Nine-month clinical outcomes in patients with diabetes treated with polymer free sirolimus-eluting stents and dual-anti platelet therapy (DAPT) for 6 months versus DAPT for 12 months

P3689Levels of platelet micro-RNA-223, microRNA-150 and microRNA-21 in patients with coronary artery disease during dual anti platelet therapy and after cessation of P2Y12-inhibitor therapy

P3689Levels of platelet micro-RNA-223, microRNA-150 and microRNA-21 in patients with coronary artery disease during dual anti platelet therapy and after cessation of P2Y12-inhibitor therapy

P3685Management of aspirin intolerance in patients undergoing percutaneous coronary intervention: the role of mono anti platelet therapy. A retrospective, multicenter, study

P3685Management of aspirin intolerance in patients undergoing percutaneous coronary intervention: the role of mono anti platelet therapy. A retrospective, multicenter, study

Rheumatoid arthritis: The ins and outs of platelets in RA.

New insights into the ability of platelets to modify lymphocyte biology suggest a potential anti-inflammatory role for platelet therapy in rheumatoid arthritis. The success of this therapy will depend on researchers being able to define the best formulation to manipulate the crosstalk between inflammatory, vascular and synovial cells.