Dual antiplatelet therapy for acute coronary syndromes: How long to continue?

2016 ◽  
Vol 83 (9) ◽  
pp. 675-688 ◽  
Author(s):  
Meghana Halkar ◽  
A. Michael Lincoff
Keyword(s):  
Antiplatelet Therapy ◽  
Acute Coronary Syndromes ◽  
Dual Antiplatelet Therapy ◽  
Coronary Syndromes

scholarly journals DUAL ANTIPLATELET THERAPY AND OUTCOMES IN PATIENTS WITH ATRIAL FIBRILLATION AND ACUTE CORONARY SYNDROMES

2014 ◽  
Vol 63 (12) ◽  
pp. A103
Author(s):  
Jonathan P. Piccini ◽  
Derek Cyr ◽  
Matthew Roe ◽  
Megan Neely ◽  
Felipe Martinez ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Antiplatelet Therapy ◽  
Acute Coronary Syndromes ◽  
Dual Antiplatelet Therapy ◽  
Coronary Syndromes

Response to Dual Antiplatelet Therapy Does Not Impact Bleeding Risks in Patients Undergoing Oral Surgery after Acute Coronary Syndromes

Cardiology ◽  
2015 ◽  
Vol 132 (2) ◽  
pp. 119-123 ◽  
Author(s):  
Damian Dudek ◽  
Wiktor Kuliczkowski ◽  
Jacek Kaczmarski ◽  
Joanna Wiechec ◽  
Edyta Reichman-Warmusz ◽  
...  
Keyword(s):  
Platelet Aggregation ◽  
Antiplatelet Therapy ◽  
Acute Coronary Syndromes ◽  
Dual Antiplatelet Therapy ◽  
Oral Surgery ◽  
Antiplatelet Agent ◽  
Real Life ◽  
Control Group ◽  
Platelet Activity ◽  
Coronary Syndromes

Introduction: Oral surgery (OS) in patients on antecedent dual antiplatelet therapy (DAPT) may be associated with extra bleeding risks. Monitoring platelet activity in such patients may be beneficial for safety when performing OS. Objectives: The aim of this study was to assess whether platelet function during DAPT impacted the risk of bleeding following OS in patients with acute coronary syndromes (ACS). Patients and Methods: Patients who required OS on top of DAPT with aspirin and clopidogrel (n = 55) for invasively treated ACS were included. The control group (n = 33) consisted of patients who underwent OS with no antiplatelet agent. Platelet aggregation before OS was assessed with a Multiplate® analyzer. Bleeding during OS and at days 1, 3, 7 and 10 after surgery was serially evaluated. Results: All 88 patients completed the study. An incomplete response to aspirin or clopidogrel was observed in 43.6% of the patients. In 11% of the cases, an excessive response to clopidogrel was demonstrated. No excessive bleeding upon OS was exhibited in either group during the entire follow-up. Platelet aggregation values and the use of DAPT did not impact the performance of OS. Conclusion: Therapy with clopidogrel and aspirin after ACS does not seem to increase the risk of real-life bleeding following OS, regardless of the platelet activity response to DAPT.

High post-treatment platelet reactivity is associated with a high incidence of myonecrosis after stenting for non-ST elevation acute coronary syndromes

2007 ◽  
Vol 97 (02) ◽  
pp. 282-287 ◽  
Author(s):  
Corinne Frere ◽  
Jacques Quilici ◽  
Pierre-Emmanuel Morange ◽  
Lyassine Nait-Saidi ◽  
Christopher Mielot ◽  
...  
Keyword(s):  
Platelet Aggregation ◽  
Antiplatelet Therapy ◽  
Acute Coronary Syndromes ◽  
Troponin I ◽  
Dual Antiplatelet Therapy ◽  
Platelet Reactivity ◽  
Post Treatment ◽  
Increased Risk ◽  
Coronary Syndromes ◽  
St Elevation

SummaryHigh post-treatment platelet reactivity (HPPR= adenosine diphosphate [ADP] 10 µM-induced platelet aggregation > 70%) identifies low responders to dual antiplatelet therapy with increased risk of recurrent cardiovascular (CV) events after stenting for non-ST elevation acute coronary syndromes (NSTEACS). This study was designed to compare the incidence of periprocedural myocardial infarction (MI) after stenting for NSTEACS patients between non-responders to dual antiplatelet therapy defined by HPPR and normo-responders. One hundred ninety NSTE-ACS consecutive patients undergoing coronary stenting were included in this prospective study. They received 250 mg aspirin and a 600 mg loading dose of clopidogrel at least 12 hours (h) before percutaneous coronary intervention (PCI). A single post-treatment blood sample was obtained before PCI to analyze maximal intensity of ADP-induced platelet aggregation, and troponin levels were analyzed before PCI, and 12 and 24 h after PCI. Troponin I was considered elevated if > 0.4 ng/ ml. HPPR was present in 22% of patients (n=42). Periprocedural MI occurred significantly more frequently in patients with HPPR than in the normo-responders (43% vs. 24%, p=0.014). After being correlated with recurrent ischemic events after stenting for NSTE-ACS, the HPPR seems to be also a marker of increased risk of periprocedural MI for NSTE-ACS patients.

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