92 results on '"anti-platelet agents"'
Search Results
2. Sepsis -- it is all about the platelets.
- Author
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Cox, Dermot
- Subjects
SEPSIS ,DISSEMINATED intravascular coagulation ,BLOOD platelet activation ,BLOOD platelets ,MULTIPLE organ failure - Abstract
Sepsis is accompanied by thrombocytopenia and the severity of the thrombocytopenia is associated with mortality. This thrombocytopenia is characteristic of disseminated intravascular coagulation (DIC), the sepsis-associated coagulopathy. Many of the pathogens, both bacterial and viral, that cause sepsis also directly activate platelets, which suggests that pathogeninduced platelet activation leads to systemic thrombosis and drives the multiorgan failure of DIC. In this paper we review the mechanisms of platelet activation by pathogens and the evidence for a role for anti-platelet agents in the management of sepsis. [ABSTRACT FROM AUTHOR]
- Published
- 2023
- Full Text
- View/download PDF
3. Sepsis – it is all about the platelets
- Author
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Dermot Cox
- Subjects
platelets ,sepsis ,innate immunity ,thrombosis ,anti-platelet agents ,Immunologic diseases. Allergy ,RC581-607 - Abstract
Sepsis is accompanied by thrombocytopenia and the severity of the thrombocytopenia is associated with mortality. This thrombocytopenia is characteristic of disseminated intravascular coagulation (DIC), the sepsis-associated coagulopathy. Many of the pathogens, both bacterial and viral, that cause sepsis also directly activate platelets, which suggests that pathogen-induced platelet activation leads to systemic thrombosis and drives the multi-organ failure of DIC. In this paper we review the mechanisms of platelet activation by pathogens and the evidence for a role for anti-platelet agents in the management of sepsis.
- Published
- 2023
- Full Text
- View/download PDF
4. Survival outcomes of patients with concomitant acute variceal bleeding and acute coronary syndrome, and the role of antiplatelet agents: an institutional experience from a lower middle-income Country.
- Author
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Shafqat, Shameel, Lohana, Ajeet Kumar, Bansari, Rajesh Kumar, and Parkash, Om
- Subjects
ACUTE coronary syndrome ,SURVIVAL rate ,PLATELET aggregation inhibitors ,MIDDLE-income countries ,ESOPHAGEAL varices ,TREATMENT effectiveness - Abstract
Background: There is strong evidence demonstrating the incidence of Acute Coronary Syndrome (ACS) among patients with cirrhosis, with the initiation of antiplatelet therapy being subject to debate due to an increased risk of bleeding. This study aimed to determine mortality among patients presenting with concomitant Acute Variceal Bleeding (AVB) and ACS at Index admission. Furthermore, the recurrence of AVB and ACS among patients discharged with or without antiplatelet therapy was determined. Methods: This retrospective study was conducted at the Aga Khan University Hospital, Karachi, Pakistan on patients ≥ 18 years of age admitted to our ER with concomitant ACS and AVB between January 2002 to December 2017. Follow-up for 6 months or till death (if < 6 months), was observed, to help determine the incidence of recurrent AVB and ACS. The incidence of AVB and ACS was then compared amongst patient groups based on the usage of anti-platelet drugs on discharge. Results: A total of 29 patients were included, with a mean age of 58.7 ± 11.0 years. Seven patients died on admission, having worse underlying liver disease. No mortality was reported among the remaining 22 patients. All 22 patients underwent surveillance endoscopy with variceal band ligation until obliteration, as needed. Only 7 patients from the surviving cohort received antiplatelet therapy. After 6.05 ± 1.1 months of follow-up, 1/22 (4.5%) developed recurrent AVB and 2/22 (9.1%) developed cardiovascular events. Importantly, there was no significant difference in the incidence of recurrent AVB (P = 1.000) and ACS (P = 0.091), depending on the use of antiplatelet therapy. Conclusion: Concomitant AVB and ACS is a severe disorder with increased mortality among cirrhotic patients at presentation. The incidence of AVB does not seem to exacerbate with the use of antiplatelet agents, provided successful obliteration of varices is achieved using elective band ligation. [ABSTRACT FROM AUTHOR]
- Published
- 2022
- Full Text
- View/download PDF
5. Stable Angina
- Author
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Roble, Sharon, Baliga, Ragavendra R., editor, and Eagle, Kim A., editor
- Published
- 2020
- Full Text
- View/download PDF
6. Platelet Effects of Anti-diabetic Therapies: New Perspectives in the Management of Patients with Diabetes and Cardiovascular Disease
- Author
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Annunziata Nusca, Dario Tuccinardi, Silvia Pieralice, Sara Giannone, Myriam Carpenito, Lavinia Monte, Mikiko Watanabe, Ilaria Cavallari, Ernesto Maddaloni, Gian Paolo Ussia, Silvia Manfrini, and Francesco Grigioni
- Subjects
anti-diabetic therapies ,glucose-lowering drugs ,platelet ,anti-platelet agents ,cardiovascular disease ,thrombotic risk ,Therapeutics. Pharmacology ,RM1-950 - Abstract
In type 2 diabetes, anti-thrombotic management is challenging, and current anti-platelet agents have demonstrated reduced efficacy. Old and new anti-diabetic drugs exhibited—besides lowering blood glucose levels—direct and indirect effects on platelet function and on thrombotic milieu, eventually conditioning cardiovascular outcomes. The present review summarizes existing evidence on the effects of glucose-lowering agents on platelet properties, addressing pre-clinical and clinical research, as well as drug–drug interactions with anti-platelet agents. We aimed at expanding clinicians’ understanding by highlighting new opportunities for an optimal management of patients with diabetes and cardiovascular disease. We suggest how an improvement of the thrombotic risk in this large population of patients may be achieved by a careful and tailored combination of anti-diabetic and anti-platelet therapies.
- Published
- 2021
- Full Text
- View/download PDF
7. Endoscopie digestive et gestion des patients sous antithrombotiques oraux.
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Deutsch, David and Boustière, Christian
- Abstract
Résumé: La gestion des patients sous antiagrégants ou anticoagulants oraux directs (AOD) avant de réaliser une endoscopie digestive nécessite de connaître le risque hémorragique des actes et les modalités d'arrêt de ces médicaments quand ils doivent être temporairement suspendus. Les endoscopies diagnostiques sont des actes à faible risque et peuvent être réalisées sans modifier les traitements antithrombotiques. Les endoscopies thérapeutiques comprenant tous les actes avec résection, ponction, section, dilatation sont à haut risque et doivent faire interrompre le traitement anticoagulant ou antiagrégant, à l'exception de l'aspirine à faible dose qui doit toujours être maintenue pour prévenir la thrombose de stent coronaire. Contrairement aux antivitamines K, les AOD ne nécessitent ni relais par héparine de bas poids moléculaire ni contrôle biologique. Les modalités d'arrêt et de reprise de ces traitements sont bien définies par des recommandations récentes prenant en compte le risque thrombotique du patient, la durée d'action du médicament et le risque hémorragique de la procédure. L'information des patients, la traçabilité des consignes thérapeutiques et la surveillance post-examen sont indispensables pour éviter une complication hémorragique, de survenue en général différée ou un accident vasculaire conséquence d'un arrêt non justifié ou trop prolongé. Management of patients on antiplatelet therapy or direct oral anticoagulants undergoing elective digestive endoscopy procedures relies on the knowledge of bleeding risk stratification of endoscopic procedures and modalities for discontinuation of antithrombotic agents when justified. Diagnostic procedures are associated with a low bleeding risk and can be performed without change in antithrombotic treatment. However, most therapeutic procedures (including resection, fine needle aspiration, dilation, stenting) are associated with a high bleeding risk of bleeding and require discontinuation of anticoagulants and most of antiplatelet agents except low-dose aspirin which should always be continued to prevent coronary stent thrombosis. Contrary to vitamin K antagonists, there is no need for any biological monitoring or bridging therapy with low molecular weight heparin when using direct oral anticoagulants. Recent guidelines have given direction in the discontinuation and subsequent restart of antithrombotic agents, depending on the patient's individual thrombotic risk, treatment's length of action and bleeding risk stratification of endoscopic procedures. Patient information, traceability of treatment modification recommendations, and post-endoscopy surveillance are mandatory to avoid bleeding complications (mostly delayed post-polypectomy bleeding) or major adverse cardiovascular events (related to unjustified or prolonged antithrombotic treatment discontinuation). [ABSTRACT FROM AUTHOR]
- Published
- 2021
- Full Text
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8. Platelets and Their Role in the Pathogenesis of Cardiovascular Events in Patients With Community-Acquired Pneumonia
- Author
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Charles Feldman and Ronald Anderson
- Subjects
anti-platelet agents ,community-acquired pneumonia ,pneumococcus ,platelets ,pneumolysin ,thrombocytopenia ,Immunologic diseases. Allergy ,RC581-607 - Abstract
Community-acquired pneumonia (CAP) remains an important cause of morbidity and mortality throughout the world with much recent and ongoing research focused on the occurrence of cardiovascular events (CVEs) during the infection, which are associated with adverse short-term and long-term survival. Much of the research directed at unraveling the pathogenesis of these events has been undertaken in the settings of experimental and clinical CAP caused by the dangerous, bacterial respiratory pathogen, Streptococcus pneumoniae (pneumococcus), which remains the most common bacterial cause of CAP. Studies of this type have revealed that although platelets play an important role in host defense against infection, there is also increasing recognition that hyperactivation of these cells contributes to a pro-inflammatory, prothrombotic systemic milieu that contributes to the etiology of CVEs. In the case of the pneumococcus, platelet-driven myocardial damage and dysfunction is exacerbated by the direct cardiotoxic actions of pneumolysin, a major pore-forming toxin of this pathogen, which also acts as potent activator of platelets. This review is focused on the role of platelets in host defense against infection, including pneumococcal infection in particular, and reviews the current literature describing the potential mechanisms by which platelet activation contributes to cardiovascular complications in CAP. This is preceded by an evaluation of the burden of pneumococcal infection in CAP, the clinical features and putative pathogenic mechanisms of the CVE, and concludes with an evaluation of the potential utility of the anti-platelet activity of macrolides and various adjunctive therapies.
- Published
- 2020
- Full Text
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9. TRENDS IN PRESCRIBING ANTIPLATELET DRUGS FOR SECONDARY PREVENTION OF NON-CARDIOEMBOLIC ISCHEMIC STROKE
- Author
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Muhammad Tariq, Faisal Naveed Akhtar, and Muhammad Aamir Khan Babar
- Subjects
anti-platelet agents ,non-cardio embolic stroke ,Medicine ,Medicine (General) ,R5-920 - Abstract
Objective: To determine the trends of physicians and neurologists in prescribing anti-platelet agents for secondary prevention of non-cardio embolic stroke after 3 months of stroke. Study Design: A descriptive study. Place and Duration of Study: Combined Military Hospital (CMH) Lahore over a period of four months. Material and Methods: Patients suffering from old (≥3 months) non-cardio embolic stroke, taking anti-platelet agents for secondary prevention and visiting CMH Lahore neurology clinic. Information about their stroke and treatment was obtained from their previous investigations and medical prescriptions. Results: A total of 60 patients met the inclusion criteria of the study; 36 (60%) were taking a combination of clopidogrel 75mg plus Aspirin 75 mg and 12 (20%) received Aspirin 75 mg daily while 12 (20%) were getting other regimens. Conclusion: Combination of clopidogrel 75mg plus Aspirin 75 mg was the most common anti-platelet regimen prescribed for secondary prevention of non-cardio embolic stroke in our study population.
- Published
- 2018
10. Platelets and Their Role in the Pathogenesis of Cardiovascular Events in Patients With Community-Acquired Pneumonia.
- Author
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Feldman, Charles and Anderson, Ronald
- Subjects
COMMUNITY-acquired pneumonia ,PATHOLOGY ,CARDIOVASCULAR diseases ,HIGH mobility group proteins ,BLOOD platelets ,BACTERIAL meningitis - Abstract
Community-acquired pneumonia (CAP) remains an important cause of morbidity and mortality throughout the world with much recent and ongoing research focused on the occurrence of cardiovascular events (CVEs) during the infection, which are associated with adverse short-term and long-term survival. Much of the research directed at unraveling the pathogenesis of these events has been undertaken in the settings of experimental and clinical CAP caused by the dangerous, bacterial respiratory pathogen, Streptococcus pneumoniae (pneumococcus), which remains the most common bacterial cause of CAP. Studies of this type have revealed that although platelets play an important role in host defense against infection, there is also increasing recognition that hyperactivation of these cells contributes to a pro-inflammatory, prothrombotic systemic milieu that contributes to the etiology of CVEs. In the case of the pneumococcus, platelet-driven myocardial damage and dysfunction is exacerbated by the direct cardiotoxic actions of pneumolysin, a major pore-forming toxin of this pathogen, which also acts as potent activator of platelets. This review is focused on the role of platelets in host defense against infection, including pneumococcal infection in particular, and reviews the current literature describing the potential mechanisms by which platelet activation contributes to cardiovascular complications in CAP. This is preceded by an evaluation of the burden of pneumococcal infection in CAP, the clinical features and putative pathogenic mechanisms of the CVE, and concludes with an evaluation of the potential utility of the anti-platelet activity of macrolides and various adjunctive therapies. [ABSTRACT FROM AUTHOR]
- Published
- 2020
- Full Text
- View/download PDF
11. Effects of Pre-Hospital Antiplatelet Therapy on the Incidence of ARDS.
- Author
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Weizhong Jin, Chia-Chen Chuang, Hualiang Jin, Jian Ye, Kandaswamy, Eswar, Limin Wang, and Li Zuo
- Subjects
EMERGENCY medicine ,INFORMATION storage & retrieval systems ,MEDICAL databases ,MEDLINE ,META-analysis ,ONLINE information services ,ADULT respiratory distress syndrome ,SYSTEMATIC reviews ,PLATELET aggregation inhibitors - Abstract
BACKGROUND: Clinical observations on the potential of pre-hospital antiplatelet therapy in preventing ARDS have been inconsistent. To further the correlation between antiplatelet therapy and ARDS, we conducted a meta-analysis to evaluate the effects of pre-hospital antiplatelet therapy on subjects with ARDS. METHODS: A literature search in major data banks was performed. We included prospective and retrospective cohorts, case-control trials, and randomized controlled trials that compared the ARDS incidence in subjects with or without pre-hospital antiplatelet agents. RESULTS: Meta-analysis of 7 studies (a total of 30,291 subjects) showed significantly lower odds of ARDS in the pre-hospital antiplatelet therapy group compared with subjects with no pre-hospital antiplatelet therapy (odds ratio 0.68, 95% CI 0.56-0.83; P < .001). However, ARDS mortalities in the hospital and ICUs were not affected. CONCLUSIONS: These findings indicated that pre-hospital antiplatelet therapy was associated with a reduced rate of ARDS but had no effect on the mortality in the subjects at high risk. [ABSTRACT FROM AUTHOR]
- Published
- 2020
- Full Text
- View/download PDF
12. Anti-platelet agents: past, present and future.
- Author
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Cox, Dermot
- Subjects
- *
PHOSPHODIESTERASE inhibitors , *ASPIRIN , *CARDIOVASCULAR diseases , *HEART diseases , *BLOOD platelets - Abstract
The discovery of the role of platelets in cardiovascular disease led to the introduction of aspirin as a therapeutic agent for heart disease. Aspirin has proven to be effective in preventing cardiovascular events but the fact that not all patients benefit from aspirin has led to the search for more effective agents. Numerous agents have been discovered including thromboxane synthase inhibitors, phosphodiesterase inhibitors, GPIIb/IIIa antagonists, P2Y12 antagonists and PAR-1 antagonists. However, all faced two challenges - their cost-benefit relationship in comparison with aspirin and the risk of bleeding that is often associated with greater efficacy. In this paper, I review the performances of these different classes of anti-platelet agent and discuss the potential future for novel anti-thrombotics. I also highlight the role of platelets in immunology and discuss the potential for targeting the immune properties of platelets. [ABSTRACT FROM AUTHOR]
- Published
- 2020
- Full Text
- View/download PDF
13. Preventing Diabetes Complications: Non-glucose Interventions
- Author
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Levy, David and Chowdhury, Tahseen A., editor
- Published
- 2014
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14. Targeting Phosphodiesterases in Anti-platelet Therapy
- Author
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Rondina, Matthew T., Weyrich, Andrew S., Gresele, Paolo, editor, Born, Gustav V. R, editor, Patrono, Carlo, editor, and Page, Clive P., editor
- Published
- 2012
- Full Text
- View/download PDF
15. TRENDS IN PRESCRIBING ANTIPLATELET DRUGS FOR SECONDARY PREVENTION OF NON-CARDIOEMBOLIC ISCHEMIC STROKE.
- Author
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Tariq, Muhammad, Akhtar, Faisal Naveed, and Muhammad Aamir Khan Babar Khan Babar
- Subjects
- *
PLATELET aggregation inhibitors , *STROKE , *DRUG prescribing - Abstract
Objective: To determine the trends of physicians and neurologists in prescribing anti-platelet agents for secondary prevention of non-cardio embolic stroke after 3 months of stroke. Study Design: A descriptive study. Place and Duration of Study: Combined Military Hospital (CMH) Lahore over a period of four months. Material and Methods: Patients suffering from old (≥3 months) non-cardio embolic stroke, taking anti-platelet agents for secondary prevention and visiting CMH Lahore neurology clinic. Information about their stroke and treatment was obtained from their previous investigations and medical prescriptions. Results: A total of 60 patients met the inclusion criteria of the study; 36 (60%) were taking a combination of clopidogrel 75mg plus Aspirin 75 mg and 12 (20%) received Aspirin 75 mg daily while 12 (20%) were getting other regimens. Conclusion: Combination of clopidogrel 75mg plus Aspirin 75 mg was the most common anti-platelet regimen prescribed for secondary prevention of non-cardio embolic stroke in our study population. [ABSTRACT FROM AUTHOR]
- Published
- 2018
16. Efficacy and safety of ticagrelor in patients with acute coronary syndrome: A meta‐analysis of randomized controlled trials.
- Author
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Jing, Yunyan, Ni, Bin, Zhou, Donglai, Zhang, Xingwei, and Liu, Shanxin
- Subjects
- *
TREATMENT of acute coronary syndrome , *ASPIRIN , *ADENOSINE diphosphate , *CLOPIDOGREL , *RANDOMIZED controlled trials , *PRASUGREL , *THERAPEUTICS - Abstract
Summary: Acute coronary syndrome (ACS) is a dangerous and urgent clinical pattern of coronary artery disease. Aspirin and adenosine diphosphate P2Y12 receptor antagonists are the standard dual anti‐platelet therapy for patients with ACS. Ticagrelor is a new oral antagonist of the adenosine diphosphate P2Y12 receptor. Randomized controlled trials (RCTs) have evaluated the efficacy and safety of ticagrelor compared to clopidogrel or prasugrel in patients with ACS, obtaining conflicting results. Thus, we conducted a meta‐analysis of these RCTs to determine the efficacy and safety of ticagrelor in patients with ACS. Results of the meta‐analysis indicate that ticagrelor decreased the risk of major adverse cardiovascular events (MACE) and all‐cause death, but increased the risk of bleeding events. In Asiatic patients, analysis indicates that ticagrelor did not decrease the risk of MACE and all‐cause death, while increasing the risk of bleeding events. Together, this meta‐analysis suggests that ticagrelor was more effective, but less safe than clopidogrel and prasugrel in patients with ACS. Subgroup analysis indicates that ticagrelor was not more effective, although less safe than clopidogrel in Asiatic patients, thus more evidence is needed to further evaluate the efficacy and safety of ticagrelor in Asiatic patients. [ABSTRACT FROM AUTHOR]
- Published
- 2018
- Full Text
- View/download PDF
17. Safety and efficacy of anti-thrombotic regimens in patients with percutaneous coronary intervention requiring oral anticoagulation: A traditional and network meta-analysis.
- Author
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Khan, Safi U., Saleem, Muhammad A., Abdullah, Amirahwaty, Ghimire, Subash, Lekkala, Manidhar, Rahman, Hammad, Lone, Ahmad N., and Kaluski, Edo
- Subjects
- *
THROMBOTIC thrombocytopenic purpura , *PERCUTANEOUS coronary intervention , *BLOOD coagulation , *CARDIOVASCULAR disease treatment , *PATIENTS , *CARDIOVASCULAR diseases , *CORONARY heart disease prevention , *MEDICAL equipment , *FIBRINOLYTIC agents , *ANTICOAGULANTS , *CARDIOVASCULAR system , *DRUG administration , *MEDICAL information storage & retrieval systems , *MEDICAL care , *MEDLINE , *META-analysis , *SYSTEMATIC reviews , *PLATELET aggregation inhibitors - Abstract
Background: Previous reports have been inconsistent in generating a consensus for optimal treatment strategy for patients with percutaneous coronary intervention (PCI) who also require oral anticoagulation (OAC). We conducted a traditional and network meta-analysis to evaluate the safety and efficacy of anti-thrombotic regimens in this subset of patients.Methods: 30 articles were recovered through preferred reporting items for systematic reviews and meta-analyses (PRISMA) using MEDLINE, EMBASE and Cochrane Central Register of Controlled Clinical Trials (CENTRAL) from inception to December 2016.Results: Dual antiplatelet therapy (DAPT) was found to be the safest treatment modality when compared to triple therapy (TT) or combination of OAC and single antiplatelet agent (OAC+SAP) [Major bleeding: (DAPT vs OAC+SAP: odds ratio (OR), 0.53; 95% credible interval (CrI), 0.30-0.91) (DAPT vs TT: OR, 0.45; 95% CrI, 0.31-0.64)]. There were no significant differences in major adverse cardiovascular events (MACE), myocardial infarction (MI), cardiovascular (CV) or total survival, stent thrombosis or target vessel revascularization (TVR) amongst the three treatment arms. TT was ranked superior for stroke reduction (SUCRA, 69%) followed by OAC+SAP and DAPT. When traditional analysis was adjusted for randomized data, OAC+SAP was equivalent to TT with regards to stroke (OR, 0.74; 95% confidence interval (CI), 0.38-1.46; p=0.39) and showed significant reduction in MACE and total mortality.Conclusion: DAPT was found to be the safest and equally effective regimen when compared to TT and OAC+SAP. However this strategy bears considerable risk to patients with high thromboembolic risk. This issue can be encountered by using OAC+SAP as an alternative of TT in patients with intermediate to high stroke risk and intermediate to high bleeding propensity. [ABSTRACT FROM AUTHOR]- Published
- 2017
- Full Text
- View/download PDF
18. Microfludic platforms for the evaluation of anti-platelet agent efficacy under hyper-shear conditions associated with ventricular assist devices.
- Author
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Dimasi, Annalisa, Rasponi, Marco, Consolo, Filippo, Fiore, Gianfranco B., Bluestein, Danny, Slepian, Marvin J., and Redaelli, Alberto
- Subjects
- *
PLATELET aggregation inhibitors , *DRUG efficacy , *HEART assist devices , *MICROFLUIDIC devices , *SHEAR flow , *CARDIOVASCULAR disease treatment , *THROMBOSIS , *THERAPEUTICS - Abstract
Thrombus formation is a major adverse event affecting patients implanted with ventricular assist devices (VADs). Despite anti-thrombotic drug administration, thrombotic events remain frequent within the first year post-implantation. Platelet activation (PA) is an essential process underling thrombotic adverse events in VAD systems. Indeed, abnormal shear forces, correlating with specific flow trajectories of VADs, are strong agonists mediating PA. To date, the ability to determine efficacy of anti-platelet (AP) agents under shear stress conditions is limited. Here, we present a novel microfluidic platform designed to replicate shear stress patterns of a clinical VAD, and use it to compare the efficacy of two AP agents in vitro. Gel-filtered platelets were incubated with i) acetylsalicylic acid (ASA) and ii) ticagrelor, at two different concentrations (ASA: 125 and 250 µM; ticagrelor: 250 and 500 nM) and were circulated in the VAD-emulating microfluidic platform using a peristaltic pump. GFP was collected after 4 and 52 repetitions of exposure to the VAD shear pattern and tested for shear-mediated PA. ASA significantly inhibited PA only at 2-fold higher concentration (250 µM) than therapeutic dose (125 µM). The effect of ticagrelor was not dependent on drug concentration, and did not show significant inhibition with respect to untreated control. This study demonstrates the potential use of microfluidic platforms as means of testing platelet responsiveness and AP drug efficacy under complex and realistic VAD-like shear stress conditions. [ABSTRACT FROM AUTHOR]
- Published
- 2017
- Full Text
- View/download PDF
19. Optimal pediatric dosing of anti-platelet agents for pipeline stent embolization -a case report and review of the literature.
- Author
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Cobb, Mary, Zomorodi, Ali, Hauck, Erik, Smith, Tony, and Fernando Gonzalez, L.
- Subjects
- *
PLATELET aggregation inhibitors , *HEMORRHAGIC diseases , *DRUG efficacy , *CHILDREN'S health , *PATIENTS , *THERAPEUTICS - Abstract
Background: Various strategies are emerging for dosing antiplatelet therapies in preparation for pipeline stent embolization in adults. Hyper-response is associated with hemorrhagic complications. Hypo-response is associated with thromboembolic events. Dosing of antiplatelet agents is highly variable, with little consensus among experts for adults-and even more so for children. To date, pipeline stents have been deployed in 11 pediatric patients, ages 4-15. A variety of clopidogrel and aspirin dosing regimens have been used, with response tested in only three patients, who were all therapeutic. Thrombotic events occurred in two patients, neither of whom were tested. Case: We describe here the first case of a hemorrhagic complication in a hyper-responsive pediatric patient undergoing placement of a pipeline stent. Discussion: As the use of endovascular therapies requiring dual anti-platelet agents becomes more established, there is an increasing need to develop titration protocols that minimizes the risk of thrombotic and hemorrhagic events. [ABSTRACT FROM AUTHOR]
- Published
- 2017
- Full Text
- View/download PDF
20. Synthesis and Evaluation of Pyrrole Derivative Conjugates of Aspirin as Anti-Platelet Agents
- Author
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Chaturvedi, Saurabh, Saini, Rakesh, Kesari, AN, Rai, Awani, Maurya, Neelotma, and ShaharYar, M
- Published
- 2010
21. Hypoxia Modulates Platelet Purinergic Signalling Pathways
- Author
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Eleanor W. Lee, Greig S. Torpey, Joseph A Willson, Timothy D. Warner, Sarah R. Walmsley, Melissa V. Chan, J K Baillie, Alfred Arthur Roger Thompson, Jason M. Young, Christopher J Graham, Gordon G. Paterson, and Rebecca C. Dru
- Subjects
0301 basic medicine ,Adult ,Blood Platelets ,Male ,P2Y receptor ,Adolescent ,Platelet Aggregation ,Platelet Function Tests ,030204 cardiovascular system & hematology ,Pharmacology ,anti-platelet agents ,Cohort Studies ,03 medical and health sciences ,chemistry.chemical_compound ,Young Adult ,0302 clinical medicine ,P2Y12 ,Cangrelor ,high altitude ,Cellular Haemostasis and Platelets ,ADP receptors ,Humans ,Platelet ,Platelet activation ,Phosphorylation ,Hypoxia ,Platelet-Rich Plasma ,Altitude ,platelet physiology ,Microfilament Proteins ,Receptors, Purinergic ,Hematology ,Purinergic signalling ,Phosphoproteins ,Platelet Activation ,Adenosine Monophosphate ,Adenosine Diphosphate ,Oxygen ,Adenosine diphosphate ,030104 developmental biology ,chemistry ,Female ,Receptors, Thrombin ,Cell Adhesion Molecules ,Platelet Aggregation Inhibitors ,Signal Transduction - Abstract
Background Hypoxia resulting from ascent to high-altitude or pathological states at sea level is known to increase platelet reactivity. Previous work from our group has suggested that this may be adenosine diphosphate (ADP)-specific. Given the clinical importance of drugs targeting ADP pathways, research into the impact of hypoxia on platelet ADP pathways is highly important. Methods Optimul aggregometry was performed on plasma from 29 lowland residents ascending to 4,700 m, allowing systematic assessment of platelet reactivity in response to several platelet agonists. Aggregometry was also performed in response to ADP in the presence of inhibitors of the two main ADP receptors, P2Y1 and P2Y12 (MRS2500 and cangrelor, respectively). Phosphorylation of vasodilator-stimulated phosphoprotein (VASP), a key determinant of platelet aggregation, was analysed using the VASPFix assay. Results Hypobaric hypoxia significantly reduced the ability of a fixed concentration of cangrelor to inhibit ADP-induced aggregation and increased basal VASP phosphorylation. However, in the absence of P2Y receptor inhibitors, we did not find evidence of increased platelet sensitivity to any of the agonists tested and found reduced sensitivity to thrombin receptor-activating peptide-6 amide. Conclusion Our results provide evidence of increased P2Y1 receptor activity at high altitude and suggest down-regulation of the P2Y12 pathway through increased VASP phosphorylation. These changes in ADP pathway activity are of potential therapeutic significance to high-altitude sojourners and hypoxic sea level patients prescribed platelet inhibitors and warrant further investigation.
- Published
- 2019
- Full Text
- View/download PDF
22. Platelet effects of anti-diabetic therapies: new perspectives in the management of patients with diabetes and cardiovascular disease
- Author
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Sara Giannone, Gian Paolo Ussia, Silvia Manfrini, Dario Tuccinardi, Mikiko Watanabe, Silvia Pieralice, Ilaria Cavallari, Lavinia Monte, Myriam Carpenito, Francesco Grigioni, Ernesto Maddaloni, and Annunziata Nusca
- Subjects
medicine.medical_specialty ,RM1-950 ,Review ,Type 2 diabetes ,Disease ,030204 cardiovascular system & hematology ,anti-platelet agents ,anti-diabetic therapies ,03 medical and health sciences ,0302 clinical medicine ,cardiovascular disease ,Diabetes mellitus ,medicine ,Pharmacology (medical) ,Platelet ,030212 general & internal medicine ,Intensive care medicine ,Pharmacology ,Thrombotic risk ,platelet ,glucose-lowering drugs ,diabetes ,business.industry ,medicine.disease ,Optimal management ,Clinical research ,thrombotic risk ,Therapeutics. Pharmacology ,business ,Cardiovascular outcomes - Abstract
In type 2 diabetes, anti-thrombotic management is challenging, and current anti-platelet agents have demonstrated reduced efficacy. Old and new anti-diabetic drugs exhibited—besides lowering blood glucose levels—direct and indirect effects on platelet function and on thrombotic milieu, eventually conditioning cardiovascular outcomes. The present review summarizes existing evidence on the effects of glucose-lowering agents on platelet properties, addressing pre-clinical and clinical research, as well as drug–drug interactions with anti-platelet agents. We aimed at expanding clinicians’ understanding by highlighting new opportunities for an optimal management of patients with diabetes and cardiovascular disease. We suggest how an improvement of the thrombotic risk in this large population of patients may be achieved by a careful and tailored combination of anti-diabetic and anti-platelet therapies.
- Published
- 2021
23. Aspirin Half Maximal Inhibitory Concentration Value on Platelet Cyclooxygenase1 in Severe Type-2 Diabetes Mellitus is not Significantly Different from that of Healthy Individuals.
- Author
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Kimura, Yukio, Takano, Katsuhiro, Satoh, Kaneo, Aida, Kaoru, Kobayashi, Tetsuro, and Ozaki, Yukio
- Abstract
It is implicated that diabetic patients are more resistant to aspirin therapy than patients with other diseases or healthy individuals. We evaluated the inhibitory effects of aspirin on aggregation and the cyclooxygenase activity of platelets of 10 patients with severe type-2 diabetes mellitis (DM) and compared the results with those of healthy individuals. Although platelet aggregation had a tendency to be more resistant to aspirin with the DM group, there was no significant difference in half maximal inhibitory concentration 50 values of aspirin on the cyclooxygenase activity between the patients with DM and healthy individuals. Thus, the residual platelet aggregability uninhibited by aspirin appears to be independent of the cyclooxygenase activity. Since adenosine diphosphate (ADP) receptor blocking almost completely inhibited the residual platelet aggregability, it is suggested that hyperreactivity to ADP is more prevalent in patients with DM. [ABSTRACT FROM PUBLISHER]
- Published
- 2014
- Full Text
- View/download PDF
24. Blocking the EP3 receptor for PGE2 with DG-041 decreases thrombosis without impairing haemostatic competence.
- Author
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Tilly, Peggy, Charles, Anne-Laure, Ludwig, Sophie, Slimani, Farid, Gross, Sabrina, Meilhac, Olivier, Geny, Bernard, Stefansson, Kari, Gurney, Mark E., and Fabre, Jean-Etienne
- Subjects
- *
HEMOSTATICS , *THROMBOSIS , *BLOOD vessels , *PLATELET aggregation inhibitors , *BLOOD coagulation , *FIBRINOLYTIC agents , *HEMORRHAGE risk factors , *DINOPROSTONE - Abstract
Aims Haemostasis interrupts bleeding from disrupted blood vessels by activating platelet aggregation and coagulation. A similar mechanism termed thrombosis generates obstructive thrombi inside diseased arteries. As a consequence of this similarity, current anti-thrombotic agents increase the risk of bleeding. Atherosclerotic plaques produce significant amounts of prostaglandin E2 (PGE2), which activates its receptor EP3 on platelets and aggravates atherothrombosis. We investigated whether blocking EP3 could dissociate atherothrombosis from haemostasis. Methods and results Inhibiting in vivo the receptor EP3 for PGE2 with the blocking agent DG-041 reduced murine thrombosis triggered by local delivery of arachidonic acid or ferric chloride on healthy arteries. Importantly, it also reduced thrombosis triggered by scratching murine atherosclerotic plaques. PGE2 was not produced at the bleeding site after tail clipping. Consistently, blocking EP3 did not alter murine tail, liver, or cerebral haemostasis. Furthermore, blocking EP3 reduced murine pulmonary embolism and intensified platelet inhibition by clopidogrel leaving tail bleeding times unchanged. Human atherosclerotic plaques produced PGE2, which facilitated platelet aggregation in human blood and rescued the function of P2Y12-blocked platelets. Finally, in healthy patients, DG-041 reduced platelet aggregation, but did not significantly alter the cutaneous bleeding time at doses up to eight times the dose that inhibited the facilitating effect of PGE2 on platelets. Conclusion In mice, blocking EP3 inhibited atherothrombosis without affecting haemostasis and intensified efficiency of conventional anti-platelet treatment without aggravating the bleeding risk. In patients, blocking EP3 should improve the prevention of cardiovascular diseases, which is currently limited by the risk of bleeding. [ABSTRACT FROM AUTHOR]
- Published
- 2014
- Full Text
- View/download PDF
25. Characteristics and Outcomes in Patients with Venous Thromboembolism Taking Concomitant Anti-Platelet Agents and Anticoagulants in the AMPLIFY Trial
- Author
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Alexander T. Cohen, Giancarlo Agnelli, Jeffrey I. Weitz, Paul Sanders, John F. Thompson, Gary E. Raskob, Harry R. Büller, Alexander Gallus, Vascular Medicine, and ACS - Pulmonary hypertension & thrombosis
- Subjects
Adult ,Male ,0301 basic medicine ,anti-platelet agents ,clinical trials: oral anticoagulants ,deep vein thrombosis ,pulmonary embolism ,venous thrombosis ,Aged ,Anticoagulants ,Double-Blind Method ,Drug Administration Schedule ,Enoxaparin ,Factor Xa Inhibitors ,Female ,Hemorrhage ,Humans ,Middle Aged ,Platelet Aggregation Inhibitors ,Pyrazoles ,Pyridones ,Risk Assessment ,Risk Factors ,Time Factors ,Treatment Outcome ,Venous Thromboembolism ,Warfarin ,medicine.medical_specialty ,030204 cardiovascular system & hematology ,03 medical and health sciences ,0302 clinical medicine ,Internal medicine ,medicine ,Stroke ,Aspirin ,business.industry ,Hematology ,medicine.disease ,Pulmonary embolism ,Venous thrombosis ,030104 developmental biology ,Concomitant ,Relative risk ,Apixaban ,business ,medicine.drug - Abstract
The double-blind, randomized, AMPLIFY trial compared 6 months' treatment with apixaban (10 mg twice daily for 7 days and 5 mg twice daily thereafter) versus conventional treatment (subcutaneous enoxaparin [1 mg/kg twice daily for ≥ 5 days] overlapped and followed by warfarin [international normalized ratio = 2.0–3.0]) in patients with acute venous thromboembolism (VTE). This post hoc analysis of AMPLIFY compared outcomes among those taking or not taking concomitant anti-platelet therapy. The primary efficacy outcome was recurrent VTE or VTE-related death; the principal safety outcome was major bleeding. Of 5,365 (apixaban, n = 2,676; enoxaparin/warfarin, n = 2,689) randomized patients, 813 (apixaban, n = 402 [15%]; enoxaparin/warfarin, n = 411 [15%]) took concomitant anti-platelet therapy, of which 92% consisted of low-dose aspirin. Rates of VTE or VTE-related death were similar whether or not anti-platelet agents were taken (apixaban: 3.6 and 2.0%; enoxaparin/warfarin: 3.0 and 2.6%; anti-platelet use: relative risk [RR], 1.23; 95% confidence interval [CI], 0.58–2.62; no anti-platelet use: RR, 0.77; 95% CI, 0.52–1.13); interaction p-value = 0.299. Major bleeding rates were threefold higher in those taking versus those not taking anti-platelet agents (apixaban: 1.2 and 0.4%; enoxaparin/warfarin: 4.1 and 1.4%; anti-platelet use: RR, 0.30; 95% CI, 0.11–0.81; no anti-platelet use: RR, 0.31; 95% CI, 0.15–0.63); interaction p-value = 0.924. Concomitant anti-platelet therapy produced a proportionally similar increase in major bleeding in patients randomized to apixaban or conventional therapy, but there were fewer major bleeds with apixaban. Therefore, the overall safety of apixaban over conventional therapy was maintained in patients receiving anti-platelet therapy. Clinicaltrials.gov: NCT00643201.
- Published
- 2019
26. Clopidogrel “resistance”: Pre- vs post-receptor determinants.
- Author
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Hurst, N.L., Nooney, V.B., Raman, B., Chirkov, Y.Y., De Caterina, R., and Horowitz, J.D.
- Subjects
- *
CLOPIDOGREL , *DRUG resistance , *DRUG antagonism , *DRUG efficacy , *THROMBOSIS , *PLATELET aggregation inhibitors , *CARDIOVASCULAR diseases risk factors , *PATIENTS - Abstract
Abstract: The clinical efficacy of the P2Y12 receptor antagonist clopidogrel as an agent to prevent thrombotic events predominantly reflects its anti-aggregatory effects. Stent thrombosis in particular is more likely to occur in patients in whom clopidogrel effect is limited. “Resistance” to clopidogrel in general should theoretically arise either because of a reduction in plasma concentration of the active metabolite and/or of the downstream intracellular biochemical changes underlying antiplatelet effects. We therefore postulate that “resistance” to clopidogrel arises via a combination of pharmacogenetic, pharmacokinetic and intracellular biochemical mechanisms. Considerable attention has been so far directed to the finding that stent thrombosis occurs more frequently in patients with loss-of-function mutations of CYP2C19, thus limiting clopidogrel bioactivation. Furthermore, a number of drug–drug interactions may marginally impair responsiveness to clopidogrel, largely via impairment of bioactivation. However, population data also suggest that clopidogrel “resistance” occurs more frequently in patients with acute coronary syndromes than in normal subjects, and that “resistance” is particularly common in obese subjects and with diabetes. Here we critically review available literature and speculate on the possibility that non-genetic causes of clopidogrel “resistance” may arise from impairments of the intracellular signaling cascade initiated by P2Y12 receptor inhibition. In such cases, “resistance” to clopidogrel may also theoretically occur with other P2Y12 receptor antagonists, irrespective of the need for bioactivation. Delineation of this non-genetic component of “resistance” to P2Y12 inhibitors may facilitate the development of optimal therapeutic strategies for high-risk cardiovascular patients. [Copyright &y& Elsevier]
- Published
- 2013
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27. Identification of the active region responsible for the anti-thrombotic activity of anopheline anti-platelet protein from a malaria vector mosquito.
- Author
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Hayashi, Hideki, Kyushiki, Hiroyuki, Nagano, Keisuke, Sudo, Toshiki, Iyori, Mitsuhiro, Matsuoka, Hiroyuki, and Yoshida, Shigeto
- Abstract
We previously identified an anti-platelet protein, anopheline anti-platelet protein (AAPP), from the salivary gland of female Anopheles stephensi (a mosquito vector of human malaria). AAPP specifically blocks platelet adhesion to collagen by binding directly to collagen and subsequently causing platelet aggregation. The aim of this study was to identify the active region of AAPP responsible for the anti-thrombotic activity because we hypothesized that AAPP could be used as a candidate anti-platelet drug. Various truncated forms of AAPP were produced using an Escherichia coli expression system. Each protein was examined for binding activities to soluble/fibrillar collagen and anti-thrombotic activity using a plate assay and platelet/whole blood aggregation study, respectively. Among the truncated forms examined, only a protein encoded by exon 3-4 (rAAPPex3-4) effectively bound to soluble/fibrillar collagen in a concentration-dependent and saturable manner. The EC50 values of full-length AAPP and rAAPPex3-4 for soluble collagen binding were 35 nM and 36 nM, respectively. In contrast to soluble collagen, there was a difference in binding affinity to fibrillar collagen between full-length AAPP and rAAPPex3-4, with EC50 values of 31 nM and 51 nM, respectively. rAAPPex3-4 also inhibited aggregation of platelets/whole blood, and the IC50 values of full-length AAPP and rAAPPex3-4 for platelet aggregation were 35 nM and 93 nM, respectively. These results indicated that the essential moiety of AAPP for collagen binding and anti-thrombotic activity was in the region encoded by exon 3-4, which is highly conserved among the counterpart regions of other mosquito species. [ABSTRACT FROM AUTHOR]
- Published
- 2013
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- View/download PDF
28. Maintenance of perioperative antiplatelet and anticoagulant therapy for vitreoretinal surgery.
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Ryan, Andrea, Saad, Tahira, Kirwan, Caitriona, Keegan, David J, and Acheson, Robert W
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- *
PLATELET aggregation inhibitors , *ANTICOAGULANTS , *PROLIFERATIVE vitreoretinopathy , *ASPIRIN , *VITREOUS body , *VITRECTOMY , *ANTERIOR chamber (Eye) , *HEMORRHAGE , *THERAPEUTICS - Abstract
Background The objective of this study was to prospectively assess the risk of bleeding from vitreoretinal surgery in a continuous unbiased cohort of patients taking unsuspended antiplatelet or anticoagulant therapy. Design Prospective hospital-based study. Participants Eighty-five patients taking unsuspended aspirin, clopidogrel and/or warfarin therapy undergoing all forms of vitreoretinal surgery at The Mater Misericordiae University and The Mater Private Hospital, Dublin, Ireland. Methods Consecutive patients undergoing vitreoretinal surgery taking unsuspended antiplatelet or anticoagulant therapy over a 1-year period were included in this prospective study to evaluate the intraoperative and postoperative bleeding complications. Main Outcome Measures The intraoperative and postoperative bleeding rates. Results One hundred and seven vitreoretinal procedures were performed on 85 patients taking unsuspended antiplatelet or anticoagulant therapy. The intraoperative bleeding rate was 23%, the majority of which consisted of mild bleeding into the vitreous cavity during vitrectomy. The postoperative bleeding rate was 22%, consisting of 3.7% anterior chamber haemorrhage, 11% dispersed vitreous cavity haemorrhage, 4.7% dense vitreous cavity haemorrhage, 0.9% subretinal haemorrhage and 1.9% localized choroidal haemorrhage. The single greatest significant independent predictor of intraoperative bleeding was proliferative diabetic retinopathy and of postoperative bleeding was the presence of diabetes mellitus. Conclusions There were no cases of uncontrolled intraoperative haemorrhage or serious postoperative choroidal haemorrhage. Mild haemorrhagic oozing during vitrectomy and dispersed vitreous cavity haemorrhage postoperatively were common. For the majority of patients taking antiplatelet or anticoagulant medication, these agents can be safely continued in the vitreoretinal surgical perioperative period. [ABSTRACT FROM AUTHOR]
- Published
- 2013
- Full Text
- View/download PDF
29. Antiplatelet therapy in ENT surgery: a review.
- Author
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Sylvester, D C and Coatesworth, A P
- Subjects
- *
SURGICAL therapeutics , *INTRAOPERATIVE monitoring , *ASPIRIN , *THROMBOSIS risk factors , *HEMORRHAGE risk factors , *CLOPIDOGREL , *PHOSPHODIESTERASE inhibitors , *DISEASES , *MEDICAL protocols , *MORTALITY , *OPERATIVE otolaryngology , *VITAL statistics , *DRUG-eluting stents , *PLATELET aggregation inhibitors , *THERAPEUTICS - Abstract
Introduction:Antiplatelet agents such as aspirin and clopidogrel are increasingly encountered in clinical practice. Otorhinolaryngological surgeons are involved in the peri-operative decision of whether to continue treatment and risk haemorrhage or to discontinue treatment and risk thrombosis.Methods:Literature relating to the risk of spontaneous or operative haemorrhage was reviewed. The morbidity and mortality associated with cessation of agents was evaluated. Published guidelines were also evaluated. A protocol for the management of antiplatelet agents in the peri-operative period, with particular reference to ENT operations, is presented.Conclusion:Significant morbidity and mortality is associated with the premature cessation of antiplatelet agents. Data from cardiac surgery suggest that operative blood loss only marginally increases in patients on aspirin and clopidogrel. However, the management of antiplatelet agents in the peri-operative period should be made after multidisciplinary consultation. [ABSTRACT FROM PUBLISHER]
- Published
- 2012
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30. Anopheline anti-platelet protein from a malaria vector mosquito has anti-thrombotic effects in vivo without compromising hemostasis
- Author
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Hayashi, Hideki, Kyushiki, Hiroyuki, Nagano, Keisuke, Sudo, Toshiki, Matsuoka, Hiroyuki, and Yoshida, Shigeto
- Subjects
- *
MALARIA , *PLATELET aggregation inhibitors , *ANOPHELES stephensi , *THROMBOEMBOLISM , *ASPIRIN , *HEMOSTASIS , *LABORATORY mice - Abstract
Abstract: Introduction: The saliva of blood-feeding animals (e.g., mosquitoes, ticks, bats) has pharmacological activities that facilitate efficient blood-sucking. We previously identified a unique anti-platelet protein, anopheline anti-platelet protein (AAPP), from the salivary gland of female Anopheles stephensi (human malaria vector mosquito). AAPP specifically blocks platelet adhesion to collagen by binding directly to collagen and subsequently aggregating platelets. To examine the potential of AAPP as a therapeutic agent, we investigated the in vivo anti-thrombotic effects of AAPP. Materials and Methods: Effects of AAPP on whole blood/platelet aggregation in mice were examined. AAPP was also challenged in an established model of pulmonary thromboembolism in mice. We simultaneously investigated the side-effects of the protein (prolongation of bleeding time and coagulation time). Aspirin was used as a positive control for comparison of anti-thrombotic effects. Results and Conclusions: AAPP inhibited whole blood aggregation induced by collagen at 10mg/kg body weight. AAPP prevented pulmonary death at a lower dose (3mg/kg) without prolongation of bleeding time compared with aspirin (100mg/kg) that compromised hemostasis. AAPP and aspirin did not affect coagulation time. These results indicate that AAPP has great potential as a new anti-platelet agent with a better risk/benefit ratio than that seen with aspirin (the most widely used anti-platelet agent). [Copyright &y& Elsevier]
- Published
- 2012
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31. The effects of cytochalasin D and abciximab on hemostasis in canine whole blood assessed by thromboelastography and the PFA-100® platelet function analyzer system.
- Author
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Brainard, Benjamin M., Abed, Janan M., and Koenig, Amie
- Subjects
CYTOCHALASINS ,ABCIXIMAB (Drug) ,HEMOSTASIS ,BLOOD ,VETERINARY medicine - Abstract
The article presents a study which aimed to determine the effects of cytochalasin D and abciximab on hemostatic parameters in canine citrated whole blood. The study found no evidence that the addition of abciximab to canine citrated whole blood would affect the thromboelastography (TEG) tracing. However, abciximab was found to inhibit platelet aggregation under shear stress.
- Published
- 2011
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32. Bleeding associated with current therapies for acute coronary syndrome: What are the mechanisms?
- Author
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Cavender, Matthew and Rao, Sunil
- Abstract
Coronary artery plaque rupture results in platelet adhesion and activation, the release of adenosine diphosphate (ADP), thromboxane A, and the generation of thrombin. These factors propagate further platelet activation through a positive feedback mechanism, resulting in the formation of a platelet plug. The treatment of patients with ACS is centered upon the prompt initiation of both antiplatelet and anticoagulant agents. The widespread use of antiplatelet and anticoagulant agents has resulted in a significant reduction in morbidity and mortality but has also increased the risk for bleeding complications. Female gender, advanced age, low body mass index (BMI), low creatinine clearance, and the use of percutaneous coronary intervention have been consistently shown to be risk factors for bleeding. While bleeding was thought to be a necessary side effect and of little clinical significance in the past, it is now clear that bleeding is an independent predictor of adverse ischemic events and mortality. The mechanisms underlying this relationship are not yet fully elucidated and are likely multifactorial (direct effects of bleeding, increased incidence of blood transfusions, less use of antiplatelet agents in both the short and long term). Current treatment guidelines for the use of antithrombotic therapy recommend utilization of evidence-based therapies using clinical strategies shown to minimize the risk of bleeding should when possible. Novel therapies that minimize bleeding risk while providing protection against thrombotic events are needed and may improve outcomes among patients with ACS. Condensed Abstract: Multiple platelet activation pathways and the coagulation cascade regulate hemostasis and thrombosis. Current antiplatelet and anticoagulant therapies for acute coronary syndromes (ACS) act on distinct sites in the pathways for platelet activation and coagulation. While these therapies are effective in reducing the morbidity and mortality associated with ACS, they are associated with a clinically significant increase in the risk of bleeding events. Novel therapies that minimize bleeding risk while providing protection against thrombotic events may improve outcomes in patients with ACS. [ABSTRACT FROM AUTHOR]
- Published
- 2010
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- View/download PDF
33. An in vitro method for screening anti-platelet agents using a microchannel array flow analyzer.
- Author
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Kamada, Haruhiko, Okamoto, Takayuki, Hayashi, Tatsuya, and Suzuki, Koji
- Abstract
New in vitro methods are desirable for the analysis of platelet aggregation and screening novel anti-platelet agents using whole blood. To this end, we examined platelet aggregation and thrombus formation in whole human blood from healthy volunteers using a microchannel array flow analyzer (MC-FAN). Platelet aggregation in whole blood, treated with the activating agents ADP, collagen or ristocetin was detected in the MC-FAN by measuring the decrease in flow rate as a function of agent concentration. The results were compared with aggregation in platelet rich plasma (PRP) in a conventional aggregometer, as measured by the increase in optical density. The MC-FAN detected platelet aggregation in whole blood at two- to four-fold lower concentrations of agonist compared to those in PRP in the aggregometer. Anti-platelet agents attenuated the decrease in blood flow rate in the MC-FAN by inhibiting fibrin formation and platelet aggregation, but anticoagulants only inhibited fibrin formation and did not affect blood flow rates. These findings suggest that the MC-FAN system may be a useful method for the evaluation of platelet activation and facilitate the development of novel anti-platelet agents. [ABSTRACT FROM AUTHOR]
- Published
- 2010
- Full Text
- View/download PDF
34. Patients under anti-platelet therapy.
- Author
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Albaladejo, Pierre and Samama, Charles Marc
- Subjects
PLATELET aggregation inhibitors ,SURGICAL stents ,DRUG side effects ,ASPIRIN ,SURGICAL complications ,HEMORRHAGE ,THROMBOSIS ,BLOOD coagulation disorders ,BLOOD platelets ,BLOOD platelet aggregation ,PHARMACODYNAMICS ,THERAPEUTICS - Abstract
Interruption or maintenance of anti-platelet agents (APAs) during surgical or invasive procedures is associated with an increase in cardiovascular or haemorrhagic complications, respectively. The pharmacology and indications of aspirin, clopidogrel and prasugrel are summarised. The utility and risks of interruption, the optimal delay between stent implantation and surgery, the appropriate window of preoperative interruption, the potential usefulness of bridging, the safest delay between the end of surgery and resumption of APA are detailed in this review. Some non- evidence-based suggestions are given to help the physicians in their daily clinical practice. [Copyright &y& Elsevier]
- Published
- 2010
- Full Text
- View/download PDF
35. Point-of-care assessment of antiplatelet agents in the perioperative period: a review.
- Author
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GIBBS, N. M.
- Subjects
- *
POINT-of-care testing , *ANTICOAGULANTS , *DRUG side effects , *HEMOSTASIS , *THROMBELASTOGRAPHY , *BLOOD coagulation - Abstract
The article discusses the strengths and limitations of point-of-care techniques for the detection of antiplatelet drug effects. Global assessments of haemostasis are not specific for platelet function and are insensitive to cyclooxygenase. The most widely used technique was the laboratory turbidometric platelet aggregometry. Thrombelastography provides a real time assessment of the clot's viscoelastic properties as it forms ex vivo. The functions of Clot Signature Analyzer and Platelet Activated Clotting Test are also described.
- Published
- 2009
36. Haemorrhagic stroke during anti-platelet therapy.
- Author
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Cattaneo, M.
- Subjects
ATHEROSCLEROSIS ,CYCLOOXYGENASES ,ISOPENTENOIDS ,ADENINE nucleotides ,BLOOD platelet activation ,NONSTEROIDAL anti-inflammatory agents ,ANTICOAGULANTS - Abstract
Drugs that inhibit platelet function are widely used to decrease the risk of occlusive arterial events in patients with atherosclerosis. There are three families of anti-platelet agents with proven clinical efficacy: (1) cyclo-oxygenase inhibitors, such as aspirin; (2) adenosine diphosphate receptor antagonists, such as the thienopyridine compounds ticlopidine and clopidogrel; and (3) glycoprotein IIb/IIIa antagonists. All these drugs are used during coronary interventions and in the medical management of acute coronary syndromes, while only aspirin and thienopyridine compounds are used in the long-term prevention of cardiovascular and cerebrovascular events in patients at risk. Despite the good risk-to-benefit ratio of anti-platelet agents, the risk of severe bleeding complications, including cerebral haemorrhage, is slightly increased, albeit to a much lesser extent than that associated with the use of other antithrombotic drugs, such as anticoagulants or thromobolytic agents. In addition, it must be noted that the increased incidence of haemorrhagic stroke is usually outweighed by a significant decrease in the incidence of ischaemic strokes. The combination of aspirin and vitamin K antagonists may be associated with the heightened risk of cerebral haemorrhage, compared to treatment with either drug alone. [ABSTRACT FROM AUTHOR]
- Published
- 2008
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37. Study for determination of the optimal cessation period of therapy with anti-platelet agents prior to invasive endoscopic procedures.
- Author
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Komatsu, Tomoko, Tamai, Yoshiko, Takami, Hideki, Yamagata, Kazufumi, Fukuda, Shinsaku, and Munakata, Akihiro
- Subjects
- *
ENDOSCOPIC surgery , *HEMORRHAGE , *BLOOD platelets , *BLOOD cells , *NONSTEROIDAL anti-inflammatory agents , *ANTICOAGULANTS - Abstract
Background. Anti-platelet agents are widely used for the treatment and prevention of thrombotic diseases. On the other hand, continuation of anti-platelet agents increases the risk of hemorrhagic complications in gastrointestinal endoscopy, and cessation of anti-platelet agents exposes the patient to the risk of thromboembolism. Only a few studies have actually studied the whether a cessation period is required prior to endoscopic procedures and if so, the optional duration of the period. The present study assessed the time course of primary hemostasis after the cessation of anti-platelet agents. Methods. Eleven healthy men (age range, 19-29 years) were assigned to each of the following regimens: aspirin (ASA; 100 mg/day), ticlopidine (TP; 300mg/ day), and a combination of ASA (100mg/day) and TP (300 mg/day) for 7 days. There was a washout period of more than 3 weeks between each regimen. A quantitative bleeding time test (QBT test) and platelet aggregation test were performed before the beginning of administration, on the last day of administration, and at 1, 3, and 5 days after cessation, and also at 7 days after cessation for the combination regimen. Results. The average bleeding time (BT) and total bleeding loss volume (Tv) of the 11 subjects after administration of the three regimens were significantly increased compared with those before administration. With the administration of ASA, increases of BT and Tv at 3 days after cessation were not significant. The Tv at 5 days after cessation of TP was not significantly increased. With the combination regimen, the BT and Tv at 7 days after cessation were not significantly increased. Conclusions. A 3-day cessation period for ASA, a 5-day cessation period for TP, and a 7-day cessation period for ASA + TP administration seem to be sufficient. [ABSTRACT FROM AUTHOR]
- Published
- 2005
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- View/download PDF
38. Managing Anti-Platelet Therapy in Thrombocytopaenic Patients with Haematological Malignancy: A Multinational Clinical Vignette-Based Experiment
- Author
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Leader, Avi, Leader, Avi, Ten Cate, Vincent, Ten Cate-Hoek, Anna J., Spectre, Galia, Beckers, Erik A. M., Raanani, Pia, Giaccherini, Cinzia, Pereg, David, Schouten, Harry C., Falanga, Anna, Ten Cate, Hugo, Leader, Avi, Leader, Avi, Ten Cate, Vincent, Ten Cate-Hoek, Anna J., Spectre, Galia, Beckers, Erik A. M., Raanani, Pia, Giaccherini, Cinzia, Pereg, David, Schouten, Harry C., Falanga, Anna, and Ten Cate, Hugo
- Abstract
Data on anti-platelet therapy (APT) for prevention of atherothrombotic events in thrombocytopaenic cancer patients is lacking. We aimed to identify patient and physician characteristics associated with APT management in thrombocytopaenic patients with haematological malignancy. A clinical vignette-based experiment was designed. Eleven haematologists were interviewed, identifying five variable categories. Next, 18 hypothetical vignettes were generated. Each physician received three vignettes and chose to: hold all APT; continue APT without platelet transfusion support; or continue APT with platelet transfusion support. The survey was distributed to haematologists and thrombosis specialists in three countries. Multivariate cluster robust Poisson regression models were used to calculate relative risks (RRs) of using one management option (over the other) for each variable in comparison to a reference variable. A total of 145 physicians answered 434 cases. Clinicians were more likely to hold APT in case of 20,000/mu L platelets (vs. 40,000/mu L; RR for continuing: 0.82 [95% confidence interval: 0.75-0.91]), recent major gastrointestinal bleeding (vs. none; RR 0.81 [0.72-0.92]) and when the physician worked at a university-affiliated community hospital (vs. non-academic community hospital; RR 0.84 [0.72-0.98]). Clinicians were more likely to continue APT in ST elevation myocardial infarction with dual APT (vs. unstable angina with single APT; RR 1.31 [1.18-1.45]) and when there were institutional protocols guiding management (vs. none; RR 1.15 [1.03-1.27]). When APT was continued, increased platelet transfusion targets were used in 34%. In summary, the decision process is complex and affected by multiple patient and physician characteristics. Platelet transfusions were frequently chosen to support APT, although no evidence supports this practice.
- Published
- 2019
39. Anticoagulant therapy, anti-platelet agents and gastrointestinal endoscopy.
- Author
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Miller, Ashley, Mcgill, Darryl, Bassett, Mark, and Bassett
- Subjects
- *
ANTICOAGULANTS , *THROMBOEMBOLISM , *ENDOSCOPY - Abstract
Background: The increasing use of anticoagulant therapy and anti-platelet agents in the primary and secondary prevention of cardiovascular, cerebrovascular and venous thromboembolic disease has increased the need for guidelines for managing these agents prior to gastrointestinal endoscopy, particularly if therapeutic manoeuvres are required. The continuation of anticoagulant therapy increases the risk of haemorrhagic complications of gastrointestinal endoscopy. Temporary suspension of anticoagulant therapy exposes the patient to the risk of thromboembolism associated with the underlying condition requiring anticoagulant treatment. Conclusions: This article reviews the literature and proposes guidelines for the management of patients taking anticoagulant and anti-platelet agents who require gastrointestinal endoscopy. [ABSTRACT FROM AUTHOR]
- Published
- 1999
- Full Text
- View/download PDF
40. Managing Anti-Platelet Therapy in Thrombocytopaenic Patients with Haematological Malignancy: A Multinational Clinical Vignette-Based Experiment
- Author
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Erik A M Beckers, Arina J. ten Cate-Hoek, Avi Leader, Anna Falanga, Cinzia Giaccherini, Galia Spectre, Pia Raanani, Vincent ten Cate, Hugo ten Cate, David Pereg, Harry C. Schouten, Leader, A, Ten Cate, V, Ten Cate-Hoek, A, Spectre, G, Beckers, E, Raanani, P, Giaccherini, C, Pereg, D, Schouten, H, Falanga, A, Ten Cate, H, RS: Carim - B04 Clinical thrombosis and Haemostasis, RS: CARIM - R1.04 - Clinical thrombosis and haemostasis, Interne Geneeskunde, RS: CAPHRI - R5 - Optimising Patient Care, Epidemiologie, Biochemie, MUMC+: MA Hematologie (9), RS: Carim - B01 Blood proteins & engineering, RS: CARIM - R1.01 - Blood proteins & engineering, RS: GROW - R3 - Innovative Cancer Diagnostics & Therapy, MUMC+: MA Alg Interne Geneeskunde (9), and MUMC+: HVC Pieken Trombose (9)
- Subjects
0301 basic medicine ,2013 ACCF/AHA GUIDELINE ,Myocardial Infarction ,arterial thrombosis ,SECONDARY PREVENTION ,030204 cardiovascular system & hematology ,anti-platelet agents, arterial thrombosis, cancer , thrombocytopaenia ,Random Allocation ,0302 clinical medicine ,Surveys and Questionnaires ,Medicine ,Poisson Distribution ,Israel ,thrombocytopaenia ,Netherlands ,Hematology ,Thrombosis ,Community hospital ,Italy ,Hematologic Neoplasms ,symbols ,Blood Platelets ,medicine.medical_specialty ,Gastrointestinal bleeding ,Decision Making ,Cardiology ,Hemorrhage ,CANCER-PATIENTS ,Platelet Transfusion ,AMERICAN-COLLEGE ,anti-platelet agents ,03 medical and health sciences ,symbols.namesake ,Internal medicine ,cancer ,PLATELET TRANSFUSIONS ,Humans ,ASSOCIATION TASK-FORCE ,Poisson regression ,CARDIOVASCULAR EVENTS ,VENOUS THROMBOEMBOLISM ,business.industry ,Unstable angina ,ACUTE CORONARY SYNDROMES ,ELEVATION MYOCARDIAL-INFARCTION ,medicine.disease ,Thrombocytopenia ,Confidence interval ,030104 developmental biology ,Platelet transfusion ,Relative risk ,business ,Platelet Aggregation Inhibitors - Abstract
Data on anti-platelet therapy (APT) for prevention of atherothrombotic events in thrombocytopaenic cancer patients is lacking. We aimed to identify patient and physician characteristics associated with APT management in thrombocytopaenic patients with haematological malignancy. A clinical vignette-based experiment was designed. Eleven haematologists were interviewed, identifying five variable categories. Next, 18 hypothetical vignettes were generated. Each physician received three vignettes and chose to: hold all APT; continue APT without platelet transfusion support; or continue APT with platelet transfusion support. The survey was distributed to haematologists and thrombosis specialists in three countries. Multivariate cluster robust Poisson regression models were used to calculate relative risks (RRs) of using one management option (over the other) for each variable in comparison to a reference variable. A total of 145 physicians answered 434 cases. Clinicians were more likely to hold APT in case of 20,000/µL platelets (vs. 40,000/µL; RR for continuing: 0.82 [95% confidence interval: 0.75–0.91]), recent major gastrointestinal bleeding (vs. none; RR 0.81 [0.72–0.92]) and when the physician worked at a university-affiliated community hospital (vs. non-academic community hospital; RR 0.84 [0.72–0.98]). Clinicians were more likely to continue APT in ST elevation myocardial infarction with dual APT (vs. unstable angina with single APT; RR 1.31 [1.18–1.45]) and when there were institutional protocols guiding management (vs. none; RR 1.15 [1.03–1.27]). When APT was continued, increased platelet transfusion targets were used in 34%. In summary, the decision process is complex and affected by multiple patient and physician characteristics. Platelet transfusions were frequently chosen to support APT, although no evidence supports this practice.
- Published
- 2019
41. Platelet Effects of Anti-diabetic Therapies: New Perspectives in the Management of Patients with Diabetes and Cardiovascular Disease.
- Author
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Nusca, Annunziata, Tuccinardi, Dario, Pieralice, Silvia, Giannone, Sara, Carpenito, Myriam, Monte, Lavinia, Watanabe, Mikiko, Cavallari, Ilaria, Maddaloni, Ernesto, Ussia, Gian Paolo, Manfrini, Silvia, and Grigioni, Francesco
- Subjects
CARDIOVASCULAR diseases ,PEOPLE with diabetes ,DRUG interactions ,BLOOD platelets ,MEDICAL research - Abstract
In type 2 diabetes, anti-thrombotic management is challenging, and current anti-platelet agents have demonstrated reduced efficacy. Old and new anti-diabetic drugs exhibited—besides lowering blood glucose levels—direct and indirect effects on platelet function and on thrombotic milieu, eventually conditioning cardiovascular outcomes. The present review summarizes existing evidence on the effects of glucose-lowering agents on platelet properties, addressing pre-clinical and clinical research, as well as drug–drug interactions with anti-platelet agents. We aimed at expanding clinicians' understanding by highlighting new opportunities for an optimal management of patients with diabetes and cardiovascular disease. We suggest how an improvement of the thrombotic risk in this large population of patients may be achieved by a careful and tailored combination of anti-diabetic and anti-platelet therapies. [ABSTRACT FROM AUTHOR]
- Published
- 2021
- Full Text
- View/download PDF
42. Two doses of rivaroxaban versus aspirin for prevention of recurrent venous thromboembolism
- Subjects
pulmonary embolism ,prevention ,Venous thrombosis ,deep-vein thrombosis ,anti-platelet agents - Abstract
Patients with unprovoked venous thromboembolism (VTE) are at high risk for recurrence. Although rivaroxaban is effective for extended VTE treatment at a dose of 20 mg once daily, use of the 10 mg dose may further improve its benefit-to-risk ratio. Low-dose aspirin also reduces rates of recurrent VIE, but has not been compared with anticoagulant therapy. The EINSTEIN CHOICE study is a multicentre, randomised, double-blind, active-controlled, event-driven study comparing the efficacy and safety of two once daily doses of rivaroxaban (20 and 10 mg) with aspirin (100 mg daily) for the prevention of recurrent VTE in patients who completed 6-12 months of anticoagulant therapy for their index acute VIE event. All treatments will be given for 12 months. The primary efficacy objective is to determine whether both doses of rivaroxaban are superior to aspirin for the prevention of symptomatic recurrent VIE, while the principal safety outcome is the incidence of major bleeding. The trial is anticipated to enrol 2,850 patients from 230 sites in 31 countries over a period of 27 months. In conclusion, the EINSTEIN CHOICE study will provide new insights into the optimal antithrombotic strategy for extended VIE treatment by comparing two doses of rivaroxaban with aspirin.
- Published
- 2015
- Full Text
- View/download PDF
43. Atorvastatin and clopidogrel. A Possible drug interaction with clinical consequences still unknown
- Author
-
Lévesque, H.
- Published
- 2003
- Full Text
- View/download PDF
44. Microfludic platforms for the evaluation of anti-platelet agent efficacy under hyper-shear conditions associated with ventricular assist devices
- Author
-
Alberto Redaelli, Marco Rasponi, Filippo Consolo, Marvin J. Slepian, Annalisa Dimasi, Danny Bluestein, Gianfranco Beniamino Fiore, Dimasi, Annalisa, Rasponi, Marco, Consolo, Filippo, Fiore, Gianfranco B., Bluestein, Danny, Slepian, Marvin J., and Redaelli, Alberto
- Subjects
Ticagrelor ,Adenosine ,medicine.medical_treatment ,Drug Evaluation, Preclinical ,02 engineering and technology ,030204 cardiovascular system & hematology ,Pharmacology ,Microfluidic flow-based assay ,Efficacy ,0302 clinical medicine ,Microfluidic flow-based assays ,Lab-On-A-Chip Devices ,Platelet ,Mechanical circulatory support device ,Anti-platelet agents ,Shear stre ,Ventricular assist device ,Anti-platelet agent ,Shear Strength ,Mechanical circulatory support devices ,medicine.drug ,0206 medical engineering ,Biophysics ,Biomedical Engineering ,Article ,Ventricular assist devices ,03 medical and health sciences ,Sonication ,Drug efficacy ,Platelet activation ,Shear stress ,Shear-mediated platelet activation ,Therapeutic index ,medicine ,cardiovascular diseases ,Thrombus ,Adverse effect ,Aspirin ,business.industry ,medicine.disease ,020601 biomedical engineering ,Biophysic ,Heart-Assist Devices ,business ,Platelet Aggregation Inhibitors ,Biomedical engineering - Abstract
Thrombus formation is a major adverse event affecting patients implanted with ventricular assist devices (VADs). Despite anti-thrombotic drug administration, thrombotic events remain frequent within the first year post-implantation. Platelet activation (PA) is an essential process underling thrombotic adverse events in VAD systems. Indeed, abnormal shear forces, correlating with specific flow trajectories of VADs, are strong agonists mediating PA. To date, the ability to determine efficacy of anti-platelet (AP) agents under shear stress conditions is limited. Here, we present a novel microfluidic platform designed to replicate shear stress patterns of a clinical VAD, and use it to compare the efficacy of two AP agents in vitro. Gel-filtered platelets were incubated with i) acetylsalicylic acid (ASA) and ii) ticagrelor, at two different concentrations (ASA: 125 and 250[U+202F]μM; ticagrelor: 250 and 500[U+202F]nM) and were circulated in the VAD-emulating microfluidic platform using a peristaltic pump. GFP was collected after 4 and 52 repetitions of exposure to the VAD shear pattern and tested for shear-mediated PA. ASA significantly inhibited PA only at 2-fold higher concentration (250[U+202F]μM) than therapeutic dose (125[U+202F]μM). The effect of ticagrelor was not dependent on drug concentration, and did not show significant inhibition with respect to untreated control. This study demonstrates the potential use of microfluidic platforms as means of testing platelet responsiveness and AP drug efficacy under complex and realistic VAD-like shear stress conditions.
- Published
- 2017
45. Intracranial hemorrhage and platelet transfusion after administration of anti-platelets agents: Fukushima Prefecture
- Author
-
Masahiro Ichikawa, Hitoshi Ohto, Yuhko Suzuki, Takeshi Goto, Kiyoshi Saito, Jun Sakuma, Kenneth E. Nollet, Yoichi Watanabe, Yugo Kishida, Taku Sato, Keiko Oda, and Masahiro Sato
- Subjects
Male ,medicine.medical_specialty ,education ,Intracranial hemorrhage ,Context (language use) ,Platelet Transfusion ,030204 cardiovascular system & hematology ,03 medical and health sciences ,Aortic aneurysm ,0302 clinical medicine ,Hematoma ,Internal medicine ,Diabetes mellitus ,494.627 ,mental disorders ,Medicine ,Humans ,cardiovascular diseases ,Aged ,Intracerebral hemorrhage ,business.industry ,Anti-platelet agents ,General Medicine ,medicine.disease ,492.26 ,Surgery ,nervous system diseases ,Platelet transfusion ,Platelet aggregation inhibitor ,Female ,Original Article ,business ,Intracranial Hemorrhages ,030217 neurology & neurosurgery ,psychological phenomena and processes ,Platelet Aggregation Inhibitors ,Case series - Abstract
We conducted a case series study to assess intracerebral hemorrhage (ICH) in the context of anti-platelets agents (APAs) and platelet (PLT) transfusion in Fukushima Prefecture.This study included patients who were newly diagnosed with ICH between January 2008 and June 2014 in the neurosurgical hospitals of Fukushima Prefecture. Four of ten neurosurgical hospitals responded to our questionnaire. Of 287 ICH patients, 51 (20.6%) were on APA therapy, of whom PLT transfusion was given to only one persistently bleeding patient who was on dual anti-platelet therapy. In a follow-up survey, 30 out of 51 ICH patients on APA therapy, average age 75 years, were analyzed, of whom 21 (70%) were male. The predominant underlying disease was diabetes mellitus. It is interesting to note that peripheral artery disease and aortic aneurysm were among the indications for APAs. ICH was mainly observed supratentorially. Hematoma enlargement was observed in 13 (44.8%) cases. By day 7, 3 patients (10%) had died from complications of ICH. In this study, we show that ICH during APA therapy matched what was observed in Kanagawa Prefecture. Whether or not a national survey differs, we anticipate greater statistical validity and an opportunity to improve patient outcomes in Japan and around the world.
- Published
- 2016
46. Effects of Pre-Hospital Antiplatelet Therapy on the Incidence of ARDS.
- Author
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Jin W, Chuang CC, Jin H, Ye J, Kandaswamy E, Wang L, and Zuo L
- Subjects
- Aspirin, Hospitals, Humans, Incidence, Prospective Studies, Retrospective Studies, Platelet Aggregation Inhibitors, Respiratory Distress Syndrome drug therapy, Respiratory Distress Syndrome epidemiology
- Abstract
Background: Clinical observations on the potential of pre-hospital antiplatelet therapy in preventing ARDS have been inconsistent. To further the correlation between antiplatelet therapy and ARDS, we conducted a meta-analysis to evaluate the effects of pre-hospital antiplatelet therapy on subjects with ARDS., Methods: A literature search in major data banks was performed. We included prospective and retrospective cohorts, case-control trials, and randomized controlled trials that compared the ARDS incidence in subjects with or without pre-hospital antiplatelet agents., Results: Meta-analysis of 7 studies (a total of 30,291 subjects) showed significantly lower odds of ARDS in the pre-hospital antiplatelet therapy group compared with subjects with no pre-hospital antiplatelet therapy (odds ratio 0.68, 95% CI 0.56-0.83; P < .001). However, ARDS mortalities in the hospital and ICUs were not affected., Conclusions: These findings indicated that pre-hospital antiplatelet therapy was associated with a reduced rate of ARDS but had no effect on the mortality in the subjects at high risk., (Copyright © 2020 by Daedalus Enterprises.)
- Published
- 2020
- Full Text
- View/download PDF
47. Two doses of rivaroxaban versus aspirin for prevention of recurrent venous thromboembolism
- Author
-
Weitz, Jeffrey I., Bauersachs, Rupert, Beyer-Westendorf, Jan, Bounameaux, Henri, Brighton, Timothy A., Cohen, Alexander T., Davidson, Bruce L., Holberg, Gerlind, Kakkar, Ajay, Lensing, Anthonie W. A., Prins, Martin, Haskell, Lloyd, van Belien, Bonno, Verhamme, Peter, Wells, Philip S., Prandoni, Paolo, Epidemiologie, MUMC+: KIO Kemta (9), and RS: CAPHRI - R5 - Optimising Patient Care
- Subjects
pulmonary embolism ,prevention ,Venous thrombosis ,deep-vein thrombosis ,anti-platelet agents - Abstract
Patients with unprovoked venous thromboembolism (VTE) are at high risk for recurrence. Although rivaroxaban is effective for extended VTE treatment at a dose of 20 mg once daily, use of the 10 mg dose may further improve its benefit-to-risk ratio. Low-dose aspirin also reduces rates of recurrent VIE, but has not been compared with anticoagulant therapy. The EINSTEIN CHOICE study is a multicentre, randomised, double-blind, active-controlled, event-driven study comparing the efficacy and safety of two once daily doses of rivaroxaban (20 and 10 mg) with aspirin (100 mg daily) for the prevention of recurrent VTE in patients who completed 6-12 months of anticoagulant therapy for their index acute VIE event. All treatments will be given for 12 months. The primary efficacy objective is to determine whether both doses of rivaroxaban are superior to aspirin for the prevention of symptomatic recurrent VIE, while the principal safety outcome is the incidence of major bleeding. The trial is anticipated to enrol 2,850 patients from 230 sites in 31 countries over a period of 27 months. In conclusion, the EINSTEIN CHOICE study will provide new insights into the optimal antithrombotic strategy for extended VIE treatment by comparing two doses of rivaroxaban with aspirin.
- Published
- 2015
48. Intracranial hemorrhage and platelet transfusion after administration of anti-platelets agents: Fukushima Prefecture
- Author
-
Suzuki, Yuhko, Sato, Taku, Sakuma, Jun, Ichikawa, Masahiro, Kishida, Yugo, Oda, Keiko, Watanabe, Yoichi, Goto, Takeshi, Sato, Masahiro, Nollet, Kenneth E, Saito, Kiyoshi, Ohto, Hitoshi, Suzuki, Yuhko, Sato, Taku, Sakuma, Jun, Ichikawa, Masahiro, Kishida, Yugo, Oda, Keiko, Watanabe, Yoichi, Goto, Takeshi, Sato, Masahiro, Nollet, Kenneth E, Saito, Kiyoshi, and Ohto, Hitoshi
- Abstract
type:Text, We conducted a case series study to assess intracerebral hemorrhage (ICH) in the context of anti-platelets agents (APAs) and platelet (PLT) transfusion in Fukushima Prefecture.This study included patients who were newly diagnosed with ICH between January 2008 and June 2014 in the neurosurgical hospitals of Fukushima Prefecture. Four of ten neurosurgical hospitals responded to our questionnaire. Of 287 ICH patients, 51 (20.6%) were on APA therapy, of whom PLT transfusion was given to only one persistently bleeding patient who was on dual anti-platelet therapy. In a follow-up survey, 30 out of 51 ICH patients on APA therapy, average age 75 years, were analyzed, of whom 21 (70%) were male. The predominant underlying disease was diabetes mellitus. It is interesting to note that peripheral artery disease and aortic aneurysm were among the indications for APAs. ICH was mainly observed supratentorially. Hematoma enlargement was observed in 13 (44.8%) cases. By day 7, 3 patients (10%) had died from complications of ICH. In this study, we show that ICH during APA therapy matched what was observed in Kanagawa Prefecture. Whether or not a national survey differs, we anticipate greater statistical validity and an opportunity to improve patient outcomes in Japan and around the world.
- Published
- 2016
49. Cardiac medications and their association with cardiovascular events in incident dialysis patients: Cause or effect?
- Author
-
Charles A. Herzog, Allan J. Collins, Areef Ishani, and Robert N. Foley
- Subjects
Adult ,Male ,medicine.medical_specialty ,medicine.medical_treatment ,Population ,Adrenergic beta-Antagonists ,Myocardial Infarction ,Angiotensin-Converting Enzyme Inhibitors ,Comorbidity ,anti-platelet agents ,cardiovascular disease ,Internal medicine ,Cause of Death ,medicine ,Humans ,HMG-CoA reductase inhibitors ,education ,Dialysis ,Cause of death ,Aged ,Proportional Hazards Models ,Heart Failure ,Peripheral Vascular Diseases ,education.field_of_study ,Proportional hazards model ,business.industry ,Incidence ,Warfarin ,Middle Aged ,medicine.disease ,Calcium Channel Blockers ,Surgery ,warfarin ,Clinical trial ,Stroke ,Cardiovascular Diseases ,Nephrology ,Cohort ,Multivariate Analysis ,dialysis ,Kidney Failure, Chronic ,Female ,Hydroxymethylglutaryl-CoA Reductase Inhibitors ,business ,Platelet Aggregation Inhibitors ,medicine.drug - Abstract
Cardiac medications and their association with cardiovascular events in incident dialysis patients: Cause or effect? Background There are no large randomized, controlled trials evaluating the efficacy of common cardioprotective medications on cardiovascular outcomes in the dialysis population. We aimed to determine the association between cardioprotective medications and a composite end point of cardiovascular events or death in an incident dialysis cohort. Methods Medicare claims data were utilized to determine outcomes in participants of the Dialysis Morbidity and Mortality Wave 2 cohort. Information was gathered at baseline regarding demographics, comorbidities, medication use, and lab data. Cox proportional hazard models were developed to determine the association between cardioprotective medication use at baseline and the subsequent development of a composite of cardiovascular events or death. Results Two thousand two hundred thirty-four of 3044 individuals experienced a cardiovascular event or death. Use of the following medications at baseline was associated with an increased event rate: nitrates, antiplatelet agents, and warfarin. There was no association between the use of angiotensin-converting enzyme inhibitors, beta-blockers, or 3-hydroxy-3-methylglutaryl coenzyme A (HMG-CoA) reductase inhibitors and a composite cardiovascular outcome or death. Only use of a calcium channel blocker at baseline was associated with a reduced risk of events. This beneficial association did not persist when death was excluded as an outcome. Many of the associations observed varied substantially depending on the outcome utilized. Conclusion Use of cohort data to determine an association between medication use and outcome is difficult because the indication for the medication confounds the observed association. Before widespread practice changes, rigorous clinical trials of common cardioprotective medications on cardiovascular morbidity and mortality in dialysis should be performed.
- Published
- 2004
- Full Text
- View/download PDF
50. Perioperatives hämostaseologisches Management
- Author
-
Tiede, A.
- Published
- 2007
- Full Text
- View/download PDF
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