15,179 results match your criteria Clopidogrel Dosing and CYP2C19


Antiplatelet therapy after transcatheter aortic valve implantation: a systematic review and meta-analysis.

Eur J Cardiothorac Surg 2021 Jun 20. Epub 2021 Jun 20.

Serviço de Cardiologia, Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal.

Objectives: The aim of this study was to compare antithrombotic regimens after transcatheter aortic valve implantation (TAVI) in patients without an indication for long-term anticoagulation. TAVI is a safe and effective approach for patients with symptomatic severe aortic stenosis and an intermediate-to-high surgical risk. Nevertheless, the antithrombotic regimen after procedure remains controversial. Read More

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Electrical impedance vs. light transmission aggregometry: Testing platelet reactivity to antiplatelet drugs using the MICELI POC impedance aggregometer as compared to a commercial predecessor.

Thromb Res 2021 Jun 5;204:66-75. Epub 2021 Jun 5.

Department of Medicine, Sarver Heart Center, University of Arizona, Tucson, AZ, United States of America; Department of Biomedical Engineering, Sarver Heart Center, University of Arizona, Tucson, AZ, United States of America. Electronic address:

Background: Patients' responses to antiplatelet therapy significantly vary, with individuals showing high residual platelet reactivity associated with thrombosis. To personalize thrombosis management, platelet function testing has been suggested as a promising tool able to monitor the antithrombotic effect of antiplatelet agents in real-time. We have prototyped the MICELI, a miniature and easy-to-use electrical impedance aggregometer (EIA), measuring platelet aggregation in whole blood. Read More

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Clinical validation of AggreGuide A-100 ADP, a novel assay for assessing the antiplatelet effect of oral P2Y antagonists.

J Thromb Thrombolysis 2021 Jun 18. Epub 2021 Jun 18.

PCS Houston LLC, Houston, TX, USA.

In this prospective, 3-arm, repeated-measure multicenter investigation in 280 patients with cardiovascular risk factors, platelet aggregation was measured with the novel AggreGuide A-100 ADP (A-100 ADP) and VerifyNow (VN)-PRU assays at baseline, and after United States Food and Drug Administration approved loading and 7 days maintenance doses of clopidogrel (n = 94), prasugrel (n = 43) or ticagrelor, (n = 143). Based on the predetermined cutoff values of < 4.7 platelet activity index with A-100 ADP assay to indicate antiplatelet response, more than 91% of patients met the criteria following loading and maintenance doses of prasugrel and more than 84% patients met the criteria following loading and maintenance doses of ticagrelor whereas only 32% and 51% of patients met the criteria following loading and maintenance doses of clopidogrel, respectively. Read More

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P2Y12 inhibitor monotherapy or dual antiplatelet therapy after coronary revascularisation: individual patient level meta-analysis of randomised controlled trials.

BMJ 2021 06 16;373:n1332. Epub 2021 Jun 16.

Icahn School of Medicine at Mount Sinai, New York, NY, USA.

Objective: To assess the risks and benefits of P2Y inhibitor monotherapy compared with dual antiplatelet therapy (DAPT) and whether these associations are modified by patients' characteristics.

Design: Individual patient level meta-analysis of randomised controlled trials.

Data Sources: Searches were conducted in Ovid Medline, Embase, and three websites (www. Read More

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Is monitoring of antiplatelet therapy by light transmission aggregometry dependent on instrument and reagent used?

Int J Lab Hematol 2021 Jun 15. Epub 2021 Jun 15.

Coagulation Laboratory, Department of Laboratory Medicine, University Hospital Ghent, Ghent, Belgium.

Introduction: Light transmission aggregometry (LTA), used to detect clopidogrel resistance in patients under antiplatelet therapy, is prone to multiple variables potentially influencing results and interpretation. Currently, no attention is given to type of aggregometer or reagent used. The aim of this study was to evaluate the interassay variability between two aggregometers (Chronolog700 and TA-8V), using two different ADP reagents (Chrono-Par and Agro-Bio ADP) in patients under clopidogrel therapy. Read More

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A retrospective study of antithrombotic therapy use in an outpatient haemodialysis unit.

J Clin Pharm Ther 2021 Jun 15. Epub 2021 Jun 15.

Department of Pharmacy, University Health Network, Toronto, Ontario, Canada.

What Is Known And Objective: Patients on haemodialysis (HD) are at increased risk of both bleeding and thrombotic events, due to comorbidities and nature of dialysis treatment. However, there is a lack of research on evidence-based treatment strategies and prescribing patterns for antithrombotic therapies (ATT) in this population. To characterize ATT use and its main indications in an outpatient HD unit. Read More

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Nickel Hypersensitivity to Atrial Septal Occluders: Smoke Without Fire?

Clin Rev Allergy Immunol 2021 Jun 15. Epub 2021 Jun 15.

First Department of Cardiology, Medical School, National and Kapodistrian University of Athens, Hippokration General Hospital, Athens, Greece.

Nickel is one of the most common contact allergens worldwide; it is used as the main component of the devices used for atrial septal defects (ASDs) and patent foramen ovale (PFO) closure. Developing nickel hypersensitivity after PFO/ASD occlusion is significantly rarer described in medical literature than typical nickel contact sensitization. The exact pathophysiological mechanism of this "device syndrome" remains unknown, and many question the real incidence or even the existence of this clinical entity. Read More

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Evidence-based oral antiplatelet therapy among hospitalized Chinese patients with acute myocardial infarction: results from the Chinese acute myocardial infarction registry.

BMC Cardiovasc Disord 2021 Jun 14;21(1):299. Epub 2021 Jun 14.

Department of Cardiology, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Science and Peking Union Medical College, No. 167 North Lishi Road, Xicheng District, Beijing, 100037, China.

Background: Oral antiplatelet therapy is the cornerstone of treatment for acute myocardial infaction (AMI). However, detailed usage data on oral antiplatelet therapy are lacking.

Methods: Using data from a nationally representative sample of patients with AMI, the detailed usage of oral antiplatelet therapy was analyzed in 40,202 consecutive eligible patients. Read More

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The Association of Polymorphisms in Related Circadian Rhythm Genes and Clopidogrel Resistance Susceptibility.

Basic Clin Pharmacol Toxicol 2021 Jun 12. Epub 2021 Jun 12.

Department of Cardiology, Ningbo No.1 Hospital, Ningbo, Zhejiang, People's Republic of China.

Previous studies have confirmed that a dynamic change in circadian rhythm will affect platelet activity, resulting in clopidogrel resistance (CR). We attempted to evaluate whether polymorphisms of related circadian rhythm genes are involved in CR in stable coronary artery disease (SCAD) patients. A sum of 204 SCAD patients met our requirements and were recruited, and 96 patients were considered to have CR. Read More

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Impact of comorbidities and antiplatelet regimen on platelet reactivity levels in patients undergoing transcatheter aortic valve implantation.

J Cardiovasc Pharmacol 2021 May 31. Epub 2021 May 31.

Cardiology Department, Hospital Universitario de Salamanca. Instituto de Investigación Biomédica de Salamanca (IBSAL), Salamanca, Spain. Cardiology Department, Hospital Universitario Virgen de la Arrixaca, IMIB-Arrixaca, Murcia, Spain. Centro de Investigación en Red de Enfermedades Cardiovasculares (Network Research Center for Cardiovascular Diseases), CIBER-CV, Madrid, Spain. Interventional Cardiology. Instituto de Investigación del Hospital La Paz (IDIPAZ). University Hospital La Paz, Madrid, Spain. Cardiology Department, Hospital Alvaro Cunqueiro, University Hospital of Vigo,Vigo, Spain. Cardiovascular Research Unit, Cardiology Department, Hospital Alvaro Cunqueiro, University Hospital of Vigo, Vigo, Spain; Cardiovascular Research Group, Galicia Sur Health Research Institute (IIS Galicia Sur), SERGAS-UVIGO, Vigo, Spain. Cardiology Department, Hospital Universitario de Bellvitge, Barcelona,Spain. Cardiology Department, Hospital Universitario Virgen de las Nieves, Granada,Spain. Departamento de Medicina Preventiva y Salud Pública, Facultad de Medicina, Universidad de Santiago de Compostela.

Abstract: The aim of our study is to assess the impact of anemia, chronic kidney disease (CKD) and diabetes mellitus on platelet reactivity (PR) in patients with severe aortic stenosis, both at baseline and after transcatheter aortic valve implantation (TAVI). This study is a pre-specified subanalysis of the REAC-TAVI prospective, multicentre trial that included patients pre-treated with aspirin+clopidogrel before TAVI. PR was measured at baseline and at 5 different time points after TAVI with the VerifyNow assay (Accriva Diagnostics, San Diego, CA), over a 3-month follow-up period. Read More

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Cost-Effectiveness of Ticagrelor Compared with Clopidogrel in Patients with Acute Coronary Syndrome from Vietnamese Healthcare Payers' Perspective.

Adv Ther 2021 Jun 11. Epub 2021 Jun 11.

AstraZeneca Medical Affairs, Ho Chi Minh City, Vietnam.

Introduction: The PLATelet inhibition and patient Outcomes (PLATO) trial (NCT00391872) demonstrated that ticagrelor compared to clopidogrel significantly reduced the rate of death from cardiovascular causes, myocardial infarction or stroke in patients with acute coronary syndrome (ACS). The aim of this study is to analyze the long-term cost-effectiveness of ticagrelor compared to clopidogrel in ACS patients from a Vietnamese healthcare payers' perspective.

Methods: A two-part cost-effectiveness model was developed to estimate long-term costs and quality-adjusted life-years (QALY). Read More

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Impact Of Chronic Kidney Disease On The Pharmacodynamic And Pharmacokinetic Effects Of Ticagrelor In Patients With Diabetes Mellitus And Coronary Artery Disease.

Eur Heart J Cardiovasc Pharmacother 2021 Jun 11. Epub 2021 Jun 11.

University of Florida College of Medicine-Jacksonville, Jacksonville, FL, USA.

Aims: Patients with diabetes mellitus (DM) and chronic kidney disease (CKD) are at increased risk of atherothrombotic events. Ticagrelor reduces ischaemic events compared to clopidogrel, with the greatest risk reduction in patients with both DM and CKD. How CKD status affects the pharmacodynamic (PD) and pharmacokinetic (PK) profiles of different ticagrelor maintenance dose regimens in patients with DM is unknown. Read More

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Analysis of the physiological and pathological factors of hospitalized patients taking warfarin and the correlation between drug interactions and warfarin efficacy.

Ann Palliat Med 2021 May;10(5):5400-5406

Department of Pharmacy, Shenzhen Hospital of Southern Medical University, Shenzhen, China.

Background: To study the various factors affecting the anticoagulant effect of warfarin, and to promote the rational use of warfarin.

Methods: We collected the medical records of 125 hospitalized patients who used warfarin from January 2018 to December 2019. Statistical analysis was performed on characteristics such as gender, age, treatment, diabetes, hyperlipidemia, hyperthyroidism, hypothyroidism, hepatitis, renal insufficiency, and nephritis; along with other pathological factors, such as aspirin, clopidogrel, spironolactone, amiodarone, amlodipine, trimetazidine, bisoprolol, isosorbide, atorvastatin, furosemide, digoxin, metoprolol, acarbose, levamlodipine, enoxaparin, moxifloxacin, levofloxacin, other drug interactions, and comorbidities. Read More

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Safety considerations with the use of platelet inhibitors for elderly patients with non-ST- elevation acute coronary syndrome.

Expert Opin Drug Saf 2021 Jun 13:1-8. Epub 2021 Jun 13.

Department of Cardiology, St. Antonius Hospital, Nieuwegein, The Netherlands.

: Dual antiplatelet therapy (DAPT) is standard treatment for patients with acute coronary syndrome (ACS). This includes lifelong aspirin combined with a P2Y inhibitor for 1 year. The indication for one of the P2Y inhibitors (clopidogrel, prasugrel, ticagrelor) is dependent on the treatment strategy; whether patients undergo coronary angiography or are treated medically only. Read More

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Is the use of dual antiplatelet therapy following urgent and emergency coronary artery bypass surgery associated with increased risk of cardiac tamponade?

J Clin Transl Res 2021 Apr 13;7(2):229-233. Epub 2021 Mar 13.

Department of Cardiothoracic Surgery, Castle Hill Hospital, Hull University Teaching Hospitals NHS Trust, Hull, UK.

Background And Aim: Cardiac tamponade is a recognized post-cardiac surgery complication, resulting in increased morbidity and mortality. The 2016 American College of Cardiology and American Heart Association Guidelines recommended the use of Dual Antiplatelet Therapy (DAPT) in the management of patients undergoing urgent or emergency coronary artery bypass grafting (CABG). The effect of DAPT on cardiac tamponade rates was investigated in comparison to aspirin monotherapy (AMT). Read More

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Vascular Endothelial Repair and the Influence of Circulating Antiplatelet Drugs in a Carotid Coil Model.

J Cent Nerv Syst Dis 2021 20;13:11795735211011786. Epub 2021 May 20.

Department of Neurosurgery, Kindai University Hospital, Faculty of Medicine, Osakasayama, Osaka, Japan.

Background: Clinicians may choose to administer antiplatelet medications to patients with cerebral aneurysms following endovascular coiling to prevent thrombus formation and vascular occlusion, if they fear a thrombus will form on the platinum wire where it diverges into the vessel from the aneurysm sac. However, the mechanism by which vascular endothelial cells repair a vessel in the living body in the event of a coil deviation and the effects of antiplatelet drugs on these cells have not been fully elucidated. We aimed to investigate the association between endothelial progenitor cells (EPCs) and endothelium formation at the surface of the platinum coils deployed in the carotid artery of rats, and to determine the effects of different antiplatelet drugs on this process. Read More

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The GEnetic Syntax Score: a genetic risk assessment implementation tool grading the complexity of coronary artery disease-rationale and design of the GESS study.

BMC Cardiovasc Disord 2021 Jun 8;21(1):284. Epub 2021 Jun 8.

Department of Cardiology, AHEPA University Hospital, Aristotle University of Thessaloniki, St. Kiriakidi 1, 54636, Thessaloniki, Greece.

Background: Coronary artery disease (CAD) remains one of the leading causes of mortality worldwide and is associated with multiple inherited and environmental risk factors. This study is designed to identify, design, and develop a panel of genetic markers that combined with clinical and angiographic information, will facilitate the creation of a personalized risk prediction algorithm (GEnetic Syntax Score-GESS). GESS score could be a reliable tool for predicting cardiovascular risk for future adverse events and for guiding therapeutic strategies. Read More

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Analysis of the clinical characteristics of acute arthritis induced by clopidogrel.

J Clin Pharm Ther 2021 Jun 8. Epub 2021 Jun 8.

Department of Pharmacy, The Third Xiangya Hospital, Central South University, Changsha, China.

What Is Known And Objective: Knowledge regarding the association between clopidogrel exposure and acute arthritis is based mainly on case reports. The purpose of this article was to assess the clinical characteristics of clopidogrel-induced acute arthritis.

Methods: We collected literature from 1998 to 2020 in Chinese and English on acute arthritis induced by clopidogrel for retrospective analysis. Read More

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Prehospital Adenosine Diphosphate Receptor Blocker Use, Culprit Artery Flow, and Mortality in STEMI: The MADDEC Study.

Clin Drug Investig 2021 Jun 8. Epub 2021 Jun 8.

Faculty of Medicine and Health Technology, University of Tampere, Arvo Building, Arvo Ylpön Katu 34, 33520, Tampere, Finland.

Background And Objective: The newer adenosine diphosphate (ADP) receptor blockers ticagrelor and prasugrel are superior to clopidogrel in the long-term management of acute coronary syndrome (ACS). We evaluated the acute performance (prehospital loading) of these ADP receptor blockers in a primary percutaneous coronary intervention (PCI) for an ST-elevation myocardial infarction (STEMI).

Methods: In a retrospective, single-center registry study, data on all STEMI patients admitted for their first primary PCI between January 2007 and April 2020 were analyzed (n = 3218). Read More

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P2Y12 blocker monotherapy after percutaneous coronary intervention.

Neth Heart J 2021 Jun 8. Epub 2021 Jun 8.

Department of Cardiology, Radboud University Medical Centre, Nijmegen, The Netherlands.

For secondary prevention of coronary artery disease (CAD) antiplatelet therapy is essential. For patients undergoing a percutaneous coronary intervention (PCI) temporary dual antiplatelet platelet therapy (DAPT: aspirin combined with a P2Y12 blocker) is mandatory, but leads to more bleeding than single antiplatelet therapy with aspirin. Therefore, to reduce bleeding after a PCI the duration of DAPT is usually kept as short as clinically acceptable; thereafter aspirin monotherapy is administered. Read More

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Letter to the Editor: How Should We Treat High-risk Patients in the Chronic Phase Following PCI: Clopidogrel or Prolonged DAPT?

J Korean Med Sci 2021 06 7;36(22):e167. Epub 2021 Jun 7.

Department of Cardiology, Fuwai Hospital, National Center for Cardiovascular Diseases, State Key Laboratory of Cardiovascular Disease, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China.

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MiR-223 or miR-126 predicts resistance to dual antiplatelet therapy in patients with ST-elevation myocardial infarction.

J Int Med Res 2021 Jun;49(6):3000605211016209

Cardiovascular Center of Ningbo First Hospital, Ningbo, China.

Objective: To explore the role of miR-223 and miR-126 in predicting treatment responses to dual antiplatelet therapy (DAPT) in patients with ST-elevation myocardial infarction (STEMI).

Methods: Plasma miR-223 and miR-126 levels were measured before treatment. Treatment responses and 2-year survival were determined. Read More

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Carotid In-Stent Stenosis: Cutting Balloon Angioplasty: 2-Dimensional Operative Video.

Oper Neurosurg (Hagerstown) 2021 Jun 7. Epub 2021 Jun 7.

Department of Neurological Surgery, Mayo Clinic, Jacksonville, Florida, USA.

In-stent stenosis has a reported prevalence of 14% to 19% at 1-yr follow-up after carotid stenting and is associated with an increased risk of acute ischemic stroke.1,2 Risk factors include female sex, diabetes, and dyslipidemia. Cutting balloon angioplasty is a safe and effective treatment modality for the treatment of carotid in-stent stenosis, and alternative treatment options include observation with medical management and placement of another stent. Read More

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Kawasaki Disease Complicated by Late-Onset Fatal Cerebral Infarction: A Case Report and Literature Review.

Front Pediatr 2021 19;9:598867. Epub 2021 May 19.

Key Laboratory of Birth Defects and Related Diseases of Women and Children, Ministry of Education Chengdu, Sichuan University, Chengdu, China.

Cerebral infarction is a rare neurological complication of Kawasaki disease (KD) and occurs in the acute or subacute stage. There have been no reported cases of late-onset fatal cerebral infarction presenting over 1 year after the onset of KD. A 5-month-old male patient with KD received timely intravenous immunoglobulin therapy; however, extensive coronary artery aneurysms (CAA) and coronary artery thrombosis (CAT) developed 1 month later. Read More

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Non-Persistence With Antiplatelet Medications Among Older Patients With Peripheral Arterial Disease.

Front Pharmacol 2021 19;12:687549. Epub 2021 May 19.

Institute of Biomedicine, University of Turku, Turku, Finland.

Antiplatelet therapy needs to be administered life-long in patients with peripheral arterial disease (PAD). Our study was aimed at 1) the analysis of non-persistence with antiplatelet medication in older PAD patients and 2) identification of patient- and medication-related characteristics associated with non-persistence. The study data was retrieved from the database of the General Health Insurance Company. Read More

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Risk of stroke in CYP2C19 LoF polymorphism carrier coronary artery disease patients undergoing clopidogrel therapy: An ethnicity-based updated meta-analysis.

Eur J Intern Med 2021 Jun 3. Epub 2021 Jun 3.

Department of Pharmacy, Faculty of Science, Noakhali Science and Technology University, Sonapur 3814, Noakhali, Bangladesh. Electronic address:

Background: Antiplatelet agent clopidogrel has been widely used for stroke management for many years, although resistance to clopidogrel may increase the chance of stroke recurrence. CYP2C19 loss-of-function (LoF) polymorphism is assumed to be responsible for the poor metabolism of clopidogrel that ultimately turns to resistance. Previous publications could not provide firm evidence due to highly conflicting and heterogeneous outcomes. Read More

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Long-term continuous use of proton-pump inhibitors is associated with renal function decline in patients without acute kidney injury.

Clin Exp Nephrol 2021 Jun 5. Epub 2021 Jun 5.

Center of Medical Information Science, Kochi Medical School, Kochi University, Kohasu, Oko-cho, Nankoku, Japan.

Background: Proton-pump inhibitors (PPIs) are widely used to treat gastroesophageal reflex disease, peptic ulcer disease, and stress ulcer prophylaxis. This study estimated the progress rate of renal dysfunction in patients taking PPIs in clinical settings and compared the results with those of patients taking histamine-2 receptor antagonists (H2RAs).

Methods: We retrospectively reviewed patients' data collected from Kochi Medical School Hospital's information system between 2001 and 2019. Read More

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Evaluation of Systolic Blood Pressure, Use of Aspirin and Clopidogrel, and Stroke Recurrence in the Platelet-Oriented Inhibition in New TIA and Minor Ischemic Stroke Trial.

JAMA Netw Open 2021 Jun 1;4(6):e2112551. Epub 2021 Jun 1.

Department of Neurology, New York University, New York.

Importance: Elevated systolic blood pressure (SBP) after acute ischemic stroke and transient ischemic attack (TIA) is associated with future stroke risk.

Objective: To explore the association of dual antiplatelet therapy (DAPT) with stroke recurrence among patients with acute ischemic stroke and TIA with or without elevated baseline SBP.

Design, Setting, And Participants: This cohort study performed a post hoc subgroup analysis of the Platelet-Oriented Inhibition in New TIA and Minor Ischemic Stroke (POINT) trial, which was a multicenter trial conducted from 2010 to 2018 at 269 sites in 10 countries in North America, Europe, Australia, and New Zealand. Read More

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Omeprazole-clopidogrel interaction and neurovascular complications after flow-diverter device placement.

J Neurointerv Surg 2021 Jun 3. Epub 2021 Jun 3.

Department of Neurosurgery, Barrow Neurological Institute, Phoenix, Arizona, USA

Background: Omeprazole is a common proton pump inhibitor that interferes with the hepatic activation of clopidogrel and potentially reduces its platelet-inhibitory effect. Omeprazole has been shown to increase P2Y levels and adverse cardiovascular outcomes in patients treated with drug-eluting stents. However, omeprazole use among patients treated with flow-diverting stents for intracranial aneurysms has not been evaluated. Read More

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Impact of chronic kidney disease on hemoglobin among patients with peripheral artery disease treated with P2Y inhibitors: Insights from the EUCLID trial.

Vasc Med 2021 Jun 3:1358863X211017641. Epub 2021 Jun 3.

CPC Clinical Research, Aurora, CO, USA.

Patients with chronic kidney disease may develop new or more severe anemia when treated with antiplatelet agents due to blood loss in conjunction with impaired erythropoiesis. Because anemia independently predicts limb amputation and mortality among patients with peripheral artery disease (PAD), we evaluated the relationship between estimated glomerular filtration rate (eGFR) and hemoglobin (Hb) levels in the EUCLID trial in which patients with symptomatic PAD were randomized to ticagrelor or clopidogrel. At baseline, 9025, 1870, and 1000 patients had eGFR ⩾ 60, 45-59, and < 45 mL/min/1. Read More

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