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Current Pharmacotherapy Management of Children and Adults with Pericarditis: Prospectus for Improved Outcomes.

Pharmacotherapy 2021 Oct 20. Epub 2021 Oct 20.

OU Health, Oklahoma City.

Pericarditis is the most common inflammatory pericardial disease in both children and adults. Since the publication of the 2015 European Society of Cardiology Guidelines for the diagnosis and management of pericardial disease were published there have been significant updates to management. Pharmacotherapy has been historically reserved for idiopathic pericarditis (IP). Read More

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October 2021

Left atrial appendage closure: a new strategy for cardioembolic events despite oral anticoagulation.

Panminerva Med 2021 Oct 19. Epub 2021 Oct 19.

Department of Arrhythmology and Cardiac Electrophysiology, San Raffaele Hospital, Milan, Italy.

Background: Patients with non-valvular atrial fibrillation (nvAF) who experienced a cardioembolic (CE) event despite adequate oral anticoagulation (OAC) are at high risk of recurrence, and further prevention strategies are deemed necessary. The present study aimed to evaluate the safety and efficacy of off-label use of left atrial appendage closure (LAAC) in this subset of patients.

Methods And Results: Seventy-five consecutive patients with nvAF who experienced a CE event despite adequate OAC therapy were retrospectively enrolled from two Italian centers. Read More

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October 2021

The efficacy and safety of perioperative dual antiplatelet therapy with ticagrelor versus clopidogrel in carotid artery stenting.

J Vasc Surg 2021 Oct 13. Epub 2021 Oct 13.

Department of Surgery, Division of Vascular and Endovascular Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA. Electronic address:

Introduction: Clopidogrel resistance is associated with increased peri-procedural neurologic events after carotid artery stenting (CAS). Ticagrelor offers an improved resistance profile, but its bleeding risk has not been assessed with CAS. Therefore, we examined the efficacy and safety of perioperative dual antiplatelet therapy (DAPT) with aspirin(ASA)/ticagrelor versus ASA/clopidogrel in patients undergoing transfemoral carotid artery stenting (tfCAS) or transcarotid artery revascularization (TCAR). Read More

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October 2021

Reflections after TWILIGHT study: a new era in secondary prevention without aspirin?

Eur Heart J Suppl 2021 Oct 8;23(Suppl E):E45-E50. Epub 2021 Oct 8.

Dipartimento di Malattie dell'Apparato Cardiovascolare, C.A.S.T., A.O.U. Policlinico "G. Rodolico-San Marco", Università degli Studi di Catania, Via S. Sofia, 78, 95123 Catania, Italy.

Dual antiplatelet therapy (DAPT) is mandatory in patients undergoing percutaneous coronary interventions (PCIs), but carries an increased bleeding risk which must be weighed over the expected antithrombotic benefit. In recent years, DAPT optimization strategy has been enriched by the concept of early withdrawal of aspirin ('aspirin-free' strategy). This strategy is supported by the modern advancements in pharmacological and procedural fields (i. Read More

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October 2021

Robotics-assisted epicardial left atrial appendage clip exclusion.

JTCVS Tech 2021 Oct 21;9:59-68. Epub 2021 Jul 21.

Department of Anesthesiology, Health First Holmes Regional Medical Center, Melbourne, Fla.

Objectives: We demonstrate the feasibility and safety of robotics-assisted left atrial appendage clip exclusion in clinical practice.

Methods: Analysis of a single center robotics-assisted left atrial appendage clip exclusion experience using an epicardial linear clip device in patients with atrial fibrillation with high-risk of thromboembolic stroke and intolerance to oral anticoagulants.

Results: During the period from December 2017 to September 2020, we performed 42 robotics-assisted left atrial appendage clip exclusions in response to increased risk of bleeding in patients with atrial fibrillation and intolerance to oral anticoagulants. Read More

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October 2021

A Systematic Review and Meta-analysis on the Efficacy and Safety of Direct Oral Anticoagulants in Patients with Peripheral Artery Disease.

Ann Vasc Surg 2021 Oct 10. Epub 2021 Oct 10.

Division of Vascular Surgery and Endovascular Therapy, University of Colorado, Anschutz Medical Center, Aurora, CO. Electronic address:

Background-objective: PAD is a significant cause of morbidity and mortality affecting over 200 million people worldwide. Current guidelines recommend at least a single antiplatelet or anticoagulant agent in symptomatic PAD and lifelong antithrombotic treatment after a revascularization procedure. The aim of this systematic review and meta-analysis was to investigate the efficacy and safety of direct oral anticoagulants (DOACs) in patients with peripheral artery disease (PAD). Read More

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October 2021

Efficacy and safety of aspirin for cardiovascular risk prevention in younger and older age: an updated systematic review and meta-analysis.

Thromb Haemost 2021 Oct 12. Epub 2021 Oct 12.

Cardiology Unit, University of Catania, Catania, Italy.

Aims - The efficacy and safety of aspirin for primary cardiovascular disease (CVD) prevention is controversial. The aim of this study was to investigate the merits of aspirin in subjects with no overt CVD, with a focus on age as a treatment modifier. Methods and results - Randomized trials comparing aspirin use versus no aspirin use or placebo were included. Read More

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October 2021

Effect of Antithrombotic Therapy on Clinical Outcomes in Outpatients With Clinically Stable Symptomatic COVID-19: The ACTIV-4B Randomized Clinical Trial.

JAMA 2021 Oct 11. Epub 2021 Oct 11.

Brigham and Women's Hospital, Boston, Massachusetts.

Importance: Acutely ill inpatients with COVID-19 typically receive antithrombotic therapy, although the risks and benefits of this intervention among outpatients with COVID-19 have not been established.

Objective: To assess whether anticoagulant or antiplatelet therapy can safely reduce major adverse cardiopulmonary outcomes among symptomatic but clinically stable outpatients with COVID-19.

Design, Setting, And Participants: The ACTIV-4B Outpatient Thrombosis Prevention Trial was designed as a minimal-contact, adaptive, randomized, double-blind, placebo-controlled trial to compare anticoagulant and antiplatelet therapy among 7000 symptomatic but clinically stable outpatients with COVID-19. Read More

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October 2021

Unguided de-escalation from ticagrelor to clopidogrel in stabilised patients with acute myocardial infarction undergoing percutaneous coronary intervention (TALOS-AMI): an investigator-initiated, open-label, multicentre, non-inferiority, randomised trial.

Lancet 2021 Oct;398(10308):1305-1316

Department of Internal Medicine, Division of Cardiology, Seoul St Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, South Korea. Electronic address:

Background: In patients with acute myocardial infarction receiving potent antiplatelet therapy, the bleeding risk remains high during the maintenance phase. We sought data on a uniform unguided de-escalation strategy of dual antiplatelet therapy (DAPT) from ticagrelor to clopidogrel after acute myocardial infarction.

Methods: In this open-label, assessor-masked, multicentre, non-inferiority, randomised trial (TALOS-AMI), patients at 32 institutes in South Korea with acute myocardial infarction receiving aspirin and ticagrelor without major ischaemic or bleeding events during the first month after index percutaneous coronary intervention (PCI) were randomly assigned in a 1:1 ratio to a de-escalation (clopidogrel plus aspirin) or active control (ticagrelor plus aspirin) group. Read More

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October 2021

Dual Antiplatelet Therapy Using Cilostazol in Patients With Stroke and Intracranial Arterial Stenosis.

J Am Heart Assoc 2021 Oct 8;10(20):e022575. Epub 2021 Oct 8.

National Cerebral and Cardiovascular Center Osaka Japan.

Background Long-term benefit of dual antiplatelet therapy (DAPT) over single antiplatelet therapy (SAPT) for the prevention of recurrent stroke has not been established in patients with intracranial arterial stenosis. We compared the efficacy and safety of DAPT with cilostazol and clopidogrel or aspirin to those of SAPT with clopidogrel or aspirin in patients with intracranial arterial stenosis, who were recruited to the Cilostazol Stroke Prevention Study for Antiplatelet Combination trial, a randomized controlled trial in high-risk Japanese patients with ischemic stroke. Methods and Results We compared the vascular and hemorrhagic events between DAPT and SAPT in patients with ischemic stroke and symptomatic or asymptomatic intracranial arterial stenosis of at least 50% in a major intracranial artery. Read More

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October 2021

A multicenter case-control study of the effect of e-nos VNTR polymorphism on upper gastrointestinal hemorrhage in NSAID users.

Sci Rep 2021 Oct 7;11(1):19923. Epub 2021 Oct 7.

Department of Preventive Medicine, University of Santiago de Compostela, Santiago de Compostela, Spain.

Bleeding in non-steroidal anti-inflammatory drug (NSAID) users limited their prescription. This first multicenter full case-control study (325 cases and 744 controls), explored the association of e-NOS intron 4 variable number tandem repeat (VNTR) polymorphism with upper gastrointestinal hemorrhage (UGIH) in NSAID exposed and unexposed populations and assessed any interaction between this polymorphism and NSAIDs. NSAID users carrying e-NOS intron 4 wild type genotype or VNTR polymorphism have higher odds of UGIH than those unexposed to NSAIDs [Odds Ratio (OR): 6. Read More

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October 2021

Review new concepts in pharmacotherapy for peripheral arterial disease.

Curr Opin Cardiol 2021 11;36(6):720-726

Liverpool Centre for Cardiovascular Science, University of Liverpool and Liverpool Heart & Chest Hospital, Liverpool, United Kingdom.

Purpose Of Review: To provide an overview of new concepts in the pharmacotherapy of patients with peripheral artery disease (PAD).

Recent Findings: Modern therapeutic strategies for patients with PAD include specific symptom management and multidisciplinary prevention of cardiovascular events. Low-dose rivaroxaban in combination with aspirin improves outcomes compared with aspirin monotherapy among patients with PAD. Read More

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November 2021

Ticagrelor versus prasugrel in patients with acute myocardial infarction.

Int J Cardiol 2021 Oct 4. Epub 2021 Oct 4.

Department of Cardiology, Ulsan University Hospital, University of Ulsan College of Medicine, Ulsan, Republic of Korea. Electronic address:

Background: Ticagrelor and prasugrel are the mainstay of antithrombotic therapy for patients with acute myocardial infarction (MI). However, direct comparative data on clinical outcomes of potent P2Y12 inhibitors are limited, especially in East Asian populations. We aimed to evaluate the effect of ticagrelor versus prasugrel on clinical outcomes in patients with acute MI. Read More

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October 2021

Antiplatelet therapy and outcome in COVID-19: the Health Outcome Predictive Evaluation Registry.

Heart 2021 Oct 5. Epub 2021 Oct 5.

Department of Cardiology, San Carlos, University Hospital, Madrid, Spain.

Background: Standard therapy for COVID-19 is continuously evolving. Autopsy studies showed high prevalence of platelet-fibrin-rich microthrombi in several organs. The aim of the study was therefore to evaluate the safety and efficacy of antiplatelet therapy (APT) in hospitalised patients with COVID-19 and its impact on survival. Read More

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October 2021

Safety and Efficacy of Single vs Dual Antiplatelets Therapy After Atrial Septal Defect Device Closure.

J Nepal Health Res Counc 2021 Sep 6;19(2):295-299. Epub 2021 Sep 6.

Department of Cardiology, Shahid Gangalal National Heart Centre, Kathmandu, Nepal.

Background: Atrial septal defect device closure has become a standard procedure. Antiplatelet therapy is used to prevent thrombus formation in the device. There is no clear recommendation about the antiplatelets drugs. Read More

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September 2021

High On-Treatment Platelet Reactivity as Predictor of Long-term Clinical Outcomes in Stroke Patients with Antiplatelet Agents.

Transl Stroke Res 2021 Oct 1. Epub 2021 Oct 1.

Department of Neurology, Yueyang Hospital of Integrated Traditional Chinese and Western Medicine, Shanghai University of Traditional Chinese Medicine, 110 Ganhe Road, Shanghai, China.

The purpose was to explore the value of high on-treatment platelet reactivity (HTPR) in predicting long-term clinical outcomes for stroke patients. The platelet reactivity was assayed after being treated with either 75 mg clopidogrel or 100 mg aspirin daily with VerifyNow System in stroke patients. HTPR for clopidogrel was defined as PRU ≥ 208, and that for aspirin was defined as ARU ≥ 550. Read More

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October 2021

Is the Placement, Maintenance, and Removal of Femoral and Sciatic Catheters Associated With Bleeding Complications in Vascular Patients on Antithrombotics? A Single-Center, Retrospective Cohort Study.

Anesth Analg 2021 Sep 30. Epub 2021 Sep 30.

From the Department of Anesthesiology, University of Florida College of Medicine, Gainesville, Florida.

Background: Information on the safety of placement, maintenance, and removal of peripheral nerve blocks in the presence of therapeutic or prophylactic antithrombotics is limited to case reports.

Methods: In this retrospective, descriptive study, we examined the use of femoral and gluteal or subgluteal sciatic perineural catheters in 146 patients on antithrombotics who received lower limb amputation (LLA) above or below the knee at the University of Florida Health Shands Hospital between January 2015 and December 2019. We searched patient surgical records for complications such as bleeding, nerve damage, infection, and hematoma during placement, maintenance, and removal of the perineural catheters. Read More

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September 2021

Antithrombotic therapy for ambulatory patients with multiple myeloma receiving immunomodulatory agents.

Cochrane Database Syst Rev 2021 09 28;9:CD014739. Epub 2021 Sep 28.

Faculty of Medicine, American University of Beirut, Beirut, Lebanon.

Background: Multiple myeloma is a malignant plasma cell disorder characterised by clonal plasma cells that cause end-organ damage such as renal failure, lytic bone lesions, hypercalcaemia and/or anaemia. People with multiple myeloma are treated with immunomodulatory agents including lenalidomide, pomalidomide, and thalidomide. Multiple myeloma is associated with an increased risk of thromboembolism, which appears to be further increased in people receiving immunomodulatory agents. Read More

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September 2021

Platelet Function Tests Predicting the Efficacy and Safety of Aspirin Secondary Prevention.

Neurol Res 2021 Sep 28:1-8. Epub 2021 Sep 28.

Department of Neurology, Affiliated Drum Tower Hospital, Nanjing University Medical School, Nanjing, Jiangsu, China.

Objective: To precisely prevent stroke, we evaluated three platelet function tests and their associations with clinical outcomes in ischemic stroke patients.

Methods: On-treatment platelet reactivity of acute minor stroke patients taking aspirin plus clopidogrel was tested by light transmittance aggregometry (LTA), thromboelastography (TEG) and platelet function analyzer (PFA). Mann-Whitney U tests and receiver operating characteristic (ROC) curve analysis were used to assess their associations with recurrent events and clinical outcome prediction. Read More

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September 2021

Is Continuing Anticoagulation or Antiplatelet Therapy Safe Prior to Kidney Transplantation?

Ann Transplant 2021 Sep 28;26:e931648. Epub 2021 Sep 28.

Department of Surgery, AHN Transplant Institute, Allegheny General Hospital, Pittsburgh, PA, USA.

BACKGROUND Patients undergoing kidney transplantation are often placed on anticoagulation or antiplatelet therapy, and their perioperative management is often challenging. This study aimed to determine the safety of continuing anticoagulation or antiplatelet therapy prior to kidney transplantation. The primary outcome was bleeding after transplantation. Read More

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September 2021

Aspirin and cancer survival: a systematic review and meta-analyses of 118 observational studies of aspirin and 18 cancers.

Ecancermedicalscience 2021 2;15:1258. Epub 2021 Jul 2.

University Library Service, Cardiff University, Cardiff, UK.

Background: Despite the accumulation of research papers on aspirin and cancer, there is doubt as to whether or not aspirin is an acceptable and effective adjunct treatment of cancer. The results of several randomised trials are awaited, and these should give clear evidence on three common cancers: colon, breast and prostate. The biological effects of aspirin appear likely however to be of relevance to cancer generally, and to metastatic spread, rather than just to one or a few cancers, and there is already a lot of evidence, mainly from observational studies, on the association between aspirin and survival in a wide range of cancers. Read More

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Management of antithrombotic therapy in patients with atrial fibrillation and acute coronary syndromes.

Rev Cardiovasc Med 2021 Sep;22(3):659-675

Cardiology Clinic, "St. Spiridon" County Emergency Hospital, University of Medicine and Pharmacy "Grigore T. Popa", 700115 Iaşi, Romania.

If atrial fibrillation (AF) and acute coronary syndrome (ACS) coexist, they should be treated with combined antithrombotic therapy. To reduce the risk of bleeding while maintaining the desired antithrombotic effect, choices should be made for each patient according to the balance between the bleeding and the thrombotic risk. There are many ways to select the type and dose of the oral anticoagulant (OAC) and P2Y12 inhibitors. Read More

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September 2021

In-hospital Bleeding Outcomes of Oral Anticoagulant and Dual Antiplatelet Therapy During Percutaneous Coronary Intervention: An Analysis From the Japanese Nationwide Registry.

J Cardiovasc Pharmacol 2021 Apr 1;78(2):221-227. Epub 2021 Apr 1.

Department of Cardiology, Tokai University School of Medicine, Kanagawa, Japan.

Abstract: The type of periprocedural antithrombotic regimen that is the safest and most effective in percutaneous coronary intervention (PCI) patients on oral anticoagulant (OAC) therapy has not been fully investigated. We aimed to retrospectively investigate the in-hospital bleeding outcomes of patients receiving OAC and antiplatelet therapies during PCI using Japanese nationwide multicenter registry data. A total of 26,938 patients who underwent PCI with OAC and antiplatelet therapies between 2016 and 2017 were included. Read More

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Comparative efficacy and safety of monoclonal antibodies and aspirin desensitization for chronic rhinosinusitis with nasal polyposis: A systematic review and network meta-analysis.

J Allergy Clin Immunol 2021 Sep 17. Epub 2021 Sep 17.

Department of Medicine, Division of Clinical Immunology and Allergy, McMaster University, Hamilton, Ontario, Canada; Department Health Research Methods, Evidence and Impact, McMaster University, Hamilton, Ontario, Canada; Research Institute of St Joe's Hamilton, Hamilton, Ontario, Canada. Electronic address:

Background: Chronic rhinosinusitis with nasal polyposis (CRSwNP) is an inflammatory condition of the upper airways. Optimal management is unclear.

Objective: We compared the effects of mAbs and aspirin desensitization (ASA-D) for treatment of CRSwNP. Read More

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September 2021

Acetylsalicylic acid suppression of the PI3K pathway as a novel medical therapy for head and neck lymphatic malformations.

Int J Pediatr Otorhinolaryngol 2021 Aug 5;151:110869. Epub 2021 Aug 5.

Division of Pediatric Otolaryngology, Seattle Children's Hospital, Seattle, WA, USA; Department of Otolaryngology-Head and Neck Surgery, University of Washington School of Medicine, Seattle, WA, USA; Center for Clinical and Translational Research, Seattle Children's Research Institute, Seattle, WA, USA. Electronic address:

Objectives: Head and neck lymphatic malformations (HNLM) are caused by gain-of-function somatic mutations in PIK3CA. Acetylsalicylic acid (ASA/aspirin) is thought to limit growth in PIK3CA-mutated neoplasms through PI3K pathway suppression. We sought to determine if ASA could be beneficial for HNLM. Read More

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Relation of Pre-Stroke Aspirin Use With Cerebral Infarct Volume and Functional Outcomes.

Ann Neurol 2021 Nov 5;90(5):763-776. Epub 2021 Oct 5.

Department of Neurology, Dongguk University Ilsan Hospital, Goyang, South Korea.

Objective: We investigated (1) the associations of pre-stroke aspirin use with thrombus burden, infarct volume, hemorrhagic transformation, early neurological deterioration (END), and functional outcome, and (2) whether stroke subtypes modify these associations in first-ever ischemic stroke.

Methods: This multicenter magnetic resonance imaging (MRI)-based study included 5,700 consecutive patients with acute first-ever ischemic stroke, who did not undergo intravenous thrombolysis or endovascular thrombectomy, from May 2011 through February 2014. Propensity score-based augmented inverse probability weighting was performed to estimate adjusted effects of pre-stroke aspirin use. Read More

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November 2021

Efficacy and Safety of Ticagrelor Monotherapy by Clinical Presentation: Pre-Specified Analysis of the GLOBAL LEADERS Trial.

J Am Heart Assoc 2021 Sep 17;10(18):e015560. Epub 2021 Sep 17.

Department of Medicine and Institute of Health Policy, Management and Evaluation Applied Health Research CentreLi Ka Shing Knowledge Institute of St. Michael's HospitalUniversity of Toronto Canada.

Background The optimal duration of dual antiplatelet therapy after coronary drug-eluting stent placement in adults with stable coronary artery disease (SCAD) versus acute coronary syndromes (ACS) remains uncertain. Methods and Results This was a prespecified subgroup analysis of the GLOBAL LEADERS trial. Participants were randomly assigned 1:1 to the experimental or reference strategy, stratified by ACS (experimental, n=3750; reference, n=3737) versus SCAD (experimental, n=4230; reference, n=4251). Read More

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September 2021

[Rivaroxaban with aspirin for the secondary prevention of cardiovascular events in Chinese patients with stable cardiovascular diseases: subgroup analysis of COMPASS].

Zhonghua Xin Xue Guan Bing Za Zhi 2021 Sep;49(9):873-879

Emergency and Intensive Care Center, Cardiovascular Department, Fuwai Hospital, Chinses Academy of Medical Sciences and Peking Union Medical College, Beijing 100037, China.

This analysis was performed to evaluate the efficacy and the safety of rivaroxaban-aspirin combination therapy in secondary prevention of major adverse cardiovascular events in Chinese patients enrolled in the COMPASS trial. COMPASS was a prospective, international multi-center and randomized controlled trial. From September 2014 to February 2017, 1 086 patients with stable coronary artery disease and peripheral artery diseases were recruited from 31 centers in China. Read More

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September 2021

Cilostazol for Secondary Stroke Prevention: History, Evidence, Limitations, and Possibilities.

Stroke 2021 Oct 14;52(10):e635-e645. Epub 2021 Sep 14.

Department of Neurology, Stanford University (M.G.L.).

Cilostazol is a PDE3 (phosphodiesterase III) inhibitor with a long track record of safety that is Food and Drug Administration and European Medicines Agency approved for the treatment of claudication in patients with peripheral arterial disease. In addition, cilostazol has been approved for secondary stroke prevention in several Asian countries based on trials that have demonstrated a reduction in stroke recurrence among patients with noncardioembolic stroke. The onset of benefit appears after 60 to 90 days of treatment, which is consistent with cilostazol's pleiotropic effects on platelet aggregation, vascular remodeling, blood flow, and plasma lipids. Read More

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October 2021

A pilot study of the ticagrelor role in ischemic stroke secondary prevention.

Eur Neurol 2021 Aug 30:1-6. Epub 2021 Aug 30.

Department of Neurology, Faculty of Medicine, Ain Shams University, Cairo, Egypt.

Introduction: Ticagrelor is one of the most recent antiplatelet drugs used to treat ischemic heart disease. Its efficacy may equal or exceed aspirin in improving clinical outcomes in patients with acute ischemic stroke who are ineligible for rt-PA.

Aim Of The Work: We aimed at evaluating the safety (as a primary endpoint) and efficacy (as a secondary endpoint) of a 180 mg loading dose of ticagrelor given within 9 h from the onset of first-ever ischemic stroke. Read More

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